Iowa Neonatology Handbook: Infection

Management of Perinatal Herpes Simplex Infections

Charles Grose, MD
Peer Review Status: Internally Peer Reviewed

Situation I

Oral maternal herpes, or presence of genital vesicles or culture positive genital herpes, with infant delivered by C-section with intact membranes.

Management:

1. Secretion precautions for both baby and mother.
2. Newborn to room in with mother if possible; baby can go to and from mother’s room in bassinet; mother not allowed in nursery.
3. Mother should be instructed on the importance of careful hand washing before and after caring for their infant and wear a clean loving gown to help avoid contact of the infant with lesions or secretions.
4. Mother with herpes labialis should wear a mask when touching her infant and should not kiss or nuzzle the infant until the lesions are cleared.
5. Ask obstetrician to culture any maternal vesicles (if not already done); culture baby’s nasopharynx 24 hours after delivery. If the infant is asymptomatic, obtain surface cultures 24-48 hours after delivery and initiate antiviral therapy if cultures are positive.

Situation II

Presence of genital vesicles or culture positive genital herpes with infant delivered per vagina or by C-section after rupture of membranes.

Management:

1. Strict isolation of the baby from other infants; secretion precautions for the mother.
2. Baby to room with mother; mother not allowed in nursery.
3. Mother should use gloves when handling her baby.
4. Ask obstetrician to culture any maternal vesicles (if not already done); culture baby 24-48 hours after birth, sooner if symptomatic or acyclovir therapy is to be started.
5. For an infant delivered vaginally whose mother has primary, first-episode infections (risk of infection 30-50%), consider empiric acyclovir treatment after cultures are obtained.
6. For an infant delivered vaginally to mothers with active recurrent genital herpes, the risk of infection is ≤5% and emperic treatment is not required.

Situation III

History of previous genital herpes with unknown culture result and infant delivered vaginally or by C-section after rupture of membranes.

Management:

1. Secretion precautions for baby and mother until maternal culture is negative for >72 hours. Observe infant closely and obtain surface cultures 24-48 hours after delivery.
2. Baby can go to and from mother’s room in a bassinet; mother is not allowed in the nursery until her culture is negative for >72 hours.
3. If maternal culture is positive, initiate antiviral therapy and revert to management as in Situation II. Notify the senior staff obstetrician and neonatologist.

Situation IV

History of previous genital herpes with unknown culture result and infant delivered by C-section with intact membranes.

Management:

1. No isolation required.
2. If maternal culture is positive, revert to management as in Situation I.

Situation V

History of previous genital herpes but no active lesions at delivery.

Management:

1. No isolation required.
2. Monitor infant for signs of neonatal HSV infection.
3. No routine cultures of an asymptomatic newborn recommended.

Mother in Situations I, II or III should be in a private room if available.

Neonates with documented HSV infection or those suspected of HSV infection (even if no risk factors are present) should be in an isolation room with secretion precautions. Neonates with a low suspicion of HIV infection but who are being treated with acyclovir can be placed in the nurseries in an isolette with secretion precautions. Since neonatal HSV infection can occur as late as 6 weeks after delivery, physicians must be vigilant and not ignore a new rash or symptoms that might be caused by HSV.

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