related: Infections in Pregnancy
The most common mode of vertical transmission is direct contact between the fetus and genital tract lesions (eg, cervix, vagina, vulva) during vaginal delivery.
low risk of vertical transmission in patients without an active HSV lesion or prodromal symptoms (eg, malaise, myalgia).
the most effective strategy to decrease the risk of vertical transmission is to prevent an active HSV lesion at the time of delivery with suppression
Therefore, patients with a history of HSV are provided acyclovir suppression beginning at 36 weeks gestation that is continued until delivery.
At delivery, patients without prodromal symptoms or active genital HSV lesions can be delivered vaginally as the risk for perinatal transmission is minimal.
Patients with active genital HSV at delivery require a cesarean delivery to prevent direct contact between the fetus and the lesion