(History of genital herpes before third trimester)

• No swabs or treatment
• Educate parents on good hand hygiene to prevent transmission
• Observe on postnatal ward, discharge after neonatal examination at 24 hr
• Advise to seek medical help if skin, eye or mucous membrane lesions, lethargy/irritability, poor feeding
• If clinical evidence of sepsis:
  • surface swabs and blood for HSV PCR
  • aciclovir 20 mg/kg 8-hrly IVI over 1 hr

(First episode of genital herpes ≤6 weeks before vaginal delivery)

• Strict infection control
• Swab baby’s nasopharynx, conjunctiva, mouth and rectum in viral transport medium for HSV PCR
• Check baby’s ALT and send blood for HSV PCR
• Start aciclovir 20 mg/kg IVI (over 1 hr) 8-hrly
• If ALT abnormal or other signs of infection (including skin lesions) send CSF for HSV PCR 
• Recommend breastfeeding unless herpetic lesions around nipple

Duration of aciclovir IV 

• If neonatal HSV PCR negative: stop aciclovir
• If active infection ruled out: stop aciclovir
• If skin, eye or mouth lesions: lumbar puncture 
  • if CSF HSV negative and ALT normal: aciclovir IV for 10 days
  • if ALT raised and CSF negative: aciclovir IV for 14 days
  • if CSF HSV positive: repeat LP at 14 days and if negative stop at 21 days
• If any confirmed HSV disease: then give suppressive therapy with aciclovir 300 mg/m² oral 8-hrly for 6 months