Am J Obstet Gynecol. 2003 Mar;188(3):836-43.
A double-blind, randomized, placebo-controlled trial of acyclovir in late
pregnancy for the reduction of herpes simplex virus shedding and cesarean
delivery.
Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL, Corey L.
Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.
Objectives:
The purpose of this study was to assess the efficacy of acyclovir in
the reduction of herpes simplex virus culture and polymerase chain reaction
positivity and cesarean delivery.
Study Design:
Women with recurrent genital
herpes simplex virus were randomized to acyclovir 400 mg three times daily or
placebo from 36 weeks of gestation until delivery. A subset of daily specimens
for herpes simplex virus culture and DNA polymerase chain reaction was
self-collected. Analyses used chi(2), Fisher exact, and Mann-Whitney U tests.
Results:
Lesions occurred at delivery among 11 of 78 women (14%) who received
placebo and 4 of 84 women (5%) who received acyclovir (P =.08). Herpes simplex
virus culture and polymerase chain reaction positivity near delivery occurred in
7% and 34% women in the placebo group and 0 and 2% in the acyclovir group (P
=.03 and <.01, respectively). Cesarean delivery for herpes simplex virus
occurred in 8 of the women (10%) in the placebo group and in 3 of the women (4%)
in the acyclovir group (P =.17). Despite reductions in herpes simplex virus
detection, 6% of the women who received acyclovir had herpes simplex virus
detected by polymerase chain reaction on >20% of days. Neonatal outcomes were
similar between groups.
Conclusion:
Acyclovir significantly reduced, but did not
eliminate, herpes simplex virus lesions and detection in late pregnancy.
