Prevention of neonatal HSV exposure includes which measure?

• A. Antiviral medications given to the mother during pregnancy
• B. Routine vaccination during pregnancy
• C. Breastfeeding avoidance
• D. Delivery by cesarean only if lesions present

Answer: (A)

Suppressive antiviral therapy during late pregnancy is the most effective way to prevent neonatal herpes exposure. Giving antiviral medication to the mother, such as acyclovir or valacyclovir starting around 36 weeks, reduces genital viral shedding at delivery. Since newborn infection typically occurs intrapartum through contact with maternal genital lesions or shedding, lowering the amount of virus present at the time of birth significantly lowers the risk of transmitting herpes to the infant.

There isn’t a routine vaccine for HSV given during pregnancy, so vaccination isn’t a preventive strategy. Breastfeeding is not routinely avoided; it is generally allowed unless there are active breast lesions. Delivery by cesarean is used specifically when active genital lesions or prodromal symptoms are present at labor to minimize exposure during birth, but antiviral suppression addresses shedding overall and is effective even if vaginal delivery occurs.