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Cited by 679Herpesvirus Infections and TreatmentsNeonatal and Maternal InfectionsCytomegalovirus and herpesvirus research

Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant.

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Brown, Zane A., Wald, Anna, Morrow, R. Ashley, Selke, Stacy, Zeh, Judith, Corey, Lawrence·2003·JAMA
DOI 10.1001/jama.289.2.203
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Abstract

CONTEXT: Neonatal herpes most commonly results from fetal exposure to infected maternal genital secretions at the time of delivery. The risk of transmission from mother to infant as it relates to maternal herpes simplex virus (HSV) serologic status and exposure to HSV in the maternal genital tract at the time of labor has not been quantified. Furthermore, no data exist on whether cesarean delivery, the standard of care for women with genital herpes lesions at the time of delivery, reduces HSV transmission. OBJECTIVE: To determine the effects of viral shedding, maternal HSV serologic status, and delivery route on the risk of transmission of HSV from mother to infant. DESIGN: Prospective cohort of pregnant women enrolled between January 1982 and December 1999. SETTINGS: A university medical center, a US Army medical center, and 5 community hospitals in Washington State. PATIENTS: A total of 58 362 pregnant women, of whom 40 023 had HSV cultures obtained from the cervix and external genitalia and 31 663 had serum samples tested for HSV. MAIN OUTCOME MEASURE: Rates of neonatal HSV infection. RESULTS: Among the 202 women from whom HSV was isolated at the time of labor, 10 (5%) had neonates with HSV infection (odds ratio [OR], 346; 95% confidence interval [CI], 125-956 for neonatal herpes when HSV was isolated vs not isolated). Cesarean delivery significantly reduced the HSV transmission rate among women from whom HSV was isolated (1 [1.2%] of 85 cesarean vs 9 [7.7%] of 117 vaginal; OR, 0.14; 95% CI, 0.02-1.08; P =.047). Other risk factors for neonatal HSV included first-episode infection (OR, 33.1; 95% CI, 6.5-168), HSV isolation from the cervix (OR, 32.6; 95% CI, 4.1-260), HSV-1 vs HSV-2 isolation at the time of labor (OR, 16.5; 95% CI, 4.1-65), invasive monitoring (OR, 6.8; 95% CI, 1.4-32), delivery before 38 weeks (OR, 4.4; 95% CI, 1.2-16), and maternal age less than 21 years (OR, 4.1; 95% CI, 1.1-15). Neonatal HSV infection rates per 100 000 live births were 54 (95% CI, 19.8-118) among HSV-seronegative women, 26 (95% CI, 9.3-56) among women who were HSV-1-seropositive only, and 22 (95% CI, 4.4-64) among all HSV-2-seropositive women. CONCLUSION: Neonatal HSV infection rates can be reduced by preventing maternal acquisition of genital HSV-1 and HSV-2 infection near term. It can also be reduced by cesarean delivery and limiting the use of invasive monitors among women shedding HSV at the time of labor.

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  • The risk for transmission to the neonate from an infected mother is low (<1%) among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy.

    “low (<1%) among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy (516,517).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [517]

    Table 3 (COMMENT, p. 206) reports neonatal HSV in 3 of 13,795 HSV-2-seropositive women (0.022%), supporting a low overall risk in a related group. It does not give a rate specifically for women with prenatal histories of recurrent herpes, and the paper does not report transmission risk for women who acquired herpes during the first half of pregnancy. Among women shedding HSV at delivery, Table 1 reports 2 infections in 151 reactivation cases (1.3%), not less than 1%. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The risk for transmission to the neonate from an infected mother is high (30%-50%) among women who acquire genital herpes near the time of delivery.

    “The risk for transmission to the neonate from an infected mother is high (30%–50%) among women who acquire genital herpes near the time of delivery”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [517]

  • Cesarean delivery does not eliminate the risk for HSV transmission to the neonate.

    “Although cesarean delivery does not eliminate the risk for HSV transmission to the neonate (517)”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [517]

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Cites

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Research works printed but not linked: 7

  1. American Academy of Pediatrics Committee on Infectious Diseases. Herpes simplex. In: Peter G, ed. 1997 Red Book. 24th ed. Elk Grove Village, Ill: Ameri- can Academy of Pediatrics; 1977:266-276.
  2. Langenberg A, Zbanyszek R, Dragavon J, Ashley R, Corey L. Comparison of diploid fibroblast and rab- bit kidney tissue culture and diploid and fibroblast mi- crotiter plate system for the isolation of herpes sim- plex virus. J Clin Microbiol. 1988;26:1772-1774.
  3. Whitley R, Corey L, Arvin A, et al, and the NIAID Collaborative Antiviral Study Group. Changing pre- sentation of herpes simplex virus infection in neo- nates. J Infect Dis. 1988;158:109-116.
  4. Corey L, Whitley RJ, Stone EF, Mohan K. Differ- ence in neurologic outcome after antiviral therapy of neonatal central nervous system herpes simplex virus type I versus herpes simplex virus type 2 infection. Lan- cet. 1988;2:1-4.
  5. Whitley RJ, Roizman B. Herpes simplex virus in- fections. Lancet. 2001;357:1513-1518.
  6. Kinghorn GR. Should all pregnant women be of- fered type-specific serological screening for HSV in- fection? Herpes. 2002;9:46-47.
  7. Brown ZA. HSV-2 specific serology should be of- fered routinely to antenatal patients. Rev Med Virol. 2000;10:141-144.

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Authors
Brown, Z. A., Wald, A., Morrow, R. A., Selke, S., Zeh, J., & Corey, L.
Affiliations
University of Washington (US)
Corresponding author
Brown, Zane A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-01-08
Volume
289
Issue
2
Pages
203
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.289.2.203
OpenAlex
W2023088041
Cited by
679
References
43
Citations by year
2026: 21 · 2025: 16 · 2024: 21 · 2023: 26 · 2022: 16 · 2021: 24 · 2020: 38 · 2019: 28 · 2018: 30 · 2017: 40 · 2016: 25 · 2015: 32 · 2014: 46 · 2013: 24 · 2012: 27
FWCI
25.96
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Washington
  • University of Alabama
  • National Institutes of Health (AI30731)
  • National Institute of Allergy and Infectious Diseases (AI 30731, P01AI030731)
Topics
  • Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
Keywords
herpes simplex virus, neonatal herpes, mother-to-child transmission, cesarean section, genital herpes, viral shedding, herpes simplex virus type 1, herpes simplex virus type 2, vaginal delivery, risk factors, preterm birth, antiviral prophylaxis
MeSH terms
Antibodies, Viral, Cervix Uteri, Cesarean Section, Female, Herpes Simplex, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Infectious, Prospective Studies, Risk Factors, Virus Shedding, Herpesvirus 2, Human, Herpesvirus 1, Human, Infectious Disease Transmission, Vertical, Delivery, Obstetric

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