Question : In neonates infected with herpes simplex virus (HSV), how common is a maternal history of genital herpes?

Data published in 1980 from the National Institute of Allergy and Infectious Diseases (NIAID) Collaborative Antiviral Study Group by Whitley et al included 56 HSV-infected newborns.¹ While an important goal of this collaborative multicenter database was evaluating antiviral outcomes in HSV-infected newborns, maternal characteristics were also documented, and 29 of 56 (52 percent) mothers were asymptomatic—without a history of either genital or nongenital HSV. Regarding genital HSV only, 34 of 56 (61 percent) mothers of HSV-infected newborns had no history of genital HSV infections. Subsequent data from that same NIAID registry published in 1988 demonstrated no maternal history of genital HSV infections in 236 of 291 (81 percent) HSV-infected neonatal cases over a 15-year period.²

In 1984, the Centers for Disease Control and Prevention established the National Neonatal HSV Infection Surveillance System and retrospectively collected data from 3,157 hospitals that self-reported cases of neonatal HSV over an 18-month period. The data were published by Stone et al and demonstrated similar findings, with 108 of 140 (77 percent) without a maternal history of genital herpes.³ A more recent retrospective case-control study by Mark et al evaluated all children from Washington state via birth certificate data from 1987 to 2002 and identified 91 HSV-infected neonatal cases, of which 67 (74 percent) had no history of maternal genital herpes.⁴

Conclusion

In HSV-infected neonates, approximately 60 to 80 percent of mothers have no history of genital herpes.

References

1. Whitley RJ, Nahmias AJ, Visintine AM, et al. The natural history of herpes simplex virus infection of mother and newborn. Pediatrics. 1980;66(4):489-494.
2. Whitley RJ, Corey L, Arvin A, et al. Changing presentation of herpes simplex virus infection in neonates. J Infect Dis. 1988;158(1):109-116.
3. Stone KM, Brooks CA, Guinan ME, et al. National surveillance for neonatal herpes simplex virus infections. Sex Transm Dis. 1989;16(3):152-156.
4. Mark KE, Kim HN, Wald A, et al. Targeted prenatal herpes simplex virus testing: can we identify women at risk of transmission to the neonate? Am J Obstet Gynecol. 2006;194(2):408-414.

Dr. Jones is assistant professor of pediatric emergency medicine at the University of Kentucky in Lexington.

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.