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She reported that she had had chickenpox as a child. Virologists believe that respiratory droplets are a major source of infectivity. Spangler and associates, who allude to the consideration of acyclovir during late primary genital herpes infections, fail to discuss the potential negative effect of treatment during this period. Therefore, a desired benefit of antiviral therapy of varicella in the adult would be a decrease in the complications of varicella, but published studies have not shown this benefit. A major factor protecting infants from developing disseminated herpes is the presence of maternal antibody,[15] but acyclovir may diminish antibody response to HSV. [16] As previously suggested by Brown and Baker,[17] it is theoretically possible that acyclovir could blunt the humoral immune response during pregnancy after an acyclovir during pregnancy episode of primary genital herpes and thereby increase the risk of the neonate developing HSV infection. Anecdotal reports acyclovir during pregnancy suggest that adenine arabinoside can also be used, but comparisons of efficacy and side effects with acyclovir have not been made. Information is obtained from mailed questionnaires (primarily to obstetricians) regarding pregnancy dates; maternal risk factors; dose, length, and indication of acyclovir therapy; and pregnancy outcome.
Although the findings to date are reassuring, the number of cases is still too small to make reliable and definitive conclusions about the use of acyclovir in pregnancy. Of the 601 (74%) women for whom pregnancy outcome data were obtained (Table 1), 456 (76%) were being treated for herpes simplex virus; 120 (20%), for varicella-zoster virus; and 25 (4%), acyclovir during pregnancy for other or unspecified conditions. Sheffield and colleagues reviewed the evidence for effective prophylaxis therapy with acyclovir during the last month of pregnancy.
If the patient reported any prodromal symptoms or had any findings suggestive of active viral shedding, delivery was by cesarean section. Both groups were similar in age, ethnicity, parity, gestational age at first diagnosis of genital herpes, and number of outbreaks during pregnancy. The proven benefits of treating chickenpox with acyclovir in adolescents and young adults include a reduction in the number of lesions and in the duration acyclovir during pregnancy of time of new lesion formation as well as the defervescence of fever. [10] During pregnancy, an increased risk of complication beyond that seen in the acyclovir during pregnancy nonpregnant state occurs at two different times.The authors searched electronic databases, conference proceedings, bibliographies, and registries of trials for prospective, randomized controlled trials of acyclovir in pregnant women with HSV infection. Among the 239 prospectively reported cases of exposure acyclovir during pregnancy during the first trimester, there were nine congenital abnormalities, 24 spontaneous abortions and 47 induced abortions. Birth defects identified up to the first year of life are included in the registry, but for most reports, defects are generally identified during the neonatal period.