Treatment of primary herpes simplex outbreak in pregnancy! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 12-02-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Virus Treatment of primary herpes simplex outbreak in pregnancy!

A 29-year-old woman, gravida 2, para 1, at 33 weeks’ gestation is referred to your office because of a possible herpes outbreak. She developed a painful vesicular rash a few days ago in her genital area. She has never before had any similar symptoms. She has no other medical problems, takes no medications, and has no known drug allergies. Examination reveals numerous erythematous vesicles and ulcerations. Testing of the lesion demonstrates herpes simplex virus infection and serologic testing reveals that it is a primary outbreak for the patient. Which of the following is the most appropriate management of this patient?

A. Expectant management
B. Immediate cesarean delivery
C. Immediate induction of labor
D. Intravenous acyclovir
E. Oral acyclovir
Reply With Quote Quick reply to this message
The above post was thanked by:
bebix (12-04-2011), MANIAKOS (12-03-2011)



  #2  
Old 12-02-2011
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

E. Oral acyclovir
Reply With Quote Quick reply to this message
  #3  
Old 12-02-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 141 Times in 109 Posts
Reputation: 151
Default

E. Oral acyclovir
Reply With Quote Quick reply to this message
 
  #4  
Old 12-02-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

B. Immediate cesarean delivery
Reply With Quote Quick reply to this message
  #5  
Old 12-03-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 345 Times in 138 Posts
Reputation: 377
Default

oral acyclovir and later caesarean
Reply With Quote Quick reply to this message
  #6  
Old 12-03-2011
Adamentium's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS+3
Posts: 64
Threads: 12
Thanked 95 Times in 20 Posts
Reputation: 105
Cool

Oral Acyclovir
Reply With Quote Quick reply to this message
  #7  
Old 12-03-2011
qurat21's Avatar
USMLE Forums Master
 
Steps History: 1 + CK
Posts: 623
Threads: 62
Thanked 289 Times in 186 Posts
Reputation: 299
Default

oral acyclovir...
Reply With Quote Quick reply to this message
  #8  
Old 12-04-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default

The correct answer is E. Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases (STDs) in the United States. Although only approximately 5% of reproductive-aged women report a history of genital herpes, greater than 30% have antibodies to HSV-2, representing prior exposure to the virus. Every year in the United States more than 1000 newborns contract neonatal herpes. Although most neonatal herpes infections are mild with localized lesions, the disease also can have severe and devastating effects with central nervous system disease of the neonate or death. This patient has an HSV outbreak during pregnancy. In a patient such as this, antiviral therapy should be given to reduce viral shedding and enhance lesion healing. Acyclovir, famciclovir, and valacyclovir all can be used during pregnancy. These drugs may be given orally and the recommended treatment duration is 7 to 14 days. Together with treatment of this acute episode, consideration should be given to treating this patient, starting at 36 weeks’ gestation, with daily suppressive therapy with acyclovir, famciclovir, or valacyclovir. The daily suppressive therapy is meant to prevent an outbreak at the time of labor that would then mandate cesarean delivery.
Expectant management (choice A) would not be the correct management for this patient. Primary herpes outbreak during pregnancy should be treated to reduce viral shedding and enhance lesion healing.
Immediate cesarean delivery (choice B) is not indicated for this patient. This patient is preterm at 33 weeks’ gestation. A cesarean delivery at this point in the pregnancy would result in the delivery of a neonate who could have serious morbidity or mortality from prematurity. A patient with a primary outbreak of herpes who presents in labor at term should be delivered by cesarean.
Immediate induction of labor (choice C) would be absolutely incorrect. First, induction of labor at 33 weeks’ gestation would result in a premature neonate. Second, a woman should not be allowed to deliver vaginally (and certainly should not be induced) in the presence of an active herpes lesion or prodrome.
Intravenous acyclovir (choice D) is not necessary to treat a standard primary outbreak of herpes during pregnancy in a patient who is able to tolerate a course of oral therapy for 7 to 14 days.
Reply With Quote Quick reply to this message
The above post was thanked by:
Al-Saoudi (12-04-2011), step1an (12-04-2011)
  #9  
Old 12-04-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

Quote:
Originally Posted by drnrpatel View Post
The correct answer is E. Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases (STDs) in the United States. Although only approximately 5% of reproductive-aged women report a history of genital herpes, greater than 30% have antibodies to HSV-2, representing prior exposure to the virus. Every year in the United States more than 1000 newborns contract neonatal herpes. Although most neonatal herpes infections are mild with localized lesions, the disease also can have severe and devastating effects with central nervous system disease of the neonate or death. This patient has an HSV outbreak during pregnancy. In a patient such as this, antiviral therapy should be given to reduce viral shedding and enhance lesion healing. Acyclovir, famciclovir, and valacyclovir all can be used during pregnancy. These drugs may be given orally and the recommended treatment duration is 7 to 14 days. Together with treatment of this acute episode, consideration should be given to treating this patient, starting at 36 weeks’ gestation, with daily suppressive therapy with acyclovir, famciclovir, or valacyclovir. The daily suppressive therapy is meant to prevent an outbreak at the time of labor that would then mandate cesarean delivery.
.

