Valacyclovir prophylaxis to prevent recurrent herpes at delivery: A randomized clinical trial

Jeanne S. Sheffield, James B. Hill, Lisa M. Hollier, Vanessa R. Laibl, Scott W. Roberts, Pablo J. Sanchez, George D. Wendel

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Abstract

OBJECTIVE: To measure the efficacy of valacyclovir suppression in late pregnancy to reduce the incidence of recurrent genital herpes in labor and subsequent cesarean delivery. METHODS: A total of 350 pregnant women with a history of genital herpes were assigned randomly to oral valacyclovir 500 mg twice a day or an identical placebo from 36 weeks of gestation until delivery. In labor, vulvovaginal herpes simplex virus (HSV) culture and polymerase chain reaction (PCR) specimens were collected. Vaginal delivery was permitted if no clinical recurrence or prodromal symptoms were present. Neonatal HSV cultures and laboratory tests were obtained, and infants were followed up for 1 month after delivery. Data were analyzed using χ and Student t tests. RESULTS: One hundred seventy women treated with valacyclovir and 168 women treated with placebo were evaluated. Eighty-two percent of the women had recurrent genital herpes; 12% had first episode, nonprimary genital herpes; and 6% had first episode, primary genital herpes. At delivery, 28 women (8%) had recurrent genital herpes requiring cesarean delivery: 4% in the valacyclovir group and 13% in the placebo group (P = .009). Herpes simplex virus was detected by culture in 2% of the valacyclovir group and 24% of the placebo group (P =.02). No infants were diagnosed with neonatal HSV, and there were no significant differences in neonatal complications. There were no significant differences in maternal or obstetric complications in either group. CONCLUSION: Valacyclovir suppression after 36 weeks of gestation significantly reduces HSV shedding and recurrent genital herpes requiring cesarean delivery.

Original languageEnglish (US)
Pages (from-to)141-147
Number of pages7
JournalObstetrics and Gynecology
Volume108
Issue number1
DOIs
StatePublished - Jul 2006

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valacyclovir
Herpes Genitalis
Randomized Controlled Trials
Simplexvirus
Placebos
Pregnancy
Prodromal Symptoms
Virus Shedding
Obstetrics
Pregnant Women

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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Valacyclovir prophylaxis to prevent recurrent herpes at delivery : A randomized clinical trial. / Sheffield, Jeanne S.; Hill, James B.; Hollier, Lisa M.; Laibl, Vanessa R.; Roberts, Scott W.; Sanchez, Pablo J.; Wendel, George D.

In: Obstetrics and Gynecology, Vol. 108, No. 1, 07.2006, p. 141-147.

Research output: Contribution to journalArticle

Sheffield, Jeanne S. ; Hill, James B. ; Hollier, Lisa M. ; Laibl, Vanessa R. ; Roberts, Scott W. ; Sanchez, Pablo J. ; Wendel, George D. / Valacyclovir prophylaxis to prevent recurrent herpes at delivery : A randomized clinical trial. In: Obstetrics and Gynecology. 2006 ; Vol. 108, No. 1. pp. 141-147.
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