Millions of dollars to prevent one death: universal screening for maternal HSV very costly.(Obstetrics)

NEW ORLEANS -- Universal screening for maternal herpes simplex virus infections could reduce the incidence of neonatal infections but would cost millions of dollars to prevent one infection or death, Dr. Stephen Thung reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

"Identifying patients at risk of shedding virus at delivery would allow us to intervene with education and possibly medications to decrease the chance of a viral infection at delivery, but the cost to prevent just one infection is very high," he said in an interview.

Neonatal herpes simplex virus (HSV) infections can result in serious morbidity and mortality. Many of the infections result from asymptomatic cervical shedding of virus after a primary episode of genital HSV in the third trimester. Antibodies to HSV-2 have been detected in approximately 20% of pregnant women, but only 5% report a history of symptomatic infection.

A baby born to a mother with a primary case of genital HSV during the last trimester has a 33% chance of acquiring the virus. Most neonatal infections occur from asymptomatic cervical shedding of virus, usually after a primary episode of HSV infection. Given the frequency of asymptomatic infections in women, some experts have argued for universal screening to identify women at risk and intervene.

Dr. Thung conducted a cost-benefit analysis of three maternal screening strategies for HSV-1 and HSV-2. The first strategy, no universal screening, is the current standard of care. The second strategy was routine prenatal HSV-1 and HSV-2 antibody testing and appropriate sexual partner testing to identify discordant serostatus. This strategy also included counseling to reduce sexual transmission and increase awareness of symptomatic genital herpes.

The third ...