A recently published systematic review and meta-analysis of RCTs of acyclovir prophylaxis during late pregnancy included 5 trials enrolling a total of 799 women with prior HSV infections.41 A fixed-effects model was used to calculate a summary odds ratio comparing the effect of treatment with placebo. Prophylactic acyclovir beginning at 36 weeks' gestation reduced the risk for clinical HSV recurrence at delivery (OR, 0.25; 95% CI, 0.15-0.40), cesarean delivery for recurrent HSV (OR, 0.30; 95% CI, 0.13-0.67), and HSV shedding at delivery (OR, 0.09; 95% CI, 0.02-0.39). None of the published studies had adequate power to address the effect of prophylactic acyclovir on neonatal HSV, and no neonatal HSV infections were reported. All of the RCTs included in the meta-analysis were published since the prior USPSTF recommendation on screening for genital herpes and are included in this update (Table 3).42-46
A good-quality, randomized, double blind, placebo controlled trial was conducted to assess the efficacy of acyclovir in the reduction of HSV recurrences and cesarean delivery.42 Eligible women (n = 162, pregnant women with at least 1 symptomatic episode of genital HSV during pregnancy or the year before pregnancy) were randomly assigned to acyclovir (400 mg 3 times daily) or identical placebo after 36 weeks' gestation. Patients identified clinical lesions and collected HSV cultures and DNA PCR samples. Five percent of patients treated with acyclovir and 14 percent of patients treated with placebo had HSV lesions at delivery (P = 0.08). HSV culture and PCR positivity near delivery occurred in 7 percent and 34 percent of women in the placebo group and 0 percent and 2 percent in the acyclovir group (P = 0.03 and P < 0.01 respectively). Four percent of women in the acyclovir group delivered by cesarean compared with 10 percent in the placebo group (P = 0.17). Six percent of the women in the study had persistent detection of HSV by PCR more than 20 percent of the days, despite reporting taking 90 percent to100 percent of the acyclovir doses. Neonatal outcomes were similar between groups, and the study did not examine neonatal safety.
A fair-quality, randomized, double blind, placebo controlled trial was conducted to evaluate the use of suppressive acyclovir near term to decrease the frequency of clinical recurrences at delivery in women with recurrent genital HSV infection.43 Eligible women (n = 234 women with any frequency of recurrent HSV) were randomly assigned to either oral acyclovir (400 mg 3 times daily) or an identical placebo after 36 weeks' gestation. Clinical lesions were identified, and HSV cultures were obtained at delivery. Six percent of patients treated with acyclovir and 14 percent of patients treated with placebo had clinical HSV at delivery (P = 0.046). No patients in the acyclovir group had positive HSV cultures compared with 6 percent in the placebo group (P = 0.029). There was no significant difference in subclinical HSV shedding in the acyclovir group (0 percent) compared with the placebo group (3 percent; P = 0.102). The study was not designed to evaluate the safety of suppressive acyclovir on the fetus.
A poor-quality, randomized, double blind, placebo controlled trial was conducted to evaluate the efficacy of suppressive acyclovir in late pregnancy to prevent recurrent genital HSV.44 Eligible women (n = 63) with recurrent HSV infection under 36 weeks' gestation were randomly assigned to acyclovir (200 mg 4 times daily) or placebo from 36 weeks' gestation until the time of delivery. Women were followed weekly, and viral cultures were obtained from the cervix and vulva. No specific instructions were set up for obstetrical management. The proportion of women undergoing cesarean delivery for recurrent HSV at delivery was 19 percent (n = 12). The odds ratio for clinical HSV recurrence was significantly reduced in the treatment group (0.10; 95% CI, 0.00-0.86). Odds ratios for cesarean deliveries (0.44; 95% CI, 0.09-1.59) and asymptomatic shedding during treatment (0.32; 95% CI, 0.05-1.56) were not statistically significantly reduced among women in the treatment group. No information was reported on adverse experiences.
