The authors acknowledge that there are no data to support this opinion. Viral resistance was not considered in the analysis. It would be helpful to know how increasing levels of resistance would affect the analysis. Outcomes measured Primary outcomes measured were the frequency of infections, morbidity and mortality, the direct cost per neonatal life saved, and the direct cost for prevention of long term neurologic sequelae associated with each strategy. In this analysis, the use of acyclovir is clearly beneficial.
Cesarean section appears beneficial but the true effect is unknown because the data are inadequate.
A policy of routine drug prophylaxis for pregnant women with recurrent genital herpes is cost effective. The evidence for the effectiveness of acylovir is based on trials looking at intermediate outcomes. Acyclovir is currently not approved for use in pregnant women. Assuming that it is proven safe for use in the third trimester, providers should offer prophylactic acyclovir to pregnant women with a history of genital herpes. The data are too weak to make a strong recommendation for or against prophylactic cesarean section.