Treatment of HSV infection in late pregnancy.

Evidence-Based Answer Pregnant women with a primary or recurrent episode of genital HSV infection who are later than 36 weeks of gestation should be treated with acyclovir (Zovirax) or valacyclovir (Valtrex) for viral suppression. (Strength of Recommendation [SOR]: A, based on one systematic review.) Suppressive therapy at the time of delivery can reduce the rate of recurrence, the risk of asymptomatic viral shedding, and the number of cesarean deliveries because of active HSV infection. Women with active lesions at the time of labor should have a cesarean delivery to decrease vertical transmission of HSV. (SOR: B, based on one prospective cohort study.) Acyclovir prophylaxis is more cost-effective than expectant management with cesarean delivery in women with a history of genital HSV infection, with or without recurrence during pregnancy.