Pediatric Herpes Simplex Virus Infection Guidelines

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Guidelines Summary

AAP clinical practice guidelines

In January 2013, the American Academy of Pediatrics issued new guidelines for the evaluation of asymptomatic neonates exposed to HSV during delivery. [73, 16, 74] The guidelines assume laboratory access to polymerase chain reaction (PCR) assays for HSV DNA or type-specific serologic tests and may not be applicable in clinical settings without rapid testing turnaround times. Recommendations include the following:

  • Women in labor with visible genital lesions should be swabbed for HSV PCR and culture, and positive test results should be further analyzed to distinguish HSV-1 from HSV-2

  • A history of genital herpes should be obtained before the pregnancy

  • In women with a recurrent maternal herpes outbreak, skin and mucosal specimens should be obtained from the neonate for culture and PCR assay (the latter only if desired) about 24 hours after delivery, and blood should be sent for HSV DNA PCR assay; preemptive treatment with acyclovir need not be started if the infant remains asymptomatic. If results become positive within 5 days, confirming neonatal HSV infection, the infant should undergo a complete evaluation to determine the extent of disease, and intravenous acyclovir should be initiated as soon as possible.

  • In women without a history of genital herpes who have genital lesions at delivery, serologic testing (for HSV-1 IgG and HSV-2 IgG) should be performed on maternal blood samples obtained during delivery to determine the type of infection present (that is, primary versus nonprimary versus recurrent). The infant should undergo a complete evaluation – including obtaining of surface viral cultures of the conjunctivae, naso-/oropharynx, and rectum (and PCRs of those sites if desired), HSV blood PCR, lumbar puncture with obtaining of CSF cell counts and chemistries, HSV CSF PCR, serum ALT, and IV acyclovir should be initiated. If the mother has a first-episode (primary or non-primary) infection and the neonate’s results are normal, the infant should be treated with IV acyclovir for 10 days; if the neonate’s results are positive, the infant should be treated with IV acyclovir for 14-21 days (depending on the extent of disease) and reevaluated to ensure clearance of the virus. After completion of IV acyclovir treatment durations of greater than or equal to 14-21 days, infants should receive suppressive therapy with oral acyclovir for 6 months