HSV Serotesting in pregnancy.(Guest Editorial)

To help stop the spread of genital herpes and HIV infection among adults in the United States and to prevent most cases of neonatal herpes, physicians should obtain type-specific herpes simplex virus serology from all pregnant women at the first prenatal visit.

Genital herpes is primarily transmitted to other adults or newborns from people who are unaware of their infection. Approximately 90% of individuals who have antibodies to herpes simplex virus (HSV)-2 are unaware of their infection and are experiencing recurrent genital symptoms that are often attributed to other problems such as a genital yeast infections, recurrent urinary tract infections, or semen or condom allergies.

Unrecognized genital ulceration with subclinical viral shedding may occur during as many as 20% of days in women who are HSV-2 seropositive but unaware of their infection.

As a predominantly subclinical genital ulcerative disease, genital herpes is a major risk factor for the acquisition of HIV infection. It is likely that control of the HIV epidemic will not be possible without first controlling the HSV epidemic. Not only does herpes cause unrecognized recurrent ulcers on the mucosal surfaces of the female genitalia that serve as portals of entry for HIV, but it draws to the environment of the ulcers those cells that are the primary target for HIV.

Neonatal herpes is the most devastating complication of genital herpes. Despite strategies designed to prevent perinatal transmission, the number of cases of neonatal HSV infection continues to rise, mirroring the rising prevalence of infection in women of childbearing age. About one-half to two-thirds of cases of neonatal herpes are a consequence of a mother acquiring a new infection in the third trimester of pregnancy and shedding virus in her genital secretions at the time of labor. Approximately two-thirds to three-quarters of new infections during pregnancy go unrecognized by either the patient or her provider, because she is either asymptomatic at the time of the infection or her symptoms are attributed to another organism such as yeast.

Pregnant women who are shown by serologic testing to be susceptible for acquiring genital ...