CLINICAL MANIFESTATIONS OF

HERPES SIMPLEX VIRUS

In the mother, herpes simplex typically presents with one or a cluster of painful vesicular lesions that develop into ulcers of the external genitalia and cervix. This results in pain, dysuria, vaginal discharge and local lymphadenopathy. Atypical lesions include small fissures, areas of irritation or painless ulcers.
The virus may become latent in the local sensory ganglions and periodically reactivate and cause either symptomatic lesions or asymptomatic shedding.

In the neonate, herpes has three clinical presentations:

• Disseminated HSV (20%).
• 50% mortality.
• 41% have severe neurologic morbidity if they survive.
• Central Nervous System (35%).
• 15% mortality.
• 65% severe neurologic morbidity if they survive.
• Limited Dissemination (45%).
• >95% survival.
• Mainly involves skin and mucus membranes.
• Long term morbidity in 5%.

Neonatal herpes can be caused by either HSV 1 or HSV 2 (HSV 2 has a poorer prognosis). If vaginal delivery occurs, primary infection is associated with a 41% risk of neonatal infection (2). Primary asymptomatic infection is associated with a 33% risk of neonatal infection and recurrent infection has a 4% risk of infection (3).

Cesarean delivery appears to decrease the risk of neonatal infection. 20-30% of infections occur after cesarean section (8-10% of infections are associated with intact membranes) (3).

REFERENCES

1. Crane JMG. Perinatal exposure to viral infections. Can J of CME 1998:61-74.
2. Smith JR, Cowan FM, Munday P. Pregnancy subgroup of Herpes Simplex Advisory Panel. The management of herpes simplex virus in pregnancy. Br J Obstet Gynecol 1998;105;255-260.
3. Scott LL, Hollier LM, Dias K. Perinatal herpesvirus infection. Infect Dis Clin North Am 1997;11(1):27-53.