CHICAGO -- Genital herpes transmitted to infants during childbirth kills one-third of them and causes retardation in another third, but the cost of preventing such transmission is high in risk to mother and child and in dollars, medical researchers say.
A report in Thursday's Journal of the American Medical Association explained the physical risks to women and infants.
It estimated widespread viral culture testing and Caesarean deliveries in all cases where a pregnant woman was suspected of having an active case of genital herpes would cost $1.8 million for every case of newborn herpes avoided.
Dr. Nancy Binkin, who reported the study findings in the Journal, said the screenings would prevent more than 11 deaths and nearly 4 cases of severe retardation in babies per year.
Doctors at the Centers for Disease Control in Atlanta noted the disease is not life-threatening to adults, but can be lethal to a baby who contracts it at birth.
The genital herpes virus can strike the child's central nervous system or damage internal organs. One of every three newborns with herpes will die, and 27 percent will survive but suffer severe retardation. Another 6 percent will be mildly retarded, Ms. Binkin said.
Genital herpes is not always contagious. The virus can remain dormant in the body, occasionally becoming active and causing sores.
Because doctors are aware of the risks involved, many perform Caesarean operations routinely on mothers with herpes to avoid exposing the child to the genital infection. An editorial in the Journal said up to 54 percent of all pregnant women with herpes undergo Caesareans.
The study said the risks of a Caesarean to both mother and child are relatively high. It said Caesareans would cause 3.3 maternal deaths each year, and premature Caesareans would put the infants at risk of suffering breathing problems and other complications.
When pregnant woman tell their doctors they have herpes, doctors can rely on examinations or can also order a series of herpes virus cultures, at a cost of about $30 each.
If the mothers show symptoms the disease is active at the time of delivery, Dr. Binkin said, the doctor probably should perform a Caesarean.
The cost-benefit problem arises when no symptoms are visible. Most newborns with herpes are born to women who are unaware that they have the disease.
If doctors perform weekly cultures on women with a history of herpes, the study suggests about 30 cases of herpes in newborns could be averted each year.
But the test for herpes is slow, taking two to six days. In that time, the woman may no longer be contagious, but the positive test results could cause doctors to perform 5,700 unnecessary Caesareans each year.