A poor-quality, randomized, double blind, placebo controlled trial was conducted to determine the efficacy of acyclovir suppressive therapy to prevent cesarean delivery after a first episode of genital HSV.45 Eligible women (n = 46) with first episodes of HSV during pregnancy were randomly assigned to oral acyclovir (400 mg 3 times daily) or placebo. The study was conducted from 36 weeks' gestation to delivery, and HSV cultures were obtained at delivery. In an intention-to-treat analysis, none of the women treated with acyclovir had clinical evidence of recurrent HSV at delivery compared with 9 women taking placebo (OR, 0.04; 95% CI, 0.002-0.75; P = 0.002). Overall, 4 of 21 women in the treatment group had cesarean deliveries (none related to HSV lesions), compared with 10 of 25 women in the placebo group (OR, 0.35; 95% CI, 0.07-1.59; P = 0.22). No patient in either group experienced asymptomatic viral shedding, and no infant in either group had clinical or virological evidence of HSV infection. No adverse experiences related to acyclovir treatment in neonates were reported at 1-month followup.
A poor-quality, open-label trial evaluated the use of antiviral suppression after a first episode of genital HSV infection in late pregnancy.47 Eligible women (n = 96) diagnosed with genital herpes for the first time in the index pregnancy were prescribed 400 mg of suppressive acyclovir orally 3 times daily from 36 weeks' gestation until delivery. Herpes cultures were obtained when patients presented for delivery. Vaginal delivery was permitted if no clinical recurrence was present; otherwise, a cesarean delivery was performed. Neonatal HSV cultures were obtained, and infants were followed clinically. In 82 patients (85 percent) adherent with therapy, only 1 percent had clinical HSV recurrences at delivery. In an intention-to-treat analysis of the entire cohort, 4 percent had clinical recurrences (compared with 18 percent to 37 percent in historical controls). Asymptomatic shedding occurred in 1 percent of women without lesions at delivery. Two of the 4 clinical recurrences were HSV-culture positive. No significant maternal or fetal side effects were observed.
Limited evidence exists on the use of antiviral therapy to reduce viral shedding and therefore reduce transmission of HSV to neonates. A poor-quality randomized trial was conducted to investigate the use of acyclovir prophylaxis in late pregnancy to reduce the risk for viral shedding and mother-to-child transmission at delivery.46 Eligible women (n = 288, at least 1 episode of genital HSV during pregnancy) were randomly assigned to 2 groups: group 1 (n = 167) received oral acyclovir from 36 weeks' gestation to term; group 2 (n = 121) received no treatment. Group 3 (n = 201) comprised women who were not given prophylaxis, had a history of genital herpes, and had no active episodes during pregnancy. No specific instructions were set up for obstetrical management except for cesarean delivery in case of suspected herpes lesions at the time of labor. The rate of cesarean delivery was 8.4 percent in group 1, 16.5 percent in group 2, and 9.9 percent in group 3 (P < 0.001). Seventy-five percent of cesarean deliveries in group 2 and 10 percent in group 3 were done because of genital HSV. The percentage of viral shedding was, respectively, 0 percent in group 1, 5 percent in group 2, and 0.5 percent in group 3 (P < 0.05). The study did not report information on adverse experiences.
A prospective cohort study was designed to demonstrate prevention of transmission of HSV to neonates by using cesarean delivery—a common practice for 30 years.48 The study enrolled 58,362 pregnant women between January 1982 and December 1999 at a university medical center, a U.S. Army medical center, and 5 community hospitals in Washington State. Of these, 40,023 had HSV cultures obtained from the cervix and external genitalia, and 31,663 had serum samples tested for HSV twice. Among the 202 women HSV positive at the time of labor, 10 (5 percent) had neonates with HSV infection (OR, 346; 95% CI, 125-956 for neonatal herpes when HSV was isolated vs not isolated). There was 1 case of neonatal herpes among 85 cesarean deliveries vs 9 cases (7.7 percent) among 117 vaginal deliveries (OR, 0.14; 95% CI, 0.02-1.08; P = 0.047).
