Management of Genital Herpes in Pregnancy

Publication Date: May 1, 2020
Last Updated: March 14, 2022

Summary of Recommendations

In pregnancy, suspected genital herpes virus infections should be confirmed with type-specific laboratory testing. However, retesting is not warranted in pregnant women with a history of laboratory-confirmed genital HS. (B)

Women with a clinical history of genital herpes should be offered suppressive viral therapy at or beyond 36 weeks of gestation. For primary outbreaks that occur in the third trimester, continuing antiviral therapy until delivery may be considered. (B)

Because of enhanced renal clearance, the doses of antiviral medication used for suppressive therapy for recurrent HSV infection in pregnancy are higher than the corresponding doses in nonpregnant women. (B)

Cesarean delivery is indicated in women with active genital lesions or prodromal symptoms, such as vulvar pain or burning at delivery, because these symptoms may indicate viral shedding. (B)

Routine HSV screening of pregnant women is not recommended. In addition, routine antepartum genital HSV cultures in asymptomatic patients with recurrent disease are not recommended. (C)

In general, cesarean birth is not recommended for women with a history of HSV infection but no active genital lesions or prodromal symptoms during labor. However, for women with a primary or nonprimary first-episode genital HSV infection during the third trimester of pregnancy, cesarean delivery may be offered due to the possibility of prolonged viral shedding. (C)

Cesarean delivery is not recommended for women with nongenital lesions (eg, lesions on back, thigh, buttock). These lesions may be covered with an occlusive dressing and the patient can give birth vaginally. (C)

In women with preterm prelabor rupture of membranes, there is no consensus on the gestational age at which the risks of prematurity outweigh the risks of HSV. When expectant management is elected, treatment with an antiviral is recommended. (C)

Recommendation Grading




Management of Genital Herpes in Pregnancy

Authoring Organization

Publication Month/Year

May 1, 2020

Last Updated Month/Year

January 9, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Hospital

Intended Users

Nurse midwife, nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D011247 - Pregnancy, D006561 - Herpes Simplex, D011248 - Pregnancy Complications, D006558 - Herpes Genitalis, D011251 - Pregnancy Complications, Infectious


pregnancy, Genital herpes simplex virus, HSV