Background Transmission rates of neonatal herpes simplex virus (HSV) infection varies from 30% to 50% if shedding with primary infection during the third trimester of pregnancy, to <3% with active recurrent genital infection. Despite the low transmission risk of recurrent HSV in pregnancy, there remains confusion regarding appropriate management.
Aim To investigate the level of knowledge of BASHH guidelines regarding the management of GH in the third trimester of pregnancy amongst BASHH conference attendees.
Methods Attendees of two BASHH conferences completed a questionnaire consisting of case-scenarios regarding appropriate management of pregnant women and their partners with genital herpes infection. The first case-scenario was designed to assess familiarity with accepted guidance. The second was used to assess whether physicians followed RCOG or BASHH guidelines.
Results 94 attendees completed the survey. In line with current guidelines, 81 (74%) answered that primary HSV infection at term was an indication for Caesarian section (CS), and 37 (46%) of these 81 responders stated this CS should be carried out at 38 weeks gestation. Of these 37 responders, when questioned concerning recurrent genital infection at term, 27 (73%) believed that lesions present at delivery would necessitate a CS, and 35 (95%) felt that vaginal delivery was appropriate in the absence of lesions at delivery. Although there is specific guidance for the limited place of invasive techniques at term only 17% would advise avoidance of fetal scalp electrodes and artificial membrane rupture.
Conclusion No-one demonstrated complete familiarity with the BASHH guidelines surrounding appropriate management of HSV. Of most concern is the limited awareness of the management need of CS in third trimester first episode disease. Further training of GUM physicians is required in order to ensure practice is compatible with the best available advice.