1. 5% of patients treated with acyclovir, and 14% of patients treated with placebo had HSV lesions at delivery (P = 0.08).
2. 7% in the acyclovir group had positive HSV cultures and PCR, compared with 34% of placebo-treated patients (P = 0.03 and < 0.01 respectively).
3. 4% of women in the acyclovir group delivered by cesarean, and 10% of women in the placebo group delivered by cesarean (P = 0.17).
4. Neonatal outcomes were similar between groups.
5. Importantly, 6% of the women in the study had persistent detection of HSV by PCR on > 20% of days, despite reporting taking 90%-100% of the acyclovir doses.
6. The study did not examine safety of the neonate.

1. Decreased frequency of clinical recurrences, 6% of treatment and 14% of placebo group had clinical HSV at delivery (P = 0.046).
2. No women had positive HSV cultures in treatment group compared with 6% positives in placebo group (P = 0.029).
3. No significant difference in subclinical HSV shedding in the treatment group compared with placebo group.
4. The study did not examine safety of the neonate.

1. 85% of patients adhered to treatment, 1% had clinical HSV at delivery.
2. 4% of the cohort had clinical recurrences compared with 18%-37% of historical controls.
3. Asymptomatic shedding occurred in 1% of women without lesions at delivery.
4. No harms (neurological, hepatic, renal complications) were attributable to acyclovir during the neonatal period.

1. The rate of cesarean delivery was 8.4% in treatment group (Group 1), 16.5% in no treatment group (Group 2), and 9.9% in historical controls (Group 3) (P < 0.001).
2. 75% of cesarean deliveries in Group 2 and 10% of cesarean deliveries in Group 3 were done because of genital HSV.
3. Percentage of viral shedding was 0% in Group 1, 5% in Group 2, and 0.5% in Group 3.
4. No neonatal herpes were diagnosed during the study period and no harms for the newborn related to antiviral therapy were reported.

1. The number of clinical recurrences of genital HSV was significantly reduced in the treatment group compared with placebo (OR, 0.10; 95% CI, 0.00-0.86).
2. This trial did not demonstrate that acyclovir use in late pregnancy reduced cesarean delivery.
3. No HSV among neonates were reported, and no adverse complications were reported for the infants at 1-yr followup.

1. None of the treatment group and 35% of the placebo group had clinical evidence of recurrent genital HSV at delivery (OR, 0.04; 95% CI, 0.002-0.745; P = 0.002).
2. Women treated with acyclovir had no cesareans for genital herpes compared with 36% of placebo group (OR, 0.04; 95% CI, 0.002-0.745; P = 0.002).
3. No neonates had evidence of herpes infection or harms from acyclovir.

Notes: CI, confidence interval; DB, double blind; HSV, herpes simplex virus; OR, odds ratio; PCR, polymerase chain reaction; RCT, randomized controlled trials.