While the investigators concluded that cesarean delivery reduces the risk for HSV transmission, this conclusion is not supported for the following reasons:
There is limited evidence on the safety of antiviral treatments during pregnancy. A prospective, double-blind, phase 1 trial evaluated the pharmacokinetics and safety of valacyclovir and acyclovir during pregnancy.49 Eligible women (n = 20) with a history of recurrent genital HSV infections and positive HSV-2 serologies were randomly assigned at 36 weeks' gestation to oral valacyclovir (500 mg twice daily) or acyclovir (400 mg 3 times daily). Pharmacokinetic profiles were obtained after the initial dose (36 weeks' gestation) and at steady state (38 weeks' gestation). Amniotic fluid samples were obtained during labor, and simultaneous umbilical cord and maternal plasma samples were collected at delivery. Laboratory studies were performed to screen for evidence of toxicity in mothers and infants. There was no significant difference in drug elimination half-life or in time to peak concentration between valacyclovir and acyclovir recipients at either sampling interval. Acyclovir was more highly concentrated in the amniotic fluid, but there was no evidence of preferential fetal drug accumulation (mean maternal/umbilical vein plasma ratios at delivery were 1.7 for valacyclovir and 1.3 for acyclovir). Drugs were well tolerated, and no significant laboratory or clinical evidence of toxicity was detected. Maternal valacyclovir therapy resulted in higher plasma levels, with significantly higher peak concentrations, and daily area under the curve values than acyclovir therapy.
The acyclovir and valacyclovir pregnancy registry is maintained by GlaxoSmithKline and provides information on harms.50 Both acyclovir and valacyclovir have been designated pregnancy category B by the Food and Drug Administration (FDA) and should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Findings from the acyclovir registry did not show an increase in the number of birth defects when compared with the general population. Reported defects showed no uniqueness or pattern to suggest a common etiology. However, data from reported cases do not represent a sufficient sample size for reaching reliable and definitive conclusions regarding the risk for acyclovir to pregnant women and their developing fetuses. Similarly, the data for prenatal exposure to valacyclovir were too limited to provide useful information on pregnancy outcomes.
A cost analysis of oral acyclovir prophylaxis in late pregnancy (acyclovir and cesarean delivery when HSV lesions were present or acyclovir and followup of infants exposed to HSV lesions at delivery) was compared with the current standard of cesarean delivery for genital HSV lesions.51 Clinical outcomes and direct costs of prevention were evaluated using decision analysis. Probabilities were obtained from the literature and experts. Cost data were based on hospital costs and costs of caring for HSV infected neonates. Without prophylactic acyclovir, an estimated 1,082 cesarean deliveries would be performed to prevent 2.8 cases of neonatal HSV in a cohort of 10,000 women. Costs include $1,319,457 per case of neonatal HSV prevented, and $3,012,459 per death or disability prevented. Using prophylactic acyclovir, the rate of cesarean deliveries would be reduced to 216 per 10,000 women, preventing 5.5 neonatal HSV infections. Costs include $493,641 per case prevented, and $1,127,034 per death or disability prevented. Prophylactic acyclovir and followup of infants exposed to HSV at delivery without performing cesarean deliveries would prevent 5 cases of neonatal HSV infections at a cost of $400,382 per case prevented, and $914,114 per death or disability prevented.
Another cost analysis compared use of acyclovir suppressive therapy to prevent recurrent genital HSV at delivery to no medical treatment.52 Estimates of risk for HSV recurrence and cesarean delivery rates (in acyclovir treated and untreated patients) and frequency of neonatal acyclovir treatment were derived from literature reviews and experts. Using these data, the average obstetrical cost per patient not treated with acyclovir was estimated as $7,625. The average obstetrical cost per patient treated with acyclovir during the last weeks of pregnancy was estimated as $7,442.
Effectiveness, cost, and benefit of suppressive therapy among HSV serodiscordant sex partners during pregnancy was assessed.53 Decision and economic analyses were used to compare the incidence and costs of neonatal herpes in California (2000) for 3 interventions:
Screening and suppressive therapy was the most effective strategy. Current guidelines had limited effectiveness, but were cost saving. A potential 82 percent decrease in neonatal herpes incidence would be possible with screening and suppressive therapy, but would cost $363,000 per case prevented.
Investigators performed a decision analysis model to test the value of routine HSV serology in pregnancy to prevent neonatal HSV infection.54 Hypothetically, if one million pregnant women were screened, the rate of neonatal HSV-1 transmission would be marginally reduced from 126 to 99, and the rate of neonatal HSV-2 infection would be reduced from 157 to 124. The cost per serious case of neonatal HSV averted would be $891,000.
