What is the recommended management for a pregnant patient with a history of genital herpes?

In a pregnant patient with a history of genital herpes, the recommended management is to initiate suppression therapy starting at 36 weeks gestation. This approach is intended to minimize the risk of herpes simplex virus (HSV) transmission to the newborn during delivery. Suppressive antiviral therapy, typically with acyclovir or valacyclovir, can significantly reduce the frequency of outbreaks and the viral load, thus lowering the chances of an active lesion during labor that would increase the risk of vertical transmission to the infant.

By starting suppression therapy at this point in pregnancy, healthcare providers aim to prevent an outbreak close to the time of delivery, which is critical in making decisions about the mode of delivery. If there are no active lesions at the time of labor, a vaginal delivery may be safe. However, if active genital lesions or prodromal symptoms are present, a cesarean section may be warranted to avoid potential risks to the infant.

This management strategy balances the needs of both the mother and the fetus, ensuring careful monitoring and proactive treatment to promote a safe delivery.