Genital zoster in near term pregnancy: Case report and need of management guidelines

Abstract Genital herpes simplex infection close to delivery may be transmitted to the newborn. Guidelines for genital herpes during pregnancy have been elaborated to reduce the risks of neonatal herpes. Genital herpes zoster due to reactivation of varicella zoster virus (VZV) from sacral ganglia is an under recognized cause of genital lesions. The risks of genital zoster near delivery for the newborn have not been evaluated. No guidelines have taken into account this rare viral infection during pregnancy. A pregnant woman at 38 weeks gestation presented herpes-like genital vesicular lesions in absence of herpes simplex virus (HSV) past history. Rapid HSV molecular testing was negative despite clinically suggestive lesions. A control multiplex PCR was performed, which evidenced VZV. The woman was treated with acyclovir until delivery. The newborn was healthy. VZV should be investigated in HSV- negative herpes-like genital lesions during pregnancy. Diagnosis of genital lesions requires virological confirmation to adapt obstetrical and neonatal management.