Preventing neonatal herpes. The value of weekly viral cultures in pregnant women with recurrent genital herpes
N. J. Binkin, J. P. Koplan and W. Cates Jr
To reduce the occurrence of neonatal herpes, laboratory screening with
viral cultures during the last four to eight weeks of pregnancy has been
recommended as a way to recognize women with subclinical herpes infection
at delivery. Screening efforts have focused on a group of high-risk women,
especially those with recurrent genital herpes infection. Using the
technique of decision analysis, we examined the benefits, risks, and costs
of viral culture screening for women with recurrent genital herpes. In a
cohort of 3.6 million women, we estimate that screening would avert 11.3
neonatal deaths and 3.7 cases of severe retardation, but 3.3 women would
die as a result of cesarean deliveries necessitated by culture results.
Weekly viral cultures would diagnose one fourth of women with subclinical
recurrent infection at delivery. The cost per case averted would be
approximately $1.8 million. Future screening recommendations should
consider not only the number of cases averted but also the effectiveness of
screening and the costs in both maternal lives and medical care dollars.
