1. HSV – Virology & Microbiology (What is this virus?)

1.1 Basic classification

• Family: Herpesviridae
• Type: Enveloped, double-stranded DNA virus
• Subfamily: Alphaherpesviridae (rapid replication, latency in sensory ganglia)
• Serotypes:
• HSV-1 – classically orolabial, but increasingly genital
• HSV-2 – classically genital (most recurrent genital herpes in adults)

Key memory:

Herpes = enveloped dsDNA + lifelong latent in sensory ganglia

1.1 Basic classification — Active Recall (Fill in the Blanks)

1. Family: _____________
2. Type: _____________, _____________-stranded _____________ virus
3. Subfamily: _____________ (rapid replication, latency in _____________ _____________)

Serotypes

1. HSV-1 – classically _____________, but increasingly _____________
2. HSV-2 – classically _____________ (most _____________ genital herpes in _____________)

Key Memory Line

1. Herpes = _____________ _____________ + lifelong _____________ in _____________ _____________

1.2 Structure

• Core: linear dsDNA genome
• Capsid: icosahedral
• Tegument: protein layer around capsid (contains viral proteins that help early replication)
• Envelope: lipid bilayer derived from host, with multiple glycoproteins (gB, gC, gD, gH, etc.) → needed for binding & entry.

Clinical relevance:

• Envelope → sensitive to drying, detergents, disinfectants
• Close contact required (sexual, perinatal, mucosal).

1.2 Structure — Active Recall (Fill in the Blanks)

• Core: linear __________ genome
• Capsid: __________ symmetry
• Tegument: __________ layer around capsid containing viral __________ that help __________ replication
• Envelope: __________ bilayer derived from __________, with multiple __________ (gB, gC, gD, gH, etc.) required for __________ and __________

Clinical Relevance — Active Recall

• Presence of envelope → virus is __________ to __________, __________, and __________
• Therefore, transmission requires __________ __________
• Common modes: __________, __________, and __________ contact

1.3 Replication cycle (why latency/recurrent?)

1. Attachment to host cell
• Viral glycoproteins bind to host receptors (e.g. heparan sulfate, nectin-1).
2. Fusion & entry
• Envelope fuses with cell membrane → capsid + tegument enter cytoplasm.
3. Transport to nucleus
• Capsid goes to nuclear pore → viral DNA enters nucleus.
4. Gene expression (immediate-early → early → late genes)
• Immediate-early: regulatory proteins
• Early: DNA polymerase etc.
• Late: structural proteins (capsid, glycoproteins)
5. DNA replication – rolling circle mechanism.
6. Assembly in nucleus → nucleocapsids.
7. Envelopment via host membranes → virions released by exocytosis or cell lysis.

Active Recall — Fill in the Blanks

1. Attachment to host cell

• Viral _____________ bind to host receptors such as _____________ _____________ and _____________-___________.

2. Fusion & entry

• Viral _____________ fuses with the _____________ _____________ → _____________ + _____________ enter the _____________.

3. Transport to nucleus

• _____________ travels to the _____________ _____________ → viral _____________ enters the _____________.

4. Gene expression sequence

• Occurs in the order: __ → _____________ → _____________ genes.

Subtypes

• Immediate-early genes code for _____________ _____________.
• Early genes code for _____________ _____________ (e.g., _____________ _____________).
• Late genes code for _____________ _____________ such as _____________ and _____________.

5. DNA replication

• Viral DNA replicates via the _____________ _____________ mechanism.

6. Assembly

• Assembly occurs in the _____________ forming _____________.

7. Envelopment & release

• Envelopment occurs via _____________ _____________ → virions released by _____________ or _____________ _____________.

1.4 Latency & reactivation (very examworthy)

• After primary infection, virus travels retrograde in sensory nerves to the sensory ganglia:
• Genital HSV → sacral dorsal root ganglia (S2–S4)
• Oral HSV → trigeminal ganglion
• In latency:
• Viral DNA persists as episome in nucleus
• Only latency-associated transcripts (LATs) expressed – no full viral replication.
• Reactivation triggers:
• Stress, fever, sunlight, menstruation, immunosuppression, pregnancy.
• Reactivation → virus travels anterograde down nerve → recurrent lesions on skin/mucosa.

Key exam line:

HSV establishes lifelong latency in sensory ganglia with periodic reactivation causing recurrent lesions.

