Title: HSV management in pregnancy at a joint antenatal-genitourinary clinic in a large maternity hospital in Dublin, Ireland -  a model of care. 
Introduction: The ultimate goal of HSV management in pregnancy is to prevent perinatal transmission and, where possible, to facilitate a vaginal delivery. The GUIDE clinic in St. James’s Hospital provides a satellite genito-urinary medicine service to The Coombe Women and Infants University Hospital, Dublin. 
Methods:  Data was collected from antenatal charts of 107 women who had a prior history of HSV or a reported outbreak during that pregnancy. Descriptive column statistics were used in excel for data analysis.
Results: Between May 2013 and Feb 2017, 107 Women were referred to this service for management of HSV. The average age was 33 (range 18-45). Data on country of origin available on 100%. 9 (8%) women were HIV+.  Median gestation at referral (82/108) was 23/40 (range 2-39/40). 100% (107 women) were asked about a history of HSV at booking; 76% (82) reported a history, 23%(25) had no history of HSV.  89% (96) had HSV type-specific serology sent. Of those who were type 1 + in serum (75), 25% (19) had genital swabs for HSV PCR sent and 11 were positive. NAATs testing was done in 63% (69) pregnancies, 100% negative. 90% (96) women reported genital lesions with 5% (6) reporting lesions in extragenital sites. Last outbreak recorded in 86% (93) pregnancies and outbreak frequency recorded in (88%) 63 pregnancies – 30% (32) pregnancies had outbreak in that pregnancy. 6% (6)had primary infection during that pregnancy. 67 women were treated with Valtrex in 66 pregnancies and one woman received acyclovir. 24% (26) patients were not started on prophylaxis. Mean gestation starting prophylaxis was 36/40 (range20-39) Data on mode of delivery available for 76% (82) pregnancies: 71% (59) had vaginal deliveries, 29% (24) had lower segment caesarean sections, none for HSV.  Median gestation at delivery of 84 pregnancies 39/40 (range 29-41). To date no cases of perinatal HSV transmission have been reported.
Conclusion: There is good compliance with guidelines on HSV management in pregnancy for women who are referred to the joint clinic. HSV 2 remains an issue. This model of care should be available across all antenatal settings in Ireland.

HSV management in pregnancy at a joint antenatal-genitourinary clinic in a large maternity hospital in Dublin, Ireland – a model of care.

The Joint Annual Conference of the British Association for Sexual Health and HIV & the Society for the Study of Sexually Transmitted Diseases in Ireland