Preventing neonatal herpes. The value of weekly viral cultures in pregnant women with recurrent genital herpes.

To reduce the occurrence of neonatal herpes, laboratory screening with viral cultures during the last four to eight weeks of pregnancy has been recommended as a way to recognize women with subclinical herpes infection at delivery. Screening efforts have focused on a group of high-risk women, especially those with recurrent genital herpes infection. Using the technique of decision analysis, we examined the benefits, risks, and costs of viral culture screening for women with recurrent genital herpes. In a cohort of 3.6 million women, we estimate that screening would avert 11.3 neonatal deaths and 3.7 cases of severe retardation, but 3.3 women would die as a result of cesarean deliveries necessitated by culture results. Weekly viral cultures would diagnose one fourth of women with subclinical recurrent infection at delivery. The cost per case averted would be approximately $1.8 million. Future screening recommendations should consider not only the number of cases averted but also the effectiveness of screening and the costs in both maternal lives and medical care dollars.