1.4 Latency & Reactivation — Active Recall (Fill in the Blanks)

After Primary Infection

1. After primary infection, HSV travels _____________ in _____________ nerves to the _____________ _____________.
2. Genital HSV → _____________ _____________ _____________ _____________ (–)
3. Oral HSV → _____________ _____________

During Latency

1. Viral DNA persists in the nucleus as an _____________.
2. Only _____________ (_________) are expressed.
3. During latency, there is no full viral _____________.

Reactivation Triggers

1. Common reactivation triggers include:

Reactivation & Recurrence

1. During reactivation, virus travels _____________ down the nerve.
2. This results in _____________ _____________ on the _____________ or _____________.

Key Exam Line (Fill in the Blanks)

1. HSV establishes lifelong _____________ in _____________ _____________ with periodic _____________ causing _____________ _____________.

1.5 Transmission (focus on pregnancy)

• Sexual contact – genital-genital, oral-genital.
• Vertical transmission:
• Mostly intrapartum (during delivery) from contact with infected genital secretions.
• Rarely in utero (transplacental) or postnatally (direct contact, kissing, breast lesions).

Transmission risk is highest when:

• Mother has primary HSV infection near term, especially if she is shedding virus and has no antibodies yet.

1.5 Transmission (Focus on Pregnancy) — Active Recall

Modes of Transmission

1. Sexual contact includes:
• –
• –

Vertical Transmission

1. Vertical transmission occurs most commonly _____________ (during _____________).
2. The main mechanism is contact with infected _____________ _____________.
3. Vertical transmission may rarely occur:
• _____________ (_____________)
• _____________ (direct _____________, _____________, _____________ _____________)

Highest Risk Scenario

1. Transmission risk is highest when the mother has _____________ HSV infection _____________ _____________.
2. Risk is especially high if she is _____________ _____________ and has _____________ _____________ yet.

1.6 Immune response (why primary infection is dangerous)

• Innate:
• Interferons, NK cells.
• Adaptive:
• Humoral: neutralizing antibodies → reduce severity of subsequent infections.
• Cell-mediated immunity is critical (CD8+ T cells).
• In primary infection in pregnancy, mother is seronegative, no pre-existing antibodies → higher viraemia, higher risk to fetus/neonate.

1.6 Immune Response (Why Primary Infection Is Dangerous)

Active Recall — Fill in the Blanks

Innate Immunity

1. Key innate immune components include _____________ and _____________ .

Adaptive Immunity

1. Humoral immunity involves _____________ _____________ which reduce the _____________ of subsequent infections.
2. Cell-mediated immunity is _____________ and is mediated mainly by _____________+ __cells.

Primary Infection in Pregnancy

1. In primary HSV infection during pregnancy, the mother is _____________.
2. There are no pre-existing _____________.
3. This leads to higher _____________ and increased risk to the _____________

2. Clinical patterns of HSV relevant to pregnancy

2.1 Primary genital HSV infection

• First episode in seronegative woman (no prior HSV-1/2 antibodies).
• Features:
• Painful grouped vesicles → ulcers on vulva, vagina, cervix, perineum.
• Marked pain, dysuria, tender inguinal lymphadenopathy, fever, malaise.
• Lesions last longer (2–3 weeks) than recurrent episodes.
• Obstetric importance:
• If occurs in 1st trimester → small risk miscarriage / congenital HSV (rare).
• If occurs in 3rd trimester, especially near delivery → high risk of neonatal HSV if vaginal birth.

2.1 Primary Genital HSV Infection — Active Recall

Definition

1. Primary genital HSV infection is the first episode in a _____________ woman with no prior __________- / _____________.

Clinical Features

1. Painful _____________ _____________ progress to _____________ on the _____________, _____________, _____________, and _____________.
2. Associated symptoms include:
• Marked _____________
• Tender _____________ _____________
3. Lesions persist for __– _____________, which is _____________ than recurrent episodes.

Obstetric Importance

1. Infection in the _____________ trimester carries a small risk of _____________ or _____________ HSV (_____________).
2. Infection in the _____________ trimester, especially _____________ _____________, carries a _____________ risk of _____________ HSV if _____________ birth occurs.

2.2 Non-primary first episode

• Genital infection with one HSV type in a woman already immune to the other type

(e.g. prior HSV-1 orolabial → now genital HSV-2).

• Less severe than true primary, some cross-protection.

2.2 Non-Primary First Episode — Active Recall

1. A non-primary first episode is a _____________ infection with one _____________ type in a woman already _____________ to the _____________ type.
2. Example: prior _____________ _____________ infection → current _____________ _____________ infection.
3. Compared to a true primary infection, this episode is _____________ _____________.
4. This is because there is partial between HSV types.

