Prevention of and screening for herpes simplex infection: a survey of Quebec physicians

OBJECTIVE: To determine which methods are most used by Quebec physicians performing deliveries with regard to the prevention of and screening for infections caused by the herpes simplex virus. METHODS: A pretested bilingual questionnaire was mailed to all the general practitioners performing deliveries who belong to the Association des omnipraticiens en périnatalité du Québec, as well as to all obstetrician-gynaecologists belonging to the Association of Obstetricians and Gynecologists of Quebec, with two follow-up reminder communications. The participants' anonymity was maintained. RESULTS: Of the 877 questionnaires sent, 539 (62%) were completed and returned; 451 participants (84% of the total) met the selection criteria. The majority (92%) of physicians performing deliveries asked pregnant women if they had a history of genital herpes. To prevent primary genital herpes, 73% of physicians recommended using condoms, 42.5% recommended abstinence when lesions are present, 33% recommended that the partner be given an antiviral treatment, and 3.3 % did not provide any specific advice. For a woman who presents with a confirmed history of genital herpes, vaginal delivery was preferred in (1) 87.5% of cases when the infection did not recur during pregnancy, (2) 94% of cases when the infection recurred before the third trimester, (3) 98% of cases when the infection recurred during the third trimester and an antiviral treatment was provided. In the case of a pregnant woman at term with herpetic lesions and with ruptured membranes, Caesarean section was preferred by 79% of obstetricians and 95% of general practitioners (P