A pregnant client with no active HSV lesions at labor asks about neonatal infection risk. Which statement is most accurate?

• A. Neonatal infection is likely regardless of delivery method.
• B. Neonatal infection risk is increased only if there are active lesions during birth.
• C. Neonatal infection risk is not influenced by delivery method.
• D. Neonatal infection risk is decreased with cesarean even if no lesions.

Answer: (B)

Neonatal HSV infection risk is driven by maternal genital lesions at the time of delivery. If there are active lesions or prodromal symptoms during labor, the baby’s exposure to infected secretions in the birth canal markedly increases the chance of neonatal infection, and cesarean delivery is often recommended to reduce that risk. When there are no active lesions and no prodrome, the newborn’s risk is low, and the method of delivery has little impact on risk.

In this scenario, the statement that neonatal infection risk is increased only if there are active lesions during birth is the most accurate because it directly ties transmission risk to the presence of active maternal genital disease at delivery. The other ideas—risk being high regardless of delivery method, or not influenced by delivery method at all, or cesarean reducing risk even without lesions—do not fit the established pattern where transmission is primarily a concern when lesions are present at labor.