2.3 Recurrent genital HSV

• Reactivation from sacral ganglia.
• Mild prodromal tingling, burning → fewer lesions, faster healing (5–7 days).
• Systemic symptoms usually minimal.
• In pregnancy: much lower risk of neonatal infection compared with primary, because maternal antibodies present.

2.3 Recurrent Genital HSV — Active Recall

1. Recurrent genital HSV results from _____________ from the _____________ _____________.
2. Patients often experience mild _____________ symptoms such as _____________ and _____________ before lesions appear.
3. Recurrent episodes are characterized by _____________ lesions and _____________ healing.
4. Lesions typically heal within __– ____ _________.
5. _____________ symptoms are usually _____________ .

Pregnancy Relevance

1. In pregnancy, recurrent genital HSV carries a _____________ _____________ of _____________ infection compared with primary infection.
2. This reduced risk is because _____________ _____________ are _____________.

2.4 HSV in the fetus/neonate (for viva/short notes)

• In utero (congenital) – rare:
• Microcephaly, chorioretinitis, skin scarring, IUGR, hydrocephalus.
• Neonatal HSV – acquired around delivery:
• Localized skin/eye/mouth disease.
• CNS disease – encephalitis.
• Disseminated disease – multi-organ failure, high mortality.

Risk of neonatal HSV:

• Primary maternal infection near delivery: up to ~30–50%
• Recurrent infection with lesions at delivery: ~1–3%
• Asymptomatic shedding: smaller but real risk.

(Exact numbers vary by source, but concept = primary near term = highest risk.)

2.4 HSV in the Fetus / Neonate — Active Recall

In Utero (Congenital) Infection

1. In-utero (congenital) HSV infection is _____________.
2. Congenital HSV may present with:

Neonatal HSV (Around Delivery)

1. Neonatal HSV is usually acquired _____________ _____________.
2. The three major clinical forms are:
• _____________ _____________ / _____________ / _____________ disease
• _____________ disease – _____________
• _____________ disease – failure with _____________ mortality

Risk of Neonatal HSV

1. Risk with _____________ maternal infection _____________ _____________ is approximately _____________–___________%.
2. Risk with _____________ infection and _____________ at delivery is approximately _____________–___________%.
3. _____________ viral _____________ carries a _____________ but _____________ risk.

3. Diagnosis (mother during pregnancy)

• Clinical: characteristic painful vesicles/ulcers.
• Lab tests:
• PCR from lesion swab – most sensitive & specific (type-specific, HSV-1 vs HSV-2).
• Viral culture (less used now).
• Type-specific HSV serology (IgG) to distinguish primary vs recurrent:
• Primary = no prior antibodies, new seroconversion.
• In pregnancy, diagnosis often clinical + PCR if needed.

Diagnosis (mother during pregnancy) – Active Recall

Clinical

• Diagnosis is often __________ based on __________ painful __________ / __________.

Laboratory tests

• Most sensitive and specific test: __________ from __________ swab
• Can differentiate __________ vs __________.
• Older method now less used: __________ __________.
• To distinguish primary vs recurrent infection:
• Type-specific HSV __________ (__________)
• Primary infection = no prior __________, with new __________.

In pregnancy

• Diagnosis is usually __________ + __________ (if confirmation is needed).

4. Antiviral drugs (Mechanism + names)

• Acyclovir (and its prodrug valacyclovir): mainstay.
• They are guanosine analogues:
• Activated by viral thymidine kinase → acyclovir triphosphate.
• Inhibits viral DNA polymerase → chain termination.
• Safe and widely used in pregnancy and breastfeeding (especially acyclovir).

4. Antiviral drugs (Mechanism + names) – Active Recall

Main drugs

• First-line drug for HSV: __________
• Prodrug with better oral bioavailability: __________

Drug class

• These drugs are __________ analogues.

Activation

• Initial phosphorylation is done by __________ __________ __________.
• Active form is __________ __________ .

Mechanism of action

• Inhibits __________ __________ __________.
• Results in __________ __________ of viral DNA.

Use in pregnancy

• These drugs are considered __________ and used in __________ and __________.

5. HSV in Pregnancy – Management Strategy

Think in 3 big questions:

1. Is this primary or recurrent genital herpes?
2. What gestation? Early vs near term.
3. At delivery, are there active lesions / prodromal symptoms?

