ACYCLOVIR SUPPRESSION TO PREVENT CESAREAN DELIVERY AFTER FIRST-EPISODE GENITAL HERPES

Objective: To determine if suppressive acyclovir therapy given to term gravidas experiencing a first episode of genital herpes simplex virus (HSV) infection during pregnancy decreases the need for cesarean deli very for that indication. Methods: Forty-six pregnant women with first episodes of genital herpes during pregnancy were randomly assigned to receive oral acyclovir 400 mg or placebo, three times per day, from 3 6 weeks' gestation until delivery as part of a prospective, double-bli nd trial. Herpes simplex virus cultures were obtained when patients pr esented for delivery. Vaginal delivery was permitted if no clinical re currence was present; otherwise, a cesarean was performed. Neonatal HS V cultures were obtained and infants were followed-up clinically. Resu lts: None of the 21 patients treated with acyclovir and nine of 25 (36 %) treated with placebo had clinical evidence of recurrent genital her pes at delivery (odds ratio [OR] 0.04, 95% confidence interval [CI] 0. 002-0.745; P = .002). No woman treated with acyclovir had a cesarean f or herpes, compared with nine of 25 (36%) of those treated with placeb o (OR 0.04, CO 0.002-0.745; P = .002). No patient in either treatment group experienced asymptomatic genital viral shedding at delivery. No neonate had evidence of herpes infection or adverse effects from acycl ovir. Conclusion: Suppressive acyclovir therapy reduced the need for c esarean for recurrent herpes in women whose first clinical episode of genital HSV occurred during pregnancy. Suppressive acyclovir treatment did not increase asymptomatic viral shedding and was not harmful to t he term fetus.