There is higher transplancental infection rate (30- 50 %) for primary infection and according to your explanation treatment should be started at 36 weeks . and the patient presented at 33 weeks .so 3 weeks without treatment! should not we start at the time of diagnosis?
Reply With Quote Quick reply to this message
  #10  
Old 12-04-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,268 Times in 881 Posts
Reputation: 3278
Default

Quote:
Originally Posted by jaimin View Post
There is higher transplancental infection rate (30- 50 %) for primary infection and according to your explanation treatment should be started at 36 weeks . and the patient presented at 33 weeks .so 3 weeks without treatment! should not we start at the time of diagnosis?
UpToDate 19.3
updated: January 7, 2011

Modes of transmission:
1-The most common mode of transmission is via direct contact of the fetus with infected vaginal secretions during delivery.

2-Intrauterine transmission from transplacental or ascending infection also occurs rarely as evidenced by the presence of early neonatal infection despite delivery by cesarean delivery before both labor and rupture of fetal membranes

-----------

- In women with first episode genital HSV, recommend acyclovir (400 mg PO three times daily) for 7 to 14 days, regardless of the timing of infection during pregnancy (Grade 1A). Antiviral therapy can lessen the duration of lesions and viral shedding and decrease the risk of complicated disease in the woman.

- In women with a history of recurrent genital HSV, or primary infection during pregnancy, suggest suppressive acyclovir (400 mg three times daily) be given at 36 weeks of gestation through delivery (Grade 2A). Suppressive therapy reduces the risk of HSV viral shedding or clinical recurrence at delivery and subsequently the need for cesarean delivery. However, the clinical impact on neonatal HSV is unknown.
Reply With Quote Quick reply to this message
The above post was thanked by:
Al-Saoudi (12-04-2011), bassatom (12-05-2011), drnrpatel (12-04-2011), jaimin (12-04-2011), Mondoshawan (02-15-2012), pass7 (12-04-2011), step1an (12-04-2011)
  #11  
Old 12-04-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default

http://emedicine.medscape.com/articl...4-overview#a30

ACOG recommends it at or after 36 weeks. But elsewhere it's written that Primary infection can be treated during pregnancy.
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (12-04-2011)
  #12  
Old 12-04-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,268 Times in 881 Posts
Reputation: 3278
Default

Quote:
Originally Posted by drnrpatel View Post
http://emedicine.medscape.com/articl...4-overview#a30

ACOG recommends it at or after 36 weeks. But elsewhere it's written that Primary infection can be treated during pregnancy.
ACOG recommendations for active recurrent genital herpes
- suppressive viral therapy at or beyond 36 weeks of gestation

active recurrent genital herpes is not the same as primary infection
For Primary infection = best evidence = aciclovir for 7 - 14 days



For the guidelines
http://guideline.gov/content.aspx?id=11430#Section420
Reply With Quote Quick reply to this message
The above post was thanked by:
drnrpatel (12-04-2011), step1an (12-04-2011)
  #13  
Old 12-04-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Thumbs Up

Quote:
Originally Posted by bebix View Post
ACOG recommendations for active recurrent genital herpes
- suppressive viral therapy at or beyond 36 weeks of gestation

active recurrent genital herpes is not the same as primary infection
For Primary infection = best evidence = aciclovir for 7 - 14 days



For the guidelines
http://guideline.gov/content.aspx?id=11430#Section420
Sounds perfect
Reply With Quote Quick reply to this message



Reply

Tags
ObGyn-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Treatment of hyperthyroidism during pregnancy drnrpatel USMLE Step 2 CK Forum 4 10-18-2011 08:23 AM
Daycare Center Outbreak! ricko335 USMLE Step 1 Forum 3 07-18-2011 01:18 PM
Biostatistics #15 - Outbreak of gastritis bebix USMLE Step 1 Forum 8 06-08-2011 07:55 PM
Primary Headache Treatment Mnemonics FSUSTC USMLE Step 2 CK Mnemonics 0 03-23-2010 11:10 AM
Herpes Simplex Type 1 and Type 2 lee-usmle USMLE Step 1 Mnemonics 1 12-16-2009 10:17 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)