ORAL ACYCLOVIR AND RECURRENT GENITAL HERPES DURING LATE PREGNANCY

Objective: To assess plasma acyclovir levels in pregnant women given o ral acyclovir during late gestation and to determine the role and effe ct of oral acyclovir on asymptomatic shedding of virus in cases of rec urrent genital herpes. Methods: Five pregnant women with proven genita l herpes isolate (herpes simplex virus [HSV] 2) after 37 weeks' gestat ion were studied. Oral acyclovir was administered every 8 hours at dos ages of 300, 400, and 300 mg in two subjects, and 200 mg five times da ily in the other three until delivery. Plasma acyclovir peak and troug h levels were determined. Viral cultures were obtained from both the m others and neonates at delivery. Results: There was no difference in a cyclovir plasma levels among the patients. Furthermore, acyclovir leve ls were comparable to those of nonpregnant adults. The drug failed to suppress asymptomatic shedding of virus and transmission of HSV 2 to t he neonate in one of five of the patients. Conclusion: Our study sugge sts that asymptomatic shedding of virus is not prevented by use of ora l acyclovir during late gestation in proven recurrent genital herpes e ven though plasma acyclovir levels were within the normal range.