In these situations, the potential benefits to the fetus may not outweigh the risk of potential maternal complications associated with cesarean section. Even when performed before rupture of membranes, cesarean section may not be completely effective in preventing neonatal infection. Randomized controlled trials to assess these issues may be difficult to perform for ethical reasons. A second preventive maneuver in addition to cesarean section is prophylactic treatment of the mother with acyclovir. The American College of Obstetricians and Gynecologists recommends performing cultures for HSV in pregnant women with active lesions.
Vaginal delivery is considered acceptable if there are no visible lesions at the onset of labor.
All pregnant women should be asked at the first prenatal visit whether they or their sexual contacts have had genital herpetic lesions. Women with active lesions should be cultured, but cultures are not necessary in the absence of active disease. See Appendix A for the U.S. Preventive Services Task Force Table of Ratings for this topic. Preventive strategies in sexually transmitted diseases for the primary care physician.