Herpes Simplex Virus Infections: The Daily PANCE Blueprint
Which of the following is the best treatment option for a pregnant woman with first-episode genital herpes?
A. Acyclovir 400 mg orally Q8H x 5 days
B. Valacyclovir 1 g orally Q12H x 1 day
C. Acyclovir 5 mg/kg IV Q8H x 7 days
D. Valacyclovir 1000 mg orally Q24H until delivery
E. Ganciclovir 5 mg/kg IV infusion once a day x 7 days
Answer and topic summary
The answer is A. Acyclovir 400 mg orally Q8H x 5 days
Herpes simplex virus (HSV) infections are concerning during pregnancy, as there is a possibility of transmitting the virus from mother to fetus. Neonatal HSV infection can lead to serious complications. Transmission typically happens during labor/delivery due to direct contact with the virus. Clinical features of genital HSV infections depend on whether the infection is recurrent, primary, or non-primary first episode. These features may include fever, lymphadenopathy, headaches, chills, painful genital ulcers, etc. Patients may be asymptomatic. Diagnosis of genital HSV is made by finding vesicular/ulcerated lesions; nevertheless, lab testing (e.g., PCR, viral culture, type-specific serologic tests) should be obtained to confirm the diagnosis. Management of HSV infection during pregnancy is patient-specific, depending on the type of infection, severity, timing, etc. The best treatment option for a pregnant woman with first-episode genital herpes is acyclovir 400 mg orally Q8H x 5 days.
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