Congenital herpes simplex virus infection

Congenital herpes simplex virus (HSV) infection, also known as neonatal herpes simplex, is a serious infectious condition caused by transmission of herpes simplex virus (type 1 or type 2) from mother to infant, most commonly during passage through an infected birth canal, though in utero (transplacental) and postnatal transmission can also occur. The condition is classified under congenital viral infections and can present in three distinct clinical forms: disseminated disease affecting multiple organs including the liver, lungs, and brain; central nervous system (CNS) disease presenting as encephalitis; and disease localized to the skin, eyes, and mouth (SEM disease). Disseminated and CNS forms carry the highest morbidity and mortality. Key symptoms depend on the clinical form but may include vesicular skin lesions, seizures, lethargy, poor feeding, respiratory distress, hepatitis, disseminated intravascular coagulation, and encephalitis. Symptoms typically present within the first few weeks of life, often between days 1 and 21. Without treatment, disseminated disease has a mortality rate exceeding 80%. Ocular involvement can lead to chorioretinitis, cataracts, and microphthalmia, while CNS disease may result in long-term neurodevelopmental impairment including intellectual disability and cerebral palsy. The mainstay of treatment is high-dose intravenous acyclovir, which has significantly improved survival rates and outcomes, particularly when initiated early. Suppressive oral acyclovir therapy following acute treatment has been shown to improve neurodevelopmental outcomes in infants with CNS and SEM disease. Cesarean delivery is recommended for mothers with active genital herpes lesions at the time of delivery to reduce transmission risk. Despite advances in antiviral therapy, long-term neurological sequelae remain common, especially in infants with disseminated or CNS disease.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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