GENITAL HERPES DURING PREGNANCY - INABILITY TO DISTINGUISH PRIMARY AND RECURRENT INFECTIONS CLINICALLY

Objective: To determine if the signs and symptoms of genital herpes in pregnancy accurately identify primary genital herpes infections using serologic testing for final classification. Methods: Twenty-three wom en with clinical signs and symptoms suggestive of primary genital herp es infections in the second and third trimesters of pregnancy were sub sequently cultured and tested serologically (for herpes simplex virus type 1 and herpes simplex virus type 2 antibodies) and classified as h aving true primary (no herpes simplex virus type 1 or type 2 antibodie s), nonprimary (heterologous herpes simplex virus antibodies present), or recurrent (homologous antibodies present) infections. Results: Onl y one of 23 women with clinical illnesses consistent with primary geni tal herpes virus simplex infections had serologically-verified primary infection. This primary infection was caused by herpes simplex virus type 1. Three women had nonprimary type 2 infections, and 19 women had recurrent infections. Among culture-proven recurrent infections, 12 w ere caused by herpes simplex virus type 2 and three by herpes simplex virus type 1. Only one infant was born preterm, and no clinically sign ificant perinatal morbidity was observed. Conclusion: Correct classifi cation of gestational genital herpes infections can be accomplished on ly when clinical evaluation is correlated with viral isolation and ser ologic testing using a type-specific assay. Severe first episodes of g enital herpes infections among women in the second and third trimester s of pregnancy are not usually primary infections and are not commonly associated with perinatal morbidity. (C) 1997 by The American College of Obstetricians and Gynecologists.