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Herpes genitalis in der Schwangerschaft

Genital herpes in pregnancy

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  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Weltweit haben Herpes-genitalis-Infektionen zugenommen (überwiegend durch Herpesvirus Typ 2, HSV-2, vermehrt auch durch HSV 1). Bei 75% der Infizierten verläuft die Infektion untypisch, sodass keine exakte Diagnose gestellt werden kann. Fast 90% der Mütter von Kindern mit neonatalem Herpes sind zum Geburtszeitpunkt symptomlos. Die intrauterine Infektion durch transplazentare Transmission ist selten. Hauptweg der neonatalen Infektion ist der direkte peripartale Kontakt mit maternalem Genitalsekret. Bei einer neonatalen Infektionsrate von 40–50% beträgt die Mortalität 40% und die Morbidität 20%. Im Gegensatz dazu führt die rekurrierende Infektion nur in etwa 1–5% der Fälle zu einer neonatalen Infektion, bedingt durch maternale IgG-Antikörper und geringe Virusmengen. Das therapeutische Konzept beinhaltet zunächst die ausführliche Aufklärung der werdenden Mutter und des Partners. Bei symptomatischer Infektion sollte spätestens 4 bis 6 Stunden nach dem Blasensprung die abdominale Schnittentbindung erfolgen, sonst ist kein Vorteil für das Kind zu erwarten. Die anamnestisch rekurrierende Infektion ist keine Indikation für eine prophylaktische Sectio. Die suppressive Aciclovir-Therapie ab der 36. SSW reduziert Symptomatik und Rezidivhäufigkeit und führt zu einem Sectiorückgang. Weder die primäre Sectio noch die Aciclovir-Therapie schließen eine maternofetale Transmission aus.

Abstract

Genital herpes infections have increased worldwide, predominantly due to herpes simplex virus type 2 (HSV-2) but also increasingly to HSV-1. In 75% of cases the course of the infection is atypical so that an exact diagnosis cannot be made. Nearly 90% of mothers of children with neonatal herpes are free of symptoms until the time of birth. Intrauterine infections by transplacental transmission are rare and the main route of neonatal infection is direct contact with maternal genital secretions peripartum. The neonatal infection rate is 40-50% with a mortality of 40% and a morbidity of 20%. In contrast recurrent infections lead to neonatal infections in only 1-5% of cases due to maternal IgG antibodies and low virus counts. The therapeutic concept includes initially a comprehensive consultation with the expectant mother and partner. In cases of symptomatic infections a Caesarean section should be carried out within 4-6 h following the rupture of membranes, otherwise no advantage for the child can be expected. Recurrent infections are not an indication for a prophylactic Caesarean section. Suppressive acyclovir therapy from 36 weeks gestation onwards reduces symptoms, the frequency of recurrence and leads to a reduction in Caesarean sections. Neither primary Caesarean section nor acyclovir therapy can exclude a maternofetal transmission.

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  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Maistr. 11, 80337, München, Deutschland

    I. Mylonas

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Mylonas, I. Herpes genitalis in der Schwangerschaft. Gynäkologe 44, 623–629 (2011). https://doi.org/10.1007/s00129-011-2771-1

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