A summary of evidence considered for this update is described in Table 4.
At this time, no professional health organizations recommend routine screening for genital HSV in asymptomatic adolescents and adults.
The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention recommend against surveillance viral cultures for HSV in asymptomatic pregnant women.13,55 Rather, they recommend that all pregnant women be asked about a history of genital HSV early in the pregnancy and that they be carefully questioned about HSV symptoms and examined for genital lesions at the time of delivery. Women without known genital HSV should be counseled to avoid exposure during the third trimester with known or suspected HSV-1 or HSV-2 infection.
This brief update was funded by the Agency for Healthcare Research and Quality (AHRQ) for the U.S. Preventive Services Task Force (USPSTF), and the investigators acknowledge the contributions of Gurvaneet Randhawa, M.D., M.P.H., Task Order Officer, AHRQ, and Janelle Guirguis-Blake, M.D., Medical Officer, AHRQ. Members of the USPSTF who served as leads for this project include: Mark S. Johnson, M.D., M.P.H.; Paul S. Frame, M.D.; Carol Loveland-Cherry, Ph.D., R.N.; Leon Gordis, M.D., M.P.H., Dr.P.H.; Virginia A. Moyer, M.D., M.P.H.; Diana B. Petitti, M.D., M.P.H.; and Steven M. Teutsch, M.D., M.P.H. Additional members of the Oregon Evidence-based Practice Center (EPC) project team include Kim Villemyer, research assistant, and Andrew Hamilton, M.S., M.L.S., research librarian. Mark Helfand, M.D., M.P.H., Anna Wald, M.D., Rhoda Ashley Morrow, Ph.D., and Lawrence Corey, M.D., provided comments for the draft.
1. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes Simplex Virus Type 2 in the United States, 1976 to 1994. N Engl J Med 1997;337(16):1105-11.
2. Schomogyi M, Wald A, Corey L. Herpes simplex virus-2 infection. An emerging disease? Infect Dis Clin North Am 1998;12(1):47-61.
3. Lafferty WE, Downey L, Celum C, Wald A. Herpes simplex virus 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis 2000;181(4):1454-7.
4. Armstrong G, Schllinger J, Markowits L, et al. Incidence of herpes simplex virus type 2 infection in the United States. Am J Epidemiol 2001;153(9):912-20.
5. Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med 1999;131:14-20.
6. Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med 2000;153(12):844-50.
7. Brown ZA. HSV-2 specific serology should be offered routinely to antenatal patients [comment]. Rev Med Virol 2000;10(3):141-4.
8. Kimberlin DW, Lin CY, Jacobs RF, et al. Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics 2001;108(2):223-9.
9. Rudnick CM, Hoekzema GS. Neonatal herpes simplex virus infections. Am Fam Physician 2002;65(6):1138-42.
10. Ashley R. Type specific antibodies to HSV1 and HSV2: review of methodology. Herpes 1998;5:33-8.
11. Slomka MJ, Ashley RL, Cowan FM, Cross A, Brown DW. Monoclonal antibody blocking tests for the detection of HSV 1 and HSV 2 specific humoral responses: comparison with western blot assay. J Virol Methods 1995;55:27-35.
12. Ashley RL. Sorting out the new HSV type specific antibody tests. Sex Transm Infect 2001;77(4):232-7.
13. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR—Recommendations and Reports 2002;51(RR-6).
14. Brown ZA, Benedetti JK, Watts HD, et al. A comparison between detailed and simple histories in the diagnosis of genital herpes complicating pregnancy. Am J Obstet Gynecol 1995;172(4):1304-6.
15. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Washington, DC: Office of Disease Prevention and Health Promotion; 1996.
16. Frenkel LM, Garratty EM, Shen JP, Wheeler N, Clark O, Bryson YJ. Clinical reactivation of herpes simplex virus type 2 infection in seropositive pregnant women with no history of genital herpes. Ann Intern Med 1993;118:414-8.
