Herpes simplex natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Pregnant women who have an active herpes infection on their genitals or in their birth canal when they deliver may pass the infection to their newborn infant. The risk of passing the infection to the baby is highest if the mom first becomes infected with herpes during pregnancy. Babies of women who become infected during pregnancy are at risk for premature birth. The baby may develop brain infection (meningitis, encephalitis) , chronic skin infeciton, severe developmental delays, or death. The risk for severe infection in the baby is lower in recurrent outbreaks, with the highest risk in women experiencing an outbreak at the time of delivery. Women with a history of herpes but who only have occasional or no outbreaks rarely transmit the infection to their babies.
Natural History
If left untreated herpes simplex can become recurrent. Neonatal herpes infection is a rapidly progressive disease resulting in CNS disease and disseminated disease. Clinical presentation of herpes initially include vesicular skin rash. Early diagnosis and treatment with acyclovir prevents the progression of disease. If left untreated the infection can rarely progress to involve the CNS and other organ systems. Involvement of CNS presents with irritability, confusion and respiratory difficulty. Disseminated disease may result in rare cases. CNS disease can have residual neurological deficits. Babies can have developmental delay and death.[1]
Complications
Individuals with HIV or other immunocompromized patients are at a higher risk of complications of HIV. The complications of herpes simplex infection include: [2]
- Recurrent painful genital sores
- Severe infection in immunocompromized
- Psychological distress
- Prematurity
- Spontaneous abortion
- Genital HSV can be fatal infections in babies.
- Increased susceptibility to HIV infections
- Damaged adrenals
Prognosis
- The use of acyclovir has reduced mortality in CNS and disseminated disease but the overall prognosis is poor.[3]
References
- ↑ Kimberlin DW, Lin CY, Jacobs RF, Powell DA, Frenkel LM, Gruber WC, Rathore M, Bradley JS, Diaz PS, Kumar M, Arvin AM, Gutierrez K, Shelton M, Weiner LB, Sleasman JW, de Sierra TM, Soong SJ, Kiell J, Lakeman FD, Whitley RJ (2001). "Natural history of neonatal herpes simplex virus infections in the acyclovir era". Pediatrics. 108 (2): 223–9. PMID 11483781.
- ↑ Template:Corey, Lawrence, et al. "Genital herpes simplex virus infections: clinical manifestations, course, and complications." Annals of internal medicine 98.6 (1983): 958-972.
- ↑ Whitley RJ, Corey L, Arvin A, Lakeman FD, Sumaya CV, Wright PF, Dunkle LM, Steele RW, Soong SJ, Nahmias AJ (1988). "Changing presentation of herpes simplex virus infection in neonates". J. Infect. Dis. 158 (1): 109–16. PMID 3392410.