When Data Gaps Exist: OB HSV Suppression?

ACOG first recommended antiviral suppressive therapy at 36 weeks of gestation for women with a history of genital herpes in 2007, with the publication of Practice Bulletin No. 82 ("Management of Herpes in Pregnancy," June 2007). This was the first ACOG practice bulletin specifically dedicated to genital herpes management in pregnancy, and it established the 36-week suppressive therapy recommendation based on the RCTs available at that time (including the Watts 2003, Sheffield 2006, and Andrews 2006 trials). The recommendation was subsequently reaffirmed and updated in Practice Bulletin No. 220, published in May 2020, which is the current version. However, these trials had patients who ultimately delivered at/after 38 weeks. In a patient with a history of genital HSV for whom suppression is recommended but who will have a medically indicated delivery at 37 weeks, say for a hypertension disorder of pregnancy, is 36 week initiation of HSV antiviral medication enough time for suppression? There is a gap in high quality data on this. In this episode, we will review the published data and reach a clinical decision as to whether one week suppression is enough, or if initiation earlier is reasonable. 1. ACOG PB 822. ACOG PB 220