{"id":4872,"date":"2022-07-08T14:39:38","date_gmt":"2022-07-08T02:39:38","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/?page_id=4872"},"modified":"2025-05-05T14:28:13","modified_gmt":"2025-05-05T02:28:13","slug":"neonatal-herpes-simplex-virus","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/neonatal-herpes-simplex-virus\/","title":{"rendered":"HSV in pregnancy \/ neonatal HSV"},"content":{"rendered":"\n<p><strong>Infection:<\/strong> Neonatal herpes simplex virus (HSV) infection<\/p>\n\n\n\n<p>Also refer to:&nbsp;<a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/herpes-simplex-virus-hsv\/\">How do I diagnose \u2013 HSV<\/a><\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Brief description:<\/strong><\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>HSV is included in the \u201cTORCH\u201d causes of congenital infection, however this is a misnomer because intrauterine infection is very rare. HSV is mostly a concern in pregnancy due to the risk of neonatal acquisition at the time of delivery.<\/li>\n\n\n\n<li>The risk of transmission is highest if the mother is infected with HSV-1 or -2 for the first time (primary infection) close to delivery. Recurrent genital infection, or primary infection before 30 weeks, poses a much lower risk.<\/li>\n\n\n\n<li>There are three patterns of neonatal disease, which can be present individually or in combination: skin\/eye\/mouth, central nervous system, and disseminated disease.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Did you know?<\/strong><\/summary><div class=\"ab-accordion-text\">\n<p>The risk of transmission is highest with primary infection close to delivery because:<\/p>\n\n\n\n<ul>\n<li>The amount of virus in the maternal genital tract tends to be much higher.<\/li>\n\n\n\n<li>The mother has not had time to generate protective antibodies to pass on to the neonate prior to delivery.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Diagnostic approach:<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>In women with a known history of genital HSV, testing is not required.<\/li>\n\n\n\n<li>In women with a possible primary episode of HSV during pregnancy, testing to confirm the diagnosis is recommended.<\/li>\n\n\n\n<li>Testing of infants is recommended if there are clinical features suggestive of HSV disease, or there was high risk of transmission at birth e.g. primary maternal infection after 30 weeks, preterm infant and mother with active genital herpes. This should be guided by a specialist.<\/li>\n\n\n\n<li>Testing of infants is not recommended in low-risk scenarios e.g. recurrent active maternal genital herpes. A safety netting discussion should be had with parents.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Antenatal diagnosis (<\/strong>if possible maternal <strong>primary<\/strong> genital infection<strong>):<\/strong><\/summary><div class=\"ab-accordion-text\">\n<p><strong>Viral swab of base of lesion for <a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/26769\" target=\"_blank\" rel=\"noreferrer noopener\">HSV PCR<\/a> <\/strong>(need to obtain vesicle fluid or cellular material on swab)<\/p>\n\n\n\n<ul>\n<li>Good<strong> sensitivity &#8211; <\/strong>a <strong>negative<\/strong> result on an<strong> adequately collected sample <\/strong>makes<strong> <\/strong>the diagnosis <strong>very unlikely<\/strong><\/li>\n\n\n\n<li>Excellent<strong> specificity &#8211; <\/strong>a <strong>positive<\/strong> result <strong>confirms<\/strong> the diagnosis, and also determines HSV-1 vs -2 status<\/li>\n<\/ul>\n\n\n\n<p>If the <strong>PCR is positive<\/strong> and gestation is >30 weeks, then <strong><a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/27161\" target=\"_blank\" rel=\"noreferrer noopener\">HSV serology<\/a><\/strong> should also be sent<\/p>\n\n\n\n<ul>\n<li>If serology for the same HSV type (1 vs 2) is:\n<ul>\n<li><strong>positive<\/strong> = consistent with <strong>recurrent<\/strong> infection<\/li>\n\n\n\n<li><strong>negative<\/strong> = consistent with <strong>primary<\/strong> infection<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>Women with <strong>possible primary infection after 30 weeks gestation<\/strong> should be discussed with an <strong>obstetrician.<\/strong><\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Postnatal diagnosis (symptomatic infant):<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li><strong>Skin\/eye\/mouth disease<\/strong><ul><li>Viral swabs of any <strong>skin lesions<\/strong> for <strong>HSV PCR<\/strong><\/li><\/ul>\n<ul>\n<li>Surface viral swabs:<strong> eye, throat, umbilicus, rectum <\/strong>for<strong> HSV PCR<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Central nervous system disease<\/strong>\n<ul>\n<li><strong>HSV PCR<\/strong> on <strong>CSF<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Disseminated disease<\/strong>\n<ul>\n<li><strong>HSV PCR<\/strong> on <strong>blood<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Given the possibility for overlap, testing is usually recommended for all of the above.<\/li>\n\n\n\n<li><strong>PCR<\/strong> has <strong>high sensitivity<\/strong> and <strong>specificity<\/strong>, so is good for ruling in or out the diagnosis.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Postnatal diagnosis (asymptomatic infant with high-risk delivery)<\/strong><\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li><strong>Surface <\/strong>\u2018screening\u2019swabs<strong> for HSV PCR<\/strong><ul><li><strong>Eye, throat, umbilicus, rectum<\/strong><\/li><\/ul>\n<ul>\n<li>These should be collected at <strong>&gt;24 hours of age<\/strong> to avoid detecting possible residual maternal HSV DNA from the birth canal.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>CSF<\/strong> and <strong>blood<\/strong> for <strong>HSV PCR<\/strong><\/li>\n\n\n\n<li>Note that negative results for the above investigations do not exclude the possibility of subsequent development of HSV disease<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Tests to avoid\/specialist tests:<\/strong><\/summary><div class=\"ab-accordion-text\">\n<p><strong>HSV serology <\/strong>outside the above recommendation<\/p>\n\n\n\n<ul>\n<li>This has no role as part of general \u2018TORCH\u2019 testing for congenital abnormalities, nor for infant diagnosis.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"Infection: Neonatal herpes simplex virus (HSV) infection Also refer to:&nbsp;How do I diagnose \u2013 HSV","protected":false},"author":18,"featured_media":0,"parent":4222,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>HSV in pregnancy \/ neonatal HSV &#8211; 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