Prevention of Neonatal Herpes: US Physicians' Practices Versus Clinical Guidelines

Background: Neonatal herpes is a serious infection that can largely be prevented with appropriate management of pregnant women, including judicial use of antiviral therapy and cesarean delivery. The American College of Obstetrics and Gynecology (ACOG) has established evidence-based guidelines for prevention of neonatal herpes. In the era of healthcare reform, preventive, cost-reducing interventions and evidence-based guidelines are increasingly important.

Objectives: To describe US physicians’ practices in managing genital herpes during pregnancy in order to prevent neonatal herpes, and to assess the extent to which ACOG guidelines are followed. 

Methods: A sample of 296 prenatal care physicians from 62 counties in 7 geographically diverse areas of the US completed the Maternal Health and Delivery Study survey from 2007 to 2009.

Results: In agreement with ACOG guidelines, the majority of physicians reported “always or almost always” asking pregnant patients about genital herpes (87.4 %), prescribing suppressive antivirals at the end of pregnancy for recurrent genital herpes (89.1 %), and performing cesarean delivery if a patient had signs consistent with genital herpes at term (91.5%).  Contrary to guidelines, the majority reported always or almost always prescribing suppressive antivirals at the end of pregnancy for asymptomatic women with positive HSV 2 serology (59.5%).  Also contrary to the guidelines, a few physicians thought indications for cesarean delivery included a history of genital herpes (5.1%); a history of a partner with genital herpes (3.1%); or positive HSV 2 serology alone (2.0%).  In agreement with guidelines, 45.0% considered symptoms consistent with genital herpes near term an indication for cesarean delivery.

Conclusions: Although US physicians generally follow ACOG guidelines for prevention of neonatal herpes, the majority prescribes antivirals and some perform cesarean delivery in circumstances not recommended by the guidelines.

Implications for Programs, Policy, and Research: Education to further physicians’ awareness and understanding of the ACOG guidelines for prevention of neonatal herpes is warranted for decreasing healthcare costs and the incidence of disease.