Management of women with recurrent genital herpes in pregnancy in Australia

Objective: To document clinical practice for the management of recurrent genital herpes in pregnant women in Australia. Design and participants: A questionnaire to all doctors associated with the Royal Australian College of Obstetricians and Gynaecologists. Main outcome measures: Policies for antenatal herpes screening, circumstances in which delivery by caesarean section was considered appropriate, and the use of aciclovir during pregnancy. The results were analysed by college status, sex, and whether the doctor worked in a public or private facility. Results: 2855 (67.3%) obstetricians returned questionnaires. 696 (34.3%) stated that their hospital had a policy for managing recurrent: genital herpes in pregnancy: 44.5% examined the genitalia and 33.8% took cultures during pregnancy. Fellows were more likely to examine the genitalia (87% v 37%, p<0.001), and more likely to perform antenatal viral cultures than members (75% v 30%, p<0.001). Doctors working at private hospitals were significantly more likely to take viral cultures than doctors in public hospitals (39% v 33% p<0.05). Doctors were asked to consider five scenarios and judge whether caesarean section would be appropriate. 96% considered that a caesarean section was appropriate in women with active herpes at the onset of labour. In the case of a recurrence of genital HSV at the time of presentation with ruptured membranes longer than 4 hours, diplomats (79%) were significantly more likely to recommend a caesarean section than fellows (64%), members (63%), or trainees (49%) (all p less than or equal to 0.001). Where there were positive viral cultures before the onset of labour fellows (45%) were more likely than members (29%) (p=0.005), males (62%) were more likely than females (55%) (p=0.03), and doctors working in private hospitals (69%) were more likely than those in the public sector (54%) (p<0.001) to recommend caesarean section. Conclusion: There is considerable divergence of opinion regarding the appropriate management of recurrent genital herpes in pregnancy. The implementation of management guidelines would provide consistency of care.