임신중에 herpetic vaginitis가 있는 경우에는 ?
또한 임신중 genital herpes 감염에 대한 management는 ?
이것에 대한 해답은 다음페이지에 명확하게 나와있다.
CDC Home에 가서 원문을 읽어볼수 있다.
번역해보자면
후천적으로 neonatal herpes를 얻은 아이 엄마는 대부분 명맥한 genital herpes Hx가 없는 편이다. 감염산모로부터 신생아에게 전달될 위험은 분만기근처에서 높으며 (30%~50%) 임신 전반기동안에 성기 단순포진바이러스에 감염되거나 임신동안 반복적으로 헤르페스감염된 Hx가 있는 산모에서는 신생아에게 transmission risk가 낮다. (<1%) .
결국 신생아 헤르페스 예방 방법은 산모로부터 분만기간동안에 신생아에게 헤르베스병변에 대한 노출을 피하는 것과 후반임신기(late pregnancy)동안에 산모의 HSV 감염을 예방하는 것이 관건이다.
모든 임신여성에게 성기헤르페스가 있었는지 과거력을 물어보는 것이 중요하다. 분만이 시작되면 모든 산모에게 성기헤르페스의 증상여부에 대해 조심스럽게 물어보아야하며헤르페스 병변이 있는지 여부를 관찰해야한다. 성기헤르페스 증상이나 징후 또는 전구증상등이 없는 산모의 경우 질식분만할 수 있다. 비록 C/sec 이 HSV수직감염의 위험을 완전히 제거하지는 못하지만, 반복적인 성기헤르페스병변이 있는 산모는 신생아에게 수직감염되는 것을 막기위하여 제왕절개로 분만해야한다.
임산부에게 전신항바이러스치료 (systemic acyclovir, valacyclovir, and famciclovir therapy)의 안전성은 확립되지 않았다. Acyclovir가 성기헤르페스에 처음으로 감염된 산모에게 또는 너무 심하게 재발하는 경우에 경구로, 심한 HSV 감염에 IV로 투여할 수 있다. 임신말기에 Acyclovir치료가 반복적인 성기페르페스감염이 있는 산모들에게 분만시때 성기헤르페스 재감염율을 감소시킴으로써 제왕절개의 빈도수를 감소시킨다. 그러나 임신말기때 항바이러스치료를 함으로써 신생아헤르페스의 incidence를 낮추는 지에 대해서는 아직 알려진바 없다.
성기헤르페스 (genital herpes)의 Hx가 없는 HSV혈청양성군에서 항바이러스치료를 뒷받침하는 어떠한 데이터도 아직은 없다.
따라서첫번째 질문의 경우 해답은 일단 산모가 만삭인 경우에 C/sec이며 이때 항바이러스제에 대한 치료는 신생아수직감염을 줄이는 benefit 에 대한 data가 없으므로 권하지 않는다
CDC home에 있는 원문은 다음과 같다.
Genital Herpes in Pregnancy
Most mothers of infants who acquire neonatal herpes lack histories of clinically evident genital herpes (186). The risk for transmission to the neonate from an infected mother is high (30%--50%) among women who acquire genital herpes near the time of delivery and low (<1%) among women with histories of recurrent herpes at term or who acquire genital HSV during the first half of pregnancy (187). However, because recurrent genital herpes is much more common than initial HSV infection during pregnancy, the proportion of neonatal HSV infections acquired from mothers with recurrent herpes is substantial. Prevention of neonatal herpes depends both on preventing acquisition of genital HSV infection during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery. Because the risk for herpes is high in infants of women who acquire genital HSV during late pregnancy, these women should be managed in consultation with an infectious disease specialist.
Women without known genital herpes should be counseled to abstain from intercourse during the third trimester with partners known or suspected of having genital herpes. In addition, pregnant women without known orolabial herpes should be advised to abstain from receptive oral sex during the third trimester with partners known or suspected to have orolabial herpes. Some specialists believe that type-specific serologic tests are useful to identify pregnant women at risk for HSV infection and to guide counseling regarding the risk for acquiring genital herpes during pregnancy and that such testing should be offered to uninfected women whose sex partner has HSV infection. However, the effectiveness of antiviral therapy to decrease the risk for HSV transmission to pregnant women by infected partners has not been studied.
All pregnant women should be asked whether they have a history of genital herpes. At the onset of labor, all women should be questioned carefully about symptoms of genital herpes, including prodromal symptoms, and all women should be examined carefully for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean section does not completely eliminate the risk for HSV transmission to the infant, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean section to prevent neonatal HSV infection.
The safety of systemic acyclovir, valacyclovir, and famciclovir therapy in pregnant women has not been definitively established. Available data do not indicate an increased risk for major birth defects compared with the general population in women treated with acyclovir during the first trimester (188) --- findings that provide assurance to women who have had prenatal exposure to acyclovir. However, data regarding prenatal exposure to valacyclovir and famciclovir are too limited to provide useful information on pregnancy outcomes. Acyclovir can be administered orally to pregnant women with first episode genital herpes or severe recurrent herpes and should be administered IV to pregnant women with severe HSV infection. Acyclovir treatment late in pregnancy reduces the frequency of cesarean sections among women who have recurrent genital herpes by diminishing the frequency of recurrences at term (189--191); the effect of antiviral therapy late in pregnancy on the incidence of neonatal herpes is not known. No data support the use of antiviral therapy among HSV seropositive women without a history of genital herpes
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