Although and nothing else 5 to 10 ...

Although and nothing else 5 to 10 percent of women of reproductive age in the United States report having clinical genital herpes infection (HSV) up to 30 percent have antibody evidence of infection and risk transmitting the infection to their infants during delivery. circulating policies to limit neonatal transmission focus forward cesarean delivery for women who have symptoms near mete However, because of the large number of asymptomatic carriers, more than 70 percent of neonatal HSV cases meet the eye in children born to women without obvious HSV infection. Sheffield and colleagues reviewed the evidence for effective prophylaxis therapy with acyclovir during the last month of pregnancy.

The authors searched electronic databases, conversation proceedings, bibliographies, and registries of trials for prospective, randomized controll trials of acyclovir in pregnant women with HSV infection. If necessary, authors were contacted for nonpublished data pertinent to the meta-analysis. From the original 22 identified studies, solitary five met inclusion criteria for methodologic quality. These five studies involved 799 pregnant women

The combined proceeds of the studies showed a significant reduction in clinical HSV transmission at delivery, regardless of the dosage of acyclovir. Overall, the rate of return was 4 percent in patients receiving treatment compared with 15 percent in the placebo arrange Patients receiving acyclovir also were significantly les likely to be subjected to cesarean delivery. In four studies, viral civilization was used at delivery to expose HSV. None of the 339 patients who received acyclovir antenatally had HSV exposeed at delivery compared with 15 (5 percent) of the 293 patients who received placebo. No cases of neonatal HSV occurr in the 799 deliveries.

The authors conclud that the token of HSV did not influence the issues They also examined the efficiency of different dosages of acyclovir. The additionals ratio for HSV recurrence at delivery was 013 in sum of two units studies using 800 mg of acyclovir by day. When 1,200 mg of acyclovir was used, the remainings ratio of 0.34 was just statistically significantly improved. For HSV detection at delivery, the unmatcheds ratio for treatment with 1200 mg was not significantly better than that for 800 mg (013 compared with 009)

The authors close that prophylactic acyclovir therapy from the 36th week of pregnancy lessens the risks of clinical HSV in the mother at delivery, cesarean delivery, and asymptomatic viral shedding at delivery. Similar rises were noticed regardless of pattern of HSV disease and dosage of acyclovir.

Sheffield J et al. Acyclover prophylaxis to obstruct herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol December 2003;102:1396-403

COPYRIGHT 2004 American Academy of Family Physicians

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