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Roberta Patterson: History Roberta Patterson is a 26-year-old woman who presents for her first prenatal visit. She is concerned for her baby because of her husband Franklin’s history of genital herpes. She states that she is six weeks pregnant. Roberta has never had symptoms of vaginal or oral herpes. She was diagnosed and treated for chlamydia seven years ago (age 19); no other STD diagnoses were reported. Her 26-year-old husband had his first episode of genital herpes during his last year of high school; no other STD diagnoses were reported. Her husband (and sex partner for the last 16 months) has not had visible HSV lesions since she’s been sexually active with him, and reports having had no prodromal symptoms or symptoms of active disease. She has had no sex partners other than her husband for the last 16 months. Physical Exam Vital signs: blood pressure 112/68, pulse 58, respiration 13, temperature 38.5° C Cooperative, a good historian Chest, heart, musculoskeletal, and abdominal exams within normal limits Uterus consistent with a six-week pregnancy Normal vaginal exam without signs of lesions or discharge No lymphadenopathy Questions Which type of herpes simplex virus (HSV) is of concern to Roberta? What general information should Roberta’s doctor discuss with her? Considering her husband’s history of genital herpes, which diagnostic test should be performed to determine whether Roberta is infected with HSV? What is the appropriate drug treatment for Franklin to prevent, or shorten future herpes outbreaks? Explain the mechanism of action for the anti-viral drug you identify. If Roberta had genital herpetic lesions at the onset of labor, should she deliver vaginally or abdominally? What, if any, are the risks to the infant? If Roberta had acquired genital herpes around the time of delivery, would she be more or less likely to transmit genital herpes to her baby during a vaginal delivery than if she had a history of recurrent genital herpes? Explain your answer.

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