Skip to main content

HSV Risk Assessment Checklist

HSV risk factors, diagnostic workup, and medical decision making


  • Infants less than 29 days of life are recommended for HSV testing when they present with any of the following:

    • An ill or septic appearance including hypothermia (rectal temperature less than 36 degrees Celsius) and severe respiratory distress

    • Seizures (or the history of seizure)

    • Obvious herpetic lesions/vesicles on physical exam

    • CSF pleocytosis for age (white blood cell count greater than 20 per microliter)

    • Elevated AST and/or ALT of previous labs obtained

  • Additional risk factors as identified by Kropp et al in a prevalance study and Caviness et al in a case control study include the following. Each may increase the risk of HSV over the general population, but should be taken in the context of the entire clinical scenario. We recommend that clinicians speak with families about this risk and determine, along with the input from the family, whether or not to pursue further testing and empiric treatment with acyclovir.

    • Known maternal HSV (we recognize that primary infection places the infant at much higher risk than recurrent infection, however there appears to be a 1-2% risk of transmission with recurrent infection and this places the infant at a higher risk than the general population) (Kropp, Wong et al. 2006; Mahnert, Roberts et al. 2007; Caviness, Demmler et al. 2008)

    • Thrombocytopenia (exclusively associated with disseminated HSV)

    • Maternal fever at labor and delivery (OR: 5.8, 95% CI: 2.3–14.5) (Caviness, Demmler et al. 2008)

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.