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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (4): 604-606    DOI: 10.31083/j.ceog.2020.04.5311
Case Report Previous articles | Next articles
Outcome of shared decision-making in a patient with primary herpes gingivostomatitis during pregnancy: a case report
C.Y. Huang1, T.C. Chao1, H.C. Chien2, Y.L. Liu1, 3, 4, 5, *()
1Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2Department of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan
3Center for Reproductive Medicine, Taipei Medical University Hospital, Taipei, Taiwan
4Division of Infertility, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
5Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Abstract  

Purpose: The authors present the case of a woman in the 20th week of pregnancy with herpes simplex virus (HSV)-related gingivostomatitis. They also provide information regarding the benefits and risks of acyclovir, valacyclovir, famciclovir, and shared decision-making (SDM) through which valacyclovir was selected. Case Report: A 26-year-old primigravida woman who denied having a history of systemic diseases presented with fever, general malaise, and abdominal pain at 20 weeks of gestation. As no strong evidence supports any current treatment for primary maternal HSV-1 gingivostomatitis during pregnancy, the authors used three key steps of SDM, namely choice talk, option talk, and decision talk, to help the patient make a decision based on the benefits and ill-effects of treatment with acyclovir, valacyclovir, and famciclovir. Valacyclovir was administered for one week. Her general condition improved gradually, and the symptoms abated without recurrence of fever. Conclusions: Thus, SDM-based treatment was effective in this patient.

Key words:  Antiviral therapy      Herpes gingivostomatitis      Shared decision-making      Pregnancy     
Submitted:  20 June 2019      Accepted:  24 September 2019      Published:  15 August 2020     
Fund: MOST 106-2314-B-016-004/Ministry of Science and Technology, Taiwan, ROC;MOST 107-2314-B-016-065-MY2/Ministry of Science and Technology, Taiwan, ROC;TSGH-C106-081/ Tri-Service General Hospital;TSGH-C107-082/Tri-Service General Hospital;TSGH-C108-116/Tri-Service General Hospital;TSGH-PH-105-4/Tri-Service General Hospital, Penghu Branch
*Corresponding Author(s):  Y.L. Liu     E-mail:  h121976@yahoo.com.tw

Cite this article: 

C.Y. Huang, T.C. Chao, H.C. Chien, Y.L. Liu. Outcome of shared decision-making in a patient with primary herpes gingivostomatitis during pregnancy: a case report. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 604-606.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.04.5311     OR     https://ceog.imrpress.com/EN/Y2020/V47/I4/604

Table 1  — Treatment options in shared decision-making for herpes simplex virus type-1 gingivostomatitis during pregnancy.
Treatment FDA Pregnancy Category Intravenous administration Suggested dosage Cost Existing literature
Acyclovir B Support 200 mg 5 times a day Affordable Several large observational studies have
shown its safety during pregnancy
Valacyclovir B No support 500 mg orally twice daily High Lack of controlled studies documenting safety
Famciclovir B No support 2 g twice daily for 1 day High Lack of controlled studies documenting safety
Supportive care Free Suspected to be related to abortion or stillbirth
Figure. 1  — (A) Extraoral: angular cheilitis, blister located on the lip and commissure. (B) Intraoral: erythematous change in the gingivae and entire mouth and white plaque on her tongue, bilateral buccal mucosa, and hard palate. (C) and (D) Post-treatment: smooth and normal color of the palate and tongue.

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