5.1 General principles

• Do not terminate pregnancy solely for genital herpes.
• Aim to:
• Treat maternal symptoms.
• Reduce viral shedding.
• Prevent neonatal HSV – especially at delivery.

5. HSV in Pregnancy – Management Strategy (Active Recall)

Three key questions

1. Is the infection __________ or __________ genital herpes?
2. What is the __________ age? __________ vs __________ pregnancy.
3. At delivery, are there __________ __________ or __________ __________?

5.1 General principles

• Pregnancy should __________ be __________ solely due to genital herpes.
• Management aims to:
• __________ maternal symptoms.
• __________ viral shedding.
• __________ __________ HSV, especially at __________.

5.2 Management of primary genital HSV in pregnancy

A. During pregnancy (not at labour)

• Confirm clinically ± PCR.
• Oral acyclovir:
• Typical regimen: Acyclovir 400 mg TDS (three times daily) for 5–10 days

(Exact dose/duration can vary by guideline; know “acyclovir for 5–10 days”).

• Analgesia, local care (saline baths, topical anesthetic gel).
• Counsel:
• Avoid sexual contact (especially oral-genital) during active lesions.
• Use condoms thereafter (reduces but does not fully prevent transmission).

If primary infection occurs in 1st or 2nd trimester:

• Treat with acyclovir as above.
• Reassure: congenital infection is rare.
• Document HSV status in notes.
• Plan suppressive therapy from 36 weeks onwards (see below).

If primary infection occurs in 3rd trimester, especially within 6 weeks of delivery:

• High risk of neonatal infection if vaginal birth.
• Start oral acyclovir immediately.
• Plan elective caesarean section at onset of labour / rupture of membranes IF active lesions or infection within last ~6 weeks.
• Also start suppressive therapy from 36 weeks (see below) to reduce viral shedding and necessity for emergency CS.

5.2 Management of primary genital HSV in pregnancy – Active Recall

A. During pregnancy (not at labour)

• Diagnosis is __________ ± __________.
• First-line antiviral:
• Oral __________
• Typical regimen: __________ mg __________ (__________ times daily) for – days
• Supportive care:
• __________
• __________ care (e.g. saline baths, topical __________ gel)

Counselling

• Avoid __________ contact during active lesions (especially –).
• Use __________ thereafter:
• Reduces transmission but does __________ fully __________ it.

If primary infection occurs in 1st or 2nd trimester

• Treat with __________ as above.
• Reassure: congenital infection is __________.
• __________ HSV status clearly in antenatal notes.
• Plan __________ therapy from __________ weeks onwards.

If primary infection occurs in 3rd trimester (especially within __________ weeks of delivery)

• Risk of __________ HSV infection is __________ if vaginal delivery.
• Start oral __________ __________.
• Plan __________ caesarean section at:
• Onset of __________ or
• __________ of membranes
• IF __________ lesions are present or infection occurred within last __________ weeks.
• Also commence __________ therapy from __________ weeks to:
• Reduce __________ shedding
• Reduce need for __________ CS.

5.3 Management of recurrent genital HSV in pregnancy

• Recurrent episodes:
• Treat with short course oral acyclovir (e.g. 400 mg TDS for 5 days).
• Routine antenatal care continues.

Suppressive therapy (very exam-high-yield)

• For women with:
• Frequent recurrences, OR
• Primary infection earlier in pregnancy, OR
• Known genital HSV to reduce lesions at delivery.

From 36 weeks until delivery:

• Acyclovir 400 mg orally TDS

(or Valacyclovir 500 mg BD where available).

Benefits:

• Reduces clinical recurrences.
• Reduces asymptomatic shedding.
• Reduces need for caesarean for HSV.

5.3 Management of recurrent genital HSV in pregnancy – Active Recall

Recurrent episodes

• Managed with __________ course oral __________.
• Example regimen: __________ mg __________ for __________ days.
• __________ antenatal care continues.

Suppressive therapy (exam-high-yield)

Indications (any ONE):

• __________ recurrences
• __________ infection earlier in pregnancy
• Known __________ HSV to reduce lesions at delivery

Timing

• Start from __________ weeks until __________.

