Question

Pregnant female with herpetic lesions in the vulva. Management is?

• A. Acyclovir and elective Caesarean section
• B. Induction of labor
• C. Acyclovir and allow spontaneous progression of labor
• D. Wait and watch

Hint:

Active genital HSV lesions at delivery are an absolute indication for Caesarean section to prevent neonatal transmission.

Answer 1

The Correct Option is A

Step 1: Identify the clinical concern. Active genital herpes simplex virus (HSV) lesions in a pregnant woman at term pose a significant risk of neonatal herpes transmission during vaginal delivery. Neonatal HSV can cause severe neurological damage or death.

Step 2: Understand the indication for Caesarean section. ACOG guidelines state that Caesarean delivery is indicated in women with active genital herpetic lesions or prodromal symptoms (such as vulvar pain or burning) at the time of delivery. This is to prevent the neonate from coming into contact with the lesions during passage through the birth canal.

Step 3: Role of Acyclovir. Acyclovir (an antiviral drug) is given to:

• Treat the active herpetic lesion in the mother
• Reduce viral shedding
• Reduce the risk of neonatal transmission

It is safe in pregnancy (Category B).

Step 4: Eliminate other options.

• Induction of labor: Inappropriate as it risks vaginal delivery through active lesions
• Acyclovir alone with spontaneous labor: Inadequate -- active lesions mandate Caesarean section
• Wait and watch: Unacceptable -- active lesions require immediate intervention

Conclusion: Acyclovir combined with elective Caesarean section is the correct management for active genital herpes in pregnancy.