Acyclovir Reduces Herpes Lesions, Cesarean Section Rates. (Prophylactic Treatment).

QUEBEC CITY -- Prophylactic acyclovir given late in pregnancy significantly reduces herpes simplex virus lesions and lowers C-section rates for herpes, Dr. D. Heather Watts said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Currently, 20%-30% of pregnant women in the United States are positive for herpes simplex virus type 2 (HSV-2), and it's recommended that women with genital lesions at the time of delivery undergo C-section, she said.

In a study of 170 HIV-negative women with at least one symptomatic recurrence of genital herpes simplex virus (HSV) in the past year, 4 patients (5%) treated with acyclovir and 12 patients (15%) who received placebo had lesions at delivery, a significant difference.

Rates of C-sections for herpes were 3% among patients in the acyclovir group and 11% for women in the placebo group, a difference that was not quite statistically significant.

Eighty-seven women were randomized to take acyclovir, 400 mg t.i.d., starting at 36 weeks' gestation until delivery, while the remaining 83 women received a placebo.

All the women kept daily symptom diaries and obtained daily perineal and cervicovaginal specimens at home for culturing and DNA detection by polymerase chain reaction (PCR) analysis, explained Dr. Watts of the University of Washington, Seattle, and the University of British Columbia, Vancouver.

Those women taking acyclovir were significantly less likely than those on placebo to obtain positive genital cultures during pregnancy (11% vs. 40%). Likewise, PCR analysis showed that HSV DNA was significantly less common among women taking acyclovir than in women taking placebo (36% vs. 60%).