Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Brown and colleagues1 found that cesarean delivery offers protection
against perinatal transmission of herpes simplex virus (HSV). Their study
used the largest cohort to date to address the issue of mode of delivery and
risk of neonatal HSV. Although univariate analysis demonstrated a statistically
significant difference in risk of neonatal HSV by mode of delivery, it is
unclear whether these results are generalizable. First, the univariate results
may be misleading, as the bivariate results were not statistically significant
and the multivariate analysis did not show a benefit of cesarean delivery.
Second, the authors were not able to perform more complete multivariate adjustment
for all relevant variables because there were so few cases of neonatal HSV
among their cohort. Finally, the authors only analyzed the 202 women who had
positive viral culture results at the time of delivery. These women accounted
for only 56% (10/18) of the cases of neonatal HSV. Eight of the 18 cases of
neonatal HSV occurred in women with either no culture results available or
negative culture results. Cesarean delivery would likely have been even more
ineffective in preventing vertical transmission of HSV in these cases.
Cohan D. Cesarean Delivery and Risk of Herpes Simplex Virus InfectionCesarean Delivery and Risk of Herpes Simplex Virus Infection. JAMA. 2003;289(17):2208-2209. doi:10.1001/jama.289.17.2208-a