Skip to main content
PMC home page
Infectious Diseases in Obstetrics and Gynecology logoLink to Infectious Diseases in Obstetrics and Gynecology
. 2001;9(2):75–80. doi: 10.1155/S106474490100014X

Acyclovir Suppression to Prevent Clinical Recurrences at Delivery After First Episode Genital Herpes in Pregnancy: An Open-Label Trial

L Laurie Scott 1,2,3,✉, Lisa M Hollier 1, Donald McIntire 1, Pablo J Sanchez 2, Gregory L Jackson 2, George D Wendel Jr 1
PMCID: PMC1784644  PMID: 11495557

Abstract

Objective: To continue evaluation of the use of acyclovir suppression in late pregnancy after first episode genital herpes simplex virus (HSV) infection, using an open-label study design.

Methods: Ninety-six women diagnosed with genital herpes for the first time in the index pregnancy were prescribed suppressive acyclovir 400 mg orally three times daily from 36 weeks until delivery in an open-label fashion. Herpes cultures were obtained when patients presented for delivery. Vaginal delivery was permitted if no clinical recurrence was present; otherwise a Cesarean delivery was performed. NeonatalHSV cultures were obtained and infants were followed clinically. Rates of clinical and asymptomatic genital herpes recurrences and Cesarean delivery for genital herpes were measured, and 95% confidence intervals were calculated.

Results: In 82 patients (85%) compliant with therapy, only 1% had clinical HSV recurrences at delivery. In an intent to treat analysis of the entire cohort, 4% had clinical recurrences (compared with 18–37% in historical controls). Asymptomatic shedding occurred in 1% of women without lesions at delivery. Two of the four clinical recurrences were HSV-culture positive. No significant maternal or fetal side-effects were observed.

Conclusions: In clinical practice the majority of patients are compliant with acyclovir suppression at term. The therapy appears to be effective at reducing clinical recurrences after a first episode of genital herpes complicating a pregnancy.

