{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:13:36Z","timestamp":1788261216959,"version":"build-2803163510"},"reference-count":22,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,2,5]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>Herpes simplex virus (HSV) is a double-stranded DNA virus, whose primary target is epithelial cells. It is disseminated by hematogenous spread. HSV type 2 (HSV-2) usually causes genital infection with mucocutaneous lesions or it may be asymptomatic. HSV-2 is also an important cause of meningitis either during primary infection or by (recurrent) reactivation of dormant virus within the central nervous system. The authors present the case of a nulliparous woman in her mid-20s presenting to the emergency department at 22 weeks\u2019 gestation with acute onset of headache. CT of the head and magnetic resonance angiography (MRA) were unremarkable. She received broad-spectrum antimicrobial therapy for suspected meningitis. Her cerebrospinal fluid culture detected HSV-2. She denied a history of oral or genital herpes. She commenced treatment with intravenous acyclovir 10 mg\/kg 8\u2009hourly for 7\u2009days. She responded clinically and her headache resolved. There remains a relative dearth of cases of HSV-2 meningitis reported in the literature hence making pregnancy management and delivery planning challenging for obstetricians. This case demonstrates the importance of the multidisciplinary team involvement of genitourinary medicine and sexual health physicians, obstetricians and neonatologists with formal documentation of a birth and postnatal care plan.<\/jats:p>","DOI":"10.1136\/bcr-2024-263881","type":"journal-article","created":{"date-parts":[[2025,2,16]],"date-time":"2025-02-16T06:11:07Z","timestamp":1739686267000},"page":"e263881","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Herpes simplex-2 meningitis presenting with headache in pregnancy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-415X","authenticated-orcid":false,"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Premalatha","family":"Ulaganathan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Furara","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,16]]},"reference":[{"key":"2025082623055824000_18.2.e263881.1","doi-asserted-by":"crossref","first-page":"e193","DOI":"10.1097\/AOG.0000000000003840","article-title":"Management of genital herpes in pregnancy: ACOG Practice Bulletinacog Practice Bulletin, Number 220.","volume":"135","year":"2020","journal-title":"Obstetrics & Gynecology"},{"key":"2025082623055824000_18.2.e263881.2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1177\/09564624241280734","article-title":"Joint British Association for Sexual Health and HIV and Royal College of Obstetricians and Gynaecologists national UK guideline for the management of herpes simplex virus (HSV) in pregnancy and the neonate (2024 update)","volume":"36","author":"Clarke","year":"2025","journal-title":"Int J STD AIDS"},{"key":"2025082623055824000_18.2.e263881.3","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-022-01402-2"},{"key":"2025082623055824000_18.2.e263881.4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.7812\/TPP\/17-020","article-title":"Migraine Headache Treated with Famciclovir and Celecoxib: A Case Report","volume":"22","author":"NaPier","year":"2018","journal-title":"TPJ"},{"key":"2025082623055824000_18.2.e263881.5","doi-asserted-by":"crossref","first-page":"S281","DOI":"10.1007\/s10072-004-0310-8","article-title":"New daily persistent headache: clinical and serological characteristics in a retrospective study","volume":"25 Suppl 3","author":"Meineri","year":"2004","journal-title":"Neurol Sci"},{"key":"2025082623055824000_18.2.e263881.6","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1476863","article-title":"Association between human herpes simplex virus and severe headache or migraine among aged 20-49\u2009years: a cross-sectional study","volume":"15","author":"Zheng","year":"2024","journal-title":"Front Neurol"},{"key":"2025082623055824000_18.2.e263881.7","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/cid\/ciab1071","article-title":"Herpes Simplex Virus 2 Meningitis in Adults: A Prospective, Nationwide, Population-Based Cohort Study","volume":"75","author":"Jakobsen","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2025082623055824000_18.2.e263881.8","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/S1473-3099(18)30245-7","article-title":"Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study","volume":"18","author":"McGill","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2025082623055824000_18.2.e263881.9","doi-asserted-by":"crossref","unstructured":"Alsharekh E , Carpenter C . Herpes Simplex Virus 2 Meningitis: Clinical Presentation and Treatment Patterns. Open Forum Infect Dis 2016;3. doi:10.1093\/ofid\/ofw172.495","DOI":"10.1093\/ofid\/ofw172.495"},{"key":"2025082623055824000_18.2.e263881.10","first-page":"57","article-title":"La meningite endothelioleucocytaire multi recurrente benigