Neonatal HSV infection continues to increase in the United States. Asymptomatic exposure of the infant at delivery is the primary mode of acquisition. To develop a better understanding of the risk factors associated with asymptomatic shedding of HSV at delivery and transmission to the infant, we have, in the last 5 years, cultured all women entering the delivery room at 2 hospitals in Seattle. Out preliminary data indicate that first episodes of genital herpes in the mother, cervical as compared to vulvar shedding of HSV during labor, and HSV-1 viral type are associated with a high efficiency of transmission of HSV to the neonate. This proposal builds upon these findings to further define risk factors associated with transmission of HSV to the infant. Mothers presenting for prenatal care at the University of Washington Hospital, Stevens Memorial Hospital and Madigan Army Hospital will be serologically screened at entry and delivery to determine the frequency of asymptomatic vs symptomatic seroconversion to HSV-1 and HSV-2 during the course of pregnancy and the effects subclinical first episode genital HSV has on the infant. In addition, all women entering the delivery rooms will have HSV cultures of the cervix, vulva and rectum and their serostatus to HSV determined. All HSV exposed infants will be prospectively examined, bled and cultured. Serologic and clinical risk factors associated with symptomatic and asymptomatic shedding of HSV in the mother and subsequent transmission to the neonate will be assessed. The studies will, for the first time, accrue enough HSV exposed infants to assess the overall morbidity of asymptomatic shedding and acquisition of HSV in pregnancy and lead to practice guidelines for the obstetrical management of women with asymptomatic genital herpes.
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