A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery.
Abstract
Objective The purpose of this study was to assess the efficacy of acyclovir in the reduction of herpes simplex virus culture and polymerase chain reaction positivity and cesarean delivery.Study design Women with recurrent genital herpes simplex virus were randomized to acyclovir 400 mg three times daily or placebo from 36 weeks of gestation until delivery. A subset of daily specimens for herpes simplex virus culture and DNA polymerase chain reaction was self-collected. Analyses used chi(2), Fisher exact, and Mann-Whitney U tests.Results Lesions occurred at delivery among 11 of 78 women (14%) who received placebo and 4 of 84 women (5%) who received acyclovir (P =.08). Herpes simplex virus culture and polymerase chain reaction positivity near delivery occurred in 7% and 34% women in the placebo group and 0 and 2% in the acyclovir group (P =.03 and <.01, respectively). Cesarean delivery for herpes simplex virus occurred in 8 of the women (10%) in the placebo group and in 3 of the women (4%) in the acyclovir group (P =.17). Despite reductions in herpes simplex virus detection, 6% of the women who received acyclovir had herpes simplex virus detected by polymerase chain reaction on >20% of days. Neonatal outcomes were similar between groups.Conclusion Acyclovir significantly reduced, but did not eliminate, herpes simplex virus lesions and detection in late pregnancy.
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Suppressive acyclovir treatment starting at 36 weeks' gestation reduces the frequency of cesarean delivery among women who have recurrent genital herpes by diminishing the frequency of recurrences at term.
“Suppressive acyclovir treatment starting at 36 weeks’ gestation reduces the frequency of cesarean delivery among women who have recurrent genital herpes by diminishing the frequency of recurrences at term (521–523).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [522]
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
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- Authors
- Watts, D. H., Brown, Z. A., Money, D., Selke, S., Huang, M. L., Sacks, S. L., & Corey, L.
- Affiliations
- University of Washington (US)
- Cape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa (ZA)
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2003-03
- Volume
- 188
- Issue
- 3
- Pages
- 836-843
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2033358877
- Cited by
- 177
- References
- 25
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 5 · 2017: 11 · 2016: 6 · 2015: 8 · 2014: 13 · 2013: 8 · 2012: 5
- FWCI
- 8.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (P01AI030731, P01-AI30731)
- Topics
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Keywords
- acyclovir, herpes simplex virus, recurrent genital herpes, late pregnancy, cesarean section, viral shedding, neonatal outcomes, antiviral prophylaxis
- MeSH terms
- Acyclovir, Adult, Antiviral Agents, Cesarean Section, Double-Blind Method, Female, Follow-Up Studies, Herpes Genitalis, Humans, Placebos, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Pregnancy Trimester, Third, Virus Shedding, Simplexvirus
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