Drug & dose

• __________ __________ mg orally __________
• Alternative (where available): __________ __________ mg __________

Benefits

• Reduces __________ recurrences
• Reduces __________ viral __________
• Reduces need for __________ section for HSV

5.4 Management at time of delivery

A. Primary genital HSV near term or at labour

• Active primary lesions or prodromes (pain, burning) at onset of labour:
• Recommend caesarean section to reduce neonatal HSV.
• Ideally done within 4–6 hours of membrane rupture for maximal benefit, but still beneficial later.
• if > 6 hrs has passed give iv Acyclovir to baby for 10 days

B. Recurrent genital HSV at labour

• If recurrent lesions or prodrome present at onset of labour:
• Many guidelines recommend caesarean section, especially if first episode or frequent recurrences.

Recurrent lesions at labour → offer caesarean section to reduce neonatal risk.

• If no active lesions and no prodromes at delivery:
• Vaginal delivery is safe, even if maternal history of HSV.
• Suppressive acyclovir from 36 weeks helps.

C. Spontaneous rupture of membranes (SROM)

• Primary HSV with active lesions + SROM:
• Proceed to caesarean section as soon as possible; risk increases with duration of ruptured membranes.
• Recurrent HSV with lesions + SROM:
• Usually still offer CS, but risk somewhat lower.

5.4 Management at time of delivery – Active Recall

A. Primary genital HSV near term or at labour

• If __________ primary __________ or __________ (__________, __________) are present at __________ of __________:
• __________ caesarean section to reduce __________ HSV.
• Optimal timing:
• Ideally within – hours of __________ rupture.
• Still __________ even if done later.

B. Recurrent genital HSV at labour

• If __________ lesions or __________ present at __________ of __________:
• Most guidelines recommend __________ __________, especially if:
• __________ episode, or
• __________ recurrences.
• Exam-standard rule:
• Recurrent lesions at labour → __________ __________ to reduce __________ risk.
• If __________ active lesions AND __________ prodromes at delivery:
• __________ delivery is __________.
• Applies even with __________ history of HSV.
• __________ acyclovir from __________ weeks reduces risk.

C. Spontaneous rupture of membranes (SROM)

• __________ HSV with __________ lesions + __________:
• Proceed to __________ section as __________ as possible.
• Neonatal risk __________ with __________ of ruptured membranes.
• __________ HSV with __________ lesions + __________:
• Usually still __________ CS.
• Risk is __________ than with primary infection.

5.5 Postnatal management & breastfeeding

• Breastfeeding:
• HSV is not transmitted via breast milk.
• Breastfeeding is allowed if:
• No herpetic lesions on the breast.
• Mother practices hand hygiene.
• If lesions on breast → avoid feeding from that side until fully healed.
• Contact precautions:
• No kissing baby if orolabial lesions present.
• Handwashing after touching lesions.

5.5 Postnatal management & breastfeeding – Active Recall (Blanks)

Breastfeeding:

• HSV is not transmitted via __________ __________.
• Breastfeeding is __________ if:
• No __________ __________ on the __________.
• Mother practices __________ __________.
• If __________ on the breast → avoid feeding from that __________ until fully __________.

Contact precautions:

• No __________ baby if __________ lesions are present.
• __________ after touching __________.

6. Neonatal HSV – what to mention in an answer

If baby is born to mother with active genital HSV at delivery (especially primary):

• Assess neonate:
• Examine for lesions.
• Swabs (mouth, nasopharynx, conjunctiva, rectum) for HSV PCR.
• Blood tests, ± CSF if symptomatic.
• Empirical IV acyclovir if:
• Maternal primary HSV near delivery or
• Neonate symptomatic (lethargy, fever, seizures, respiratory distress, vesicles).

Typical neonatal regimen (conceptual, do not need exact doses in OBGYN exam):

• IV acyclovir for 14–21 days depending on disease type (local vs CNS vs disseminated).

Neonatal HSV – Active Recall (Fill in the Blanks)

If baby is born to mother with active __________ HSV at delivery (especially __________):

Assess neonate:

• Examine for __________.
• Swabs (__________, __________, __________, __________) for HSV __________.
• __________ tests, ± __________ if __________.

Empirical IV __________ if:

• Maternal __________ HSV near delivery or
• Neonate __________ (__________, __________, __________, __________, __________).

Typical neonatal regimen

(conceptual – exact doses not required in OBGYN exam):

• IV __________ for – days depending on disease type (__________ vs __________ vs __________).

7. HSV & pregnancy counselling points (for OSCE / viva)

• Explain:
• HSV is common; many adults infected.
• Once infected, virus stays in body and can recur.
• In pregnancy:
• High risk if first infection in late pregnancy.
• Lower risk with recurrent HSV because woman has antibodies.
• We use antiviral tablets (acyclovir) to:
• Make symptoms better.
• Reduce chances of passing virus to baby.
• We may recommend caesarean if infection is new or there are lesions at birth.
• Baby will be monitored, and if high risk, may need IV acyclovir.

