Self-Assessment Questions

47. Sexually transmitted diseases of viral origin

• Explain why a pregnant patient with recurrent genital herpes simplex virus (HSV) infection is less likely to have a cesarean delivery than one who has either primary or nonprimary first episode of genital HSV infection.

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  Correct answer:
  Cesarean delivery should be offered to patients with an active HSV lesion or prodromal symptoms in order to help avoid life-threatening herpetic infection to the newborn infant. Remember that mean duration of symptoms (including lesions) and of viral shedding is much shorter in recurrent genital HSV infections as opposed to the other two. Ninety percent of women with primary lesion shed virus during acute infection, and 70% of those with nonprimary first episode do so as well. In contrast, the rate of shedding drops to 12–20% for women with recurrent lesions.