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Submitted: 16 August 2011 Modified: 06 April 2018
HERDIN Record #: PCHRD08161110081848

The management of pregnant patients with Herpes simplex virus II or papillomavirus infections: Probable outcomes and costs.

Tessa T. Torres

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The study reviewed the issues in the management of pregnant patients with either human papilloma virus (HPV) or herpes simplex virus (HSV-2) infections. Foreign literature were critically appraised and local data for the HSV study were generated through patient interviews, serology and culture in 27 parturients, analysis of accounting records in the hospital and review of annual reports of pertinent professional organizations. For human papilloma a prevalence rate of 3.5% among pregnant women with prenatal care has been reported. Only 10 percent will present with condylomata. If the infected woman is seen with bulky lesions prior to the onset of labor, debulking or oblation may be attempted with the use electrocautery. Possible adverse effects include vulvar scarring. Recurrence rate is also high at 35%. Other modalities such as cryotherapy and CO2 laser are safer and have lower recurrence rates but they may not be as readily available. If the HPV infected woman presents only when labor has commenced, vaginal delivery is still the preferred mode of delivery. The indications for caesarian section remains the same as in the non-HPV infected parturient. Thus, in the few were bulky lesions may present a significant risk of obstruction or hemorrhage, caesarian section may be considered. The risk of the vaginally delivered newborn of aspirating HPV and developing juvenile laryngeal papillomatosis later in life is less than 1:1500.In all instances where HPV genital infection is suspected, biopsy of colposcopic or gross lesions is recommended to rule out dysplasia and cancer. Twenty-five percent may have co-existing neoplasia. An infected pregnant woman with genital herpes simplex virus 2 sheds intermittently the virus even in the absence of lesions. If pregnant and about to deliver, she might be shedding the virus and may possibly transmit the virus and cause neonatal infection if a vaginal delivery is attempted. This study quantified the maximum risk of viral shedding in these women as not exceeding 12%. No HSV-2 was isolated from vaginal specimens obtained within hours of delivery of 27 HSV IgC positive women who did not exhibit lesions at that point in time. The result of economic analysis using a decision tree to compare the strategy of weekly viral cultures versus physical examination alone showed that doing cultures will entail an additional cost of P8,337,500 without detecting and averting additional cases of neonatal herpes. Based on this, the adoption of the recommendations of the Infectious Disease Society of Obstetrics and Gynecology on the management of HSV-2 infections during pregnancy is suggested.

Publication Type
Research Project
Date
November 30, 1988-November 30, 1990
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)