8. “20% that gives 80% marks” – Exam-style condensation

If you’re short on time, this is what you MUST remember:

1. Virus & latency
• HSV-1, HSV-2; enveloped dsDNA; Herpesviridae.
• Establishes lifelong latency in sensory ganglia with periodic reactivation.
2. Transmission & pregnancy risk
• Transmission by sexual contact and perinatally during vaginal delivery.
• Highest risk of neonatal infection when primary maternal genital HSV occurs near term (mother seronegative, high shedding).
3. Primary vs recurrent
• Primary: severe, systemic symptoms, longer duration, no antibodies, high neonatal risk if close to delivery.
• Recurrent: milder, shorter, antibodies reduce fetal/neonatal risk.
4. Antiviral of choice
• Acyclovir – safe in pregnancy & breastfeeding.
• Treatment: e.g. 400 mg TDS for 5–10 days for acute episodes.
• Suppressive therapy from 36 weeks: acyclovir 400 mg TDS until delivery to reduce recurrences and viral shedding.
5. Mode of delivery
• Primary HSV with active lesions or first-episode near term → caesarean section recommended to prevent neonatal HSV (especially if lesions or prodrome at labour).
• Recurrent HSV with no lesions / prodrome at labour → vaginal delivery is acceptable (especially if on suppressive therapy).
• Recurrent HSV with active lesions or prodrome at labour → usually offer caesarean.
6. Neonate
• Risk: skin/eye/mouth disease, CNS disease, or disseminated infection.
• If high risk → investigate and give IV acyclovir early.

Herpetic whitlow = lesions on fingers from autoinnoculations

Eczema herpeticum = localized (on the eczema), Monomorphic lesions, pain full

TZANCK CELLS = inclusion bodies = Cowdry

complications

Erythema multiforme

steven Johnson syndrome

Sacral radiculopathy

Perfect — I’ll condense everything you listed into exam-safe, zero-omission master tables, arranged so you can revise fast, answer vivas, and convert to XMind easily.

No fluff, no missing links.

🦠 HSV — COMPLETE HIGH-YIELD TABLE SET (Zero Omission)

TABLE 1 — HSV VIROLOGY & STRUCTURE (FOUNDATION TABLE)

📌 Exam hook: Enveloped dsDNA virus → nuclear replication → lifelong latency

TABLE 2 — HSV-1 vs HSV-2 (SEROTYPE COMPARISON)

TABLE 3 — HSV REPLICATION CYCLE (STEPWISE EXAM TABLE)

TABLE 4 — LATENCY & REACTIVATION (VERY EXAM-WORTHY)

📌 Key line: HSV establishes lifelong latency with periodic reactivation.

TABLE 5 — TRANSMISSION (WITH PREGNANCY FOCUS)

TABLE 6 — IMMUNE RESPONSE & PREGNANCY RISK

TABLE 7 — CLINICAL TYPES OF GENITAL HSV (PREGNANCY-RELEVANT)

TABLE 8 — PRIMARY GENITAL HSV (DETAIL TABLE)

TABLE 9 — RECURRENT GENITAL HSV

TABLE 10 — FETAL & NEONATAL HSV

TABLE 11 — NEONATAL HSV RISK (NUMBERS TABLE)

📌 Exam logic: Primary near term = worst.

TABLE 12 — DIAGNOSIS IN PREGNANCY

TABLE 13 — ANTIVIRAL DRUGS (MECHANISM TABLE)

TABLE 14 — MANAGEMENT IN PREGNANCY (BIG PICTURE)

TABLE 15 — PRIMARY HSV MANAGEMENT IN PREGNANCY

TABLE 16 — SUPPRESSIVE THERAPY (VERY HIGH-YIELD)

TABLE 17 — DELIVERY DECISIONS

TABLE 18 — POSTNATAL & BREASTFEEDING

TABLE 19 — NEONATAL MANAGEMENT

TABLE 20 — SPECIAL HSV ENTITIES & COMPLICATIONS

✅ This set is:

• Zero omission
• Exam-safe
• Viva-ready
• Table-only as requested

If you want next:

• 🔹 One-page exam poster
• 🔹 XMind paste-ready hierarchy
• 🔹 MCQ block (UK + local style)

Just say which format.