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Infektionen mit Herpes-simplex- und Varicella-zoster-Viren in der Schwangerschaft

Infections with herpes simplex and varicella-zoster viruses during pregnancy

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Zusammenfassung

Primärinfektionen mit Herpes-simplex- (HSV) und Varicella-zoster-Virus (VZV) nehmen in der Schwangerschaft oft einen bedrohlichen Verlauf. Beide Erkrankungen können über transplazentare Virustransmission zur Infektion des Föten führen. Erkrankungen des Ungeborenen können mit Fruchttod, Missbildungen und Frühgeburten verbunden sein, das fötale/kongenitale Varizellensyndrom ist gut definiert. Herpes genitalis oder Varizellen zum Zeitpunkt der Geburt können zum gefürchteten Herpes neonatorum oder zu postpartalen Varizellen des Neugeborenen führen. Für HSV-Infektionen gibt es weder eine aktive noch passive Immunisierung. Dagegen können seronegative Frauen in gebärfähigem Alter aktiv geimpft und schwangere Frauen nach VZV-Exposition mit spezifischem Immunglobulin behandelt werden. Eine Erkrankung wird zwar selten verhindert, allerdings eine mildere Symptomatik erreicht. Schwere Erkrankungen müssen mit (Val-)Acyclovir behandelt werden. Genitale Läsionen bei Primärerkrankung und Rezidiven einer HSV-Infektion sind eine Indikation zur Sectio, allerdings könnte eine Suppressionstherapie mit (Val-)Acyclovir in den letzten Wochen vor der Geburt diese Eingriffe reduzieren. VZV-exponierte Neugeborene erhalten spezifisches Immunglobulin. Beim geringsten Hinweis auf eine neonatale Erkrankung muss Acyclovir eingesetzt werden.

Abstract

Primary infections with herpes simplex virus (HSV) and varicella-zoster virus (VZV) may lead to severe illness in pregnancy. Both diseases may be associated with transplacental virus transmission and fetal infection. Such infections can lead to intrauterine death, severe malformations and premature birth; the fetal/congenital varicella syndrome is well-defined. Herpes genitalis and varicella at the time of labor may lead to life threatening neonatal-herpes or varicella of the newborn. Currently neither active immunization nor neutralizing immunoglobulin is available for HSV infections. VZV-seronegative women in child-bearing age can be vaccinated and pregnant women exposed to VZV can be given specific immunoglobulins. While an infection is rarely blocked, the severity is generally reduced. For severe disease antiviral treatment is necessary, with valacyclovir and acyclovir represents the drugs of choice. Primary or recurrent overt disease of the genital tract at the time of delivery an indication for caesarean section. Suppression of recurrent genital herpes during the last weeks of pregnancy with valacyclovir and acyclovir reduces the need for surgical intervention. Neonates exposed to VZV should receive specific immunoglobulin. If neonates show signs of either infection, immediate treatment with acyclovir must be initiated.

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Authors and Affiliations

  1. Abteilung für Dermatologie, Krankenanstalt Rudolfstiftung, Wien

    R. Marculescu & L. Richter

  2. Abteilung für Dermatologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030 , Wien, Österreich

    K. Rappersberger

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  1. R. Marculescu
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  2. L. Richter
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  3. K. Rappersberger
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Correspondence to K. Rappersberger.

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Marculescu, R., Richter, L. & Rappersberger, K. Infektionen mit Herpes-simplex- und Varicella-zoster-Viren in der Schwangerschaft. Hautarzt 57, 207–216 (2006). https://doi.org/10.1007/s00105-006-1105-z

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