Full Text

The Full Text of this article is available as a PDF (107.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arvin A. M., Hensleigh P. A., Prober C. G., Au D. S., Yasukawa L. L., Wittek A. E., Palumbo P. E., Paryani S. G., Yeager A. S. Failure of antepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery. N Engl J Med. 1986 Sep 25;315(13):796–800. doi: 10.1056/NEJM198609253151303. [DOI] [PubMed] [Google Scholar]
  2. Brocklehurst P., Kinghorn G., Carney O., Helsen K., Ross E., Ellis E., Shen R., Cowan F., Mindel A. A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection. Br J Obstet Gynaecol. 1998 Mar;105(3):275–280. doi: 10.1111/j.1471-0528.1998.tb10086.x. [DOI] [PubMed] [Google Scholar]
  3. Frenkel L. M., Brown Z. A., Bryson Y. J., Corey L., Unadkat J. D., Hensleigh P. A., Arvin A. M., Prober C. G., Connor J. D. Pharmacokinetics of acyclovir in the term human pregnancy and neonate. Am J Obstet Gynecol. 1991 Feb;164(2):569–576. doi: 10.1016/s0002-9378(11)80023-2. [DOI] [PubMed] [Google Scholar]
  4. Frenkel L. M., Garratty E. M., Shen J. P., Wheeler N., Clark O., Bryson Y. J. Clinical reactivation of herpes simplex virus type 2 infection in seropositive pregnant women with no history of genital herpes. Ann Intern Med. 1993 Mar 15;118(6):414–418. doi: 10.7326/0003-4819-118-6-199303150-00003. [DOI] [PubMed] [Google Scholar]
  5. Goldberg L. H., Kaufman R., Kurtz T. O., Conant M. A., Eron L. J., Batenhorst R. L., Boone G. S. Long-term suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group. Arch Dermatol. 1993 May;129(5):582–587. [PubMed] [Google Scholar]
  6. Hankins G. D., Cunningham F. G., Luby J. P., Butler S. L., Stroud J., Roark M. Asymptomatic genital excretion of herpes simplex virus during early labor. Am J Obstet Gynecol. 1984 Sep 1;150(1):100–101. doi: 10.1016/s0002-9378(84)80119-2. [DOI] [PubMed] [Google Scholar]
  7. Hensleigh P. A., Andrews W. W., Brown Z., Greenspoon J., Yasukawa L., Prober C. G. Genital herpes during pregnancy: inability to distinguish primary and recurrent infections clinically. Obstet Gynecol. 1997 Jun;89(6):891–895. doi: 10.1016/s0029-7844(97)00121-x. [DOI] [PubMed] [Google Scholar]
  8. Hintz M., Connor J. D., Spector S. A., Blum M. R., Keeney R. E., Yeager A. S. Neonatal acyclovir pharmacokinetics in patients with herpes virus infections. Am J Med. 1982 Jul 20;73(1A):210–214. doi: 10.1016/0002-9343(82)90093-6. [DOI] [PubMed] [Google Scholar]
  9. Makuch R., Johnson M. Issues in planning and interpreting active control equivalence studies. J Clin Epidemiol. 1989;42(6):503–511. doi: 10.1016/0895-4356(89)90146-7. [DOI] [PubMed] [Google Scholar]
  10. Prober C. G., Corey L., Brown Z. A., Hensleigh P. A., Frenkel L. M., Bryson Y. J., Whitley R. J., Arvin A. M. The management of pregnancies complicated by genital infections with herpes simplex virus. Clin Infect Dis. 1992 Dec;15(6):1031–1038. doi: 10.1093/clind/15.6.1031. [DOI] [PubMed] [Google Scholar]
  11. Prober C. G. Herpetic vaginitis in 1993. Clin Obstet Gynecol. 1993 Mar;36(1):177–187. doi: 10.1097/00003081-199303000-00023. [DOI] [PubMed] [Google Scholar]
  12. Randolph A. G., Washington A. E., Prober C. G. Cesarean delivery for women presenting with genital herpes lesions. Efficacy, risks, and costs. JAMA. 1993 Jul 7;270(1):77–82. [PubMed] [Google Scholar]
  13. Reiff-Eldridge R., Heffner C. R., Ephross S. A., Tennis P. S., White A. D., Andrews E. B. Monitoring pregnancy outcomes after prenatal drug exposure through prospective pregnancy registries: a pharmaceutical company commitment. Am J Obstet Gynecol. 2000 Jan;182(1 Pt 1):159–163. doi: 10.1016/s0002-9378(00)70506-0. [DOI] [PubMed] [Google Scholar]
  14. Sackett D. L., Gent M. Controversy in counting and attributing events in clinical trials. N Engl J Med. 1979 Dec 27;301(26):1410–1412. doi: 10.1056/NEJM197912273012602. [DOI] [PubMed] [Google Scholar]
  15. Scott L. L., Sanchez P. J., Jackson G. L., Zeray F., Wendel G. D., Jr Acyclovir suppression to prevent cesarean delivery after first-episode genital herpes. Obstet Gynecol. 1996 Jan;87(1):69–73. doi: 10.1016/0029-7844(95)00357-6. [DOI] [PubMed] [Google Scholar]
  16. Stray-Pedersen B. Acyclovir in late pregnancy to prevent neonatal herpes simplex. Lancet. 1990 Sep 22;336(8717):756–756. doi: 10.1016/0140-6736(90)92255-g. [DOI] [PubMed] [Google Scholar]
  17. Wald A., Zeh J., Barnum G., Davis L. G., Corey L. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):8–15. doi: 10.7326/0003-4819-124-1_part_1-199601010-00002. [DOI] [PubMed] [Google Scholar]
  18. Wittek A. E., Yeager A. S., Au D. S., Hensleigh P. A. Asymptomatic shedding of herpes simplex virus from the cervix and lesion site during pregnancy. Correlation of antepartum shedding with shedding at delivery. Am J Dis Child. 1984 May;138(5):439–442. doi: 10.1001/archpedi.1984.02140430017005. [DOI] [PubMed] [Google Scholar]
  19. Yeager A. S. Use of acyclovir in premature and term neonates. Am J Med. 1982 Jul 20;73(1A):205–209. doi: 10.1016/0002-9343(82)90092-4. [DOI] [PubMed] [Google Scholar]

Articles from Infectious Diseases in Obstetrics and Gynecology are provided here courtesy of Wiley

RESOURCES