Genital Herpes including pictures: What are the symptoms, cause and treatment?

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Br J Obstet Gynaecol. 1995 Oct;102(10):791-7.

The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice. Brocklehurst P , Carney O , Ross E , Mindel A .

Academic Department of Genitourinary Medicine, Middlesex Hospital, London, UK.

Objectives:

To determine clinical practice amongst obstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection.

Methods:

All Members and Fellows of the Royal College of Obstetricians andGynaecologistsresident in the UK were sent a questionnaire re questing information concerning their management of pregnant women with recurrent genital herpes infection.

Results:

There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81%) routinely examined the genitals for evidence of a recurrence. When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (chi 2 = 30.38, P< 0.0001). Five hundred and ninety-six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group92 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal re quest for caesarean section regardless of recurrences at delivery was considered an acceptable indication for operative delivery by 745 obstetricians (62%).

Conclusions:

1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.

Please click on the required question.

• 1 What skin conditions may affect the vulva?
• 2 Which viral infections can affect the genitalia?
• 3 What problems can occur to people with herpes simplex?
• 4 What are genital warts?
• 5 What is lichen sclerosus?
• 6 How is lichen sclerosus treated?
• 7 What could be causing my vulval irritation?
• 8 How could my vulval irritation be treated?
• 9 What is a Bartholin’s cyst / abscess?
• 10 How is a Bartholin’s cyst / abscess treated?
• 11 What is vulvodynia?
• 12 How can my vulvodynia be treated?
• 13 What is vestibulitis?
• 14 How can my vestibulitis be treated?
• 15 Where can I obtain further information?
• 16 Support Groups.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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