Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus recurrences and neonatal infection

Antenatal antiviral prophylaxis appears to reduce viral shedding and recurrences at delivery and the need for caesarean section for genital herpes. There is insufficient evidence to determine if antiviral prophylaxis reduces the incidence of neonatal herpes, although the risk for neonatal infection seems to be low.

A Cochrane review included 7 trials involving a total of 1 249 participants. 5 trials compared acyclovir to placebo or no treatment and 2 trials valacyclovir to placebo. Women who received antiviral prophylaxis were less likely to have a recurrence of genital herpes at delivery (RR 0.28, 95% CI 0.18 to 0.43, I² = 0%, NNT 10), to have HSV detected at delivery (RR 0.14, 95% CI 0.05 to 0.39, I² = 0%, NNT 17), or to have a caesarean section for genital herpes (RR 0.30, 95% CI 0.20 to 0.45, I² = 27.3%, NNT 10). There were no cases of symptomatic neonatal herpes in either the treatment or placebo groups, so the effect of antepartum antiviral prophylaxis on neonatal herpes could not be estimated.

Comment: The quality of evidence is downgraded by study quality (half the trials were stopped before the planned sample sizes were reached, large study withdrawal in 2 trials).

Ədəbiyyat

1. Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev 2008 Jan 23;(1):CD004946.