Genital herpes infection remains a difficult problem to manage during pregnancy. The natural history of the infection during pregnancy is not well understood and potential management strategies remain unevaluated. For example the risk of mother-to-child transmission in women with recurrent genital herpes lesions at the time of vaginal delivery is still unknown. We do not know whether delivery by caesarean section decreases this risk and yet it is the most widely used intervention in this situation. We are only just beginning to understand the epidemiology of asymptomatic infection and the risk that asymptomatic viral shedding may pose to the newborn. In addition, new methods of diagnosis and new strategies for management are regularly being proposed with little formal evaluation of their effectiveness in the clinical setting.

This article aims to review current knowledge applicable to the clinical situation and suggest how our knowledge and management of this problem may be improved in the future.