The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of "Major Recommendations" field.
The following recommendations and conclusions are based on limited or inconsistent scientific evidence (Level B):
- Women with active recurrent genital herpes should be offered suppressive viral therapy at or beyond 36 weeks of gestation.
- Cesarean delivery is indicated in women with active genital lesions or prodromal symptoms, such as vulvar pain or burning at delivery, because these symptoms may indicate an impending outbreak.
The following recommendations and conclusions are based primarily on consensus and expert opinion (Level C):
- In women with premature rupture of membranes, there is no consensus on the gestational age at which the risks of prematurity outweigh the risks of herpes simplex virus (HSV).
- Cesarean delivery is not recommended for women with a history of HSV infection but no active genital disease during labor.
- Routine antepartum genital HSV cultures in asymptomatic patients with recurrent disease are not recommended.
- Routine HSV screening of pregnant women is not recommended.
Definitions:
Grades of Evidence
I Evidence obtained from at least one properly designed randomized controlled trial.
II-1 Evidence obtained from well-designed controlled trials without randomization.
II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments could also be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A - Recommendations are based on good and consistent scientific evidence.
Level B - Recommendations are based on limited or inconsistent scientific evidence.
Level C - Recommendations are based primarily on consensus and expert opinion.