17. Lipsitch M, Davis G, Corey L. Potential benefits of a serodiagnostic test for herpes simplex virus type 1 (HSV-1) to prevent neonatal HSV-1 infection. Sex Transm Dis 2002;29(7):399-405.
18. Cowan FM, Johnson AM, Ashley R, Corey L, Mindel A. Antibody to herpes simplex virus type 2 as serological marker of sexual lifestyle in populations. BMJ 1994;309:1325-9.
19. Langenberg AG, Corey L, Ashley RL, Leong WP, Straus SE. A prospective study of new infections with herpes simplex virus type 1 and 2. N Engl J Med 1999;341(19):1432-8.
20. Slomka MJ, Emry L, Munday PE, et al. A comparison of PCR with virus isolation and direct antigen detection and typing of genital herpes. J Med Virol 1998;55:177-83.
21. Boggess KA, Watts HD, Hobson AC, et al. Herpes simplex virus type 2 detection by culture and polymerase chain reaction and relationship to genital symptoms and cervical antibody status during the third trimester of pregnancy. Am J Obstet Gynecol 1997;176(2):443-51.
22. Wald A, Huang ML, Carrell D, Selke S, Corey L. Polymerase chain reaction for detection of herpes simplex virus (HSV) DNA on mucosal surfaces: comparison with HSV isolation in cell culture. J Infect Dis 2003;188:1345-51.
23. Prince HE, Ernst CE, Hogrefe WR. Evaluation of an enzyme immunoassay system for measuring herpes simplex virus (HSV) type 1-specific IgG antibodies. J Clin Lab Anal 2000;14:13-6.
24. Ashley RL, Wald A, Eagleton M. Premarket evaluation of the POCkit HSV2 type-specific serologic test in culture-documented cases of genital herpes simplex virus type 2. Sex Transm Dis 2000;27(5):266-9.
25. Leach CT, Ashley RL, Baillargeon J, Jenson HB. Performance of two commercial glycoprotein G-based enzyme immunoassays for detecting antibodies to herpes simplex viruses 1 and 2 in children and young adolescents. Clin Diagn Lab Immunol 2002;9(5):1124-5.
26. Melville J, Sniffen S, Crosby R, et al. Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment. Sex Transm Infect 2003;79(4):280-5.
27. Cotton S, Connelly BL, Cohen SS, Siegel RM, Stanberry LR, Rosenthal SL. Screening for neonatal herpes: physicians' descriptions of discussions with parents. Herpes 2002;9(3):60-3.
28. Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL. Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. Collaborative Famciclovir Genital Herpes Research Group. JAMA 1998;280:887-92.
29. Mertz GJ, Loveless MO, Levin MJ, et al. Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Collaborative Famciclovir Genital Herpes Research Group. Arch Intern Med 1997;157(3):343-9.
30. Reitano M, Tyring S, Lang W, et al. Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. International Valaciclovir HSV Study Group. J Infect Dis 1998;178(3):603-10.
31. Patel R, Bodsworth NJ, Woolley P, et al. Valaciclovir for the suppression of recurrent genital HSV infection: a placebo controlled study of once daily therapy. International Valaciclovir HSV Study Group. Genitourin Med 1997;73(2):105-9.
32. Wald A, Zeh J, Barnum G, et al. Suppression of subclinical shedding for herpes simplex virus type 2 with acyclovir. Ann Intern Med 1996;124:8-15.
33. Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 2004;350(1):11-20.
34. Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 2001;285(24):3100-6.
35. Wald A, Langenberg A, Kexel E, Izu A, Ashley R, Corey L. Condoms protect men and women against HSV-2 acquisition. 2002 National STD Prevention Conference. March 4-7, 2002. San Diego, CA.
36. Stanberry LR, Spruance SL, Cunningham AL, et al. Glycoprotein-D-Adjuvant vaccine to prevent genital herpes. N Engl J Med 2002;347(21):1652-61.
37. Corey L, Langenberg AG, Ashley R, et al. Recombinant glycoprotein vaccine for the prevention of genital HSV-2 infection. JAMA 1999;282(4):331-40.
38. Skinner GR, Turyk ME, Benson CA, et al. The efficacy and safety of Skinner herpes simplex vaccine towards modulation of herpes genitalis; report of a prospective double-blind placebo-controlled trial. Med Microbiol Immunol 1997;186:31-6.
39. Straus SE, Wald A, Kost RG, et al. Immunotherapy of recurrent genital herpes with recombinant herpes simplex virus type 2 glycoproteins D and B: results of a placebo-controlled vaccine trial. J Infect Dis 1997;176(5):1129-34.
40. Straus SE, Corey L, Burke RL, et al. Placebo-controlled trial of vaccination with recombinant glycoprotein D of herpes simplex virus type 2 for immunotherapy of genital herpes. Lancet 1994;343(8911):1460-3.
41. Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol 2003;102(6):1396-403.
42. Watts DH, Brown ZA, Money D, et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol 2003;188(3):836-43.
43. Scott LL, Hollier LM, McIntire D, et al. Acyclovir suppression to prevent recurrent genital herpes at delivery. Infect Dis Obstet Gynecol 2002;10(2):71-7.
44. Brocklehurst P, Kinghorn G, Carney O, et al. A randomised placebo-controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection. Br J Obstet Gynaecol 1998;105(3):275-80.
45. Scott LL, Sanchez PJ, Jackson GL, Zeray F, Wendel GD Jr. Acyclovir suppression to prevent cesarean delivery after first-episode genital herpes. Obstet Gynecol 1996;87(1):69-73.
46. Braig S, Luton D, Sibony O, et al. Acyclovir prophylaxis in late pregnancy prevents recurrent genital herpes and viral shedding. Eur J Obstet Gynecol Reprod Biol 2001;96(1):55-8.
47. Scott LL, Hollier LM, McIntire D, et al. Acyclovir suppression to prevent clinical recurrences at delivery after first episode genital herpes in pregnancy: an open-label trial. Infect Dis Obstet Gynecol 2001;9(2):75-80.
48. Brown ZA, Wald A, Morrow RA, et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant [comment]. JAMA 2003;289(2):203-9.
49. Kimberlin DF, Weller S, Whitley RJ, et al. Pharmacokinetics of oral valacyclovir and acyclovir in late pregnancy. Am J Obstet Gynecol 1998;179(4):846-51.
50. Acyclovir and Valacyclovir in Pregnancy Registry final report. April 1999. Available at: http://pregnancyregistry.gsk.com/acyclovir.html. Accessed January 18, 2005.
51. Randolph AG, Hartshorn RM, Washington AE. Acyclovir prophylaxis in late pregnancy to prevent neonatal herpes: a cost-effectiveness analysis. Obstet Gynecol 1996;88(4 Pt-1):603-10.
52. Scott LL, Alexander J. Cost-effectiveness of acyclovir suppression to prevent recurrent genital herpes in term pregnancy. Am J Perinatol 1998;15:57-62.
53. Barnabas RV, Carabin H, Garnett GP. The potential role of suppressive therapy for sex partners in the prevention of neonatal herpes: a health economic analysis. Sex Transm Infect 2002;78(6):425-9.
54. Rouse DJ, Stringer JSA. An appraisal of screening for maternal type-specific herpes simplex virus antibodies to prevent neonatal herpes. Am J Obstet Gynecol 2000;183(2):400-6.
55. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th ed. Elk Grove Village, IL: AAP; Washington, DC: ACOG; 2002.
[a] Glass: Oregon Evidence-based Practice Center and School of Nursing, Oregon Health & Science University
[b] Nelson: Oregon Evidence-based Practice Center and Departments of Medical Informatics & Clinical Epidemiology and Medicine, Oregon Health & Science University
[c] Huffman: Oregon Evidence-based Practice Center, Oregon Health & Science University
This brief update and the updated recommendation statement are available on the Agency for Healthcare Research and Quality (AHRQ) Web site (www.ahrq.gov/clinic/uspstfix.htm). The recommendation is also available on the Web site of the National Guideline Clearinghouse™ (http://www.guideline.gov).
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AHRQ Publication No. 05-0573-B
Current as of March 2005
Internet Citation:
Glass N, Nelson, HD, Huffman, L. Screening for Genital Herpes Simplex: Brief Update. AHRQ Publication No. 05-0573-B, March 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf05/herpes/herpesup.htm
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