Explaining neonatal HSV and the exposed-neonate pathway — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the postnatal ward. A mother developed a first episode of genital herpes at 38 weeks gestation and delivered vaginally 18 hours ago. Her baby boy is currently well — feeding, afebrile, no rash — but is recognised as a high-risk HSV exposure because this was a primary maternal infection near delivery. The parents are anxious and confused: the mother had never had genital herpes before, the baby looks perfectly well, and they cannot understand why the team is talking about tests, isolation and possibly an antiviral drip. ^[7]

Your tasks are: ^[2]

1. Explain in plain language why a primary maternal genital HSV near delivery is a high-risk exposure for the baby, and why the baby needs close observation, surface swabs and a low threshold for treatment. ^{[1] [7]}
2. Explain what neonatal HSV is, its three disease classes, and why the team would start an antiviral (aciclovir) promptly if the baby became unwell — including that early treatment changes the outcome. ^[2]
3. Address the parents' worry that the team is "over-treating" a well baby, and set out what the parents should watch for at home after discharge. ^[7]
4. Explain how a future pregnancy would be protected — suppressive aciclovir and caesarean delivery. ^{[1] [5]}

You are not expected to give exact aciclovir doses to the parents; explain the plan in plain language and flag that any decision to start treatment is made by the neonatal team with the parents' consent. ^[2]