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Re: acyclovirFrom: Thomas (anonymous@obgyn.net)Wed, 18 Nov 1998 01:56:42 -0600 (CST)
This is a contraversial one. It is true that a recent randomised controlled study has shown that women who have genital herpes are less likely to have a C/S if given prophylactic acyclovir. The main criticisms with the study revolve around whether a woman should have a C/S for a recurrent herpes attack. This is now beginning to be questioned (although there is no doubt that it is necessary after a primary attack). The arguments are complicated with the extreme of one side saying that Herpes transmission occurs during delivery and that prophlactic C/S prevents this and reduces the chance of hepres encephalopathy (brain damage). The extreme of other side argue that 70% of all cases occur in women with no known lesions or predisposition; that in most cases it is possible to prevent contact with vescicles by covering them up; that 90% of all sexually active women have the virus even if they don't have attacks; that the route of transmission isn't clear and may be just as likely through the placenta (C/S offering no advantage); that the risks of C/S are greater as the risks of neonatal encephalopathy are low for recurrent herpes (one author estimated that you would kill 2 mothers from the complications of C/S for every one baby saved). The simple answer is that we just don't know. If you would want a C/S if you had a recurrent attack, then prophylactic acyclovir will help reduce your risk.
-- Thomas Ind MB BS MD MRCOG St George Hospital Kogarah Sydney Australia
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