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Self-Assessment Questions

Obstetrics & Gynecology

Herpes Simplex Virus Infections in Pregnancy: Review Questions

Serdar H. Ural, MD, FACOG

Dr. Ural is an Assistant Professor of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA.

Choose the single best answer for each question.

Questions 1 through 5 refer to the following case study.

A 25-year-old single woman sees her gynecologist for a routine examination. She has no significant history of medical, surgical, gynecologic, or social issues. She takes no medications, has no known drug allergies, has never undergone surgery, and does not smoke, consume alcohol, or use illegal drugs. She reports that her relationship with her boyfriend is troubled, and she worries that he is cheating on her; on questioning, she states that she has intercourse 2 to 3 times a week. Physical examination shows all organ systems to be normal, except for the presence of 2 vesicles on the left labia majora. On further questioning, the patient admits that she has had atypical genital pain, sometimes with vesicles that disappear after a few days, approximately 5 times within the past year.

1. Which of the following infections does this patient most likely have?
  1. Candida albicans
  2. Chlamydia
  3. Gonorrhea
  4. Herpes simplex virus (HSV)
  5. HIV
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2. Which of the following is the best method of laboratory analysis for this patient’s infection?

  1. Bacterial cultures
  2. Complete blood count
  3. HSV type 2 antibody test
  4. Viral cultures
  5. Wet mount analysis
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3. The patient is also found to be pregnant at 28 weeks’ gestation at the time of her office visit. Which of the following would be the best treatment for her infection?

  1. Acyclovir 200 mg 5 times daily by mouth for 15 days
  2. Acyclovir 200 mg 5 times daily for 10 days, followed by valacyclovir 500 mg twice daily for another 10 days
  3. Valacyclovir 500 mg twice daily by mouth for 3 days
  4. Valacyclovir 500 mg twice daily for 3 days and valacyclovir suppression therapy 1000 mg once daily, beginning at 36 weeks’ gestation
  5. Valacyclovir 1000 mg once daily by mouth for 6 days
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4. When the patient is in labor at term, the obstetrician performs a pelvic examination and notices a herpetic outbreak on her labia minora. Which of the following is the recommended management at this time?
  1. Application of antibiotic ointment to the affected area
  2. Betadine douching of the affected area
  3. Cesarean delivery
  4. Expectant management
  5. Pelvic ultrasonography
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5. The patient becomes very upset after learning that she has HSV infection and inquires about future risks, especially transmission risks if she has other sexual partners without HSV. Which of the following is the most appropriate answer to her question?

  1. Daily vitamin supplementation decreases viral shedding
  2. HSV infection has been associated with uterine cancer
  3. Oral contraception has a protective effect on transmission of HSV
  4. She is always at risk for shedding the virus
  5. She is never at risk for future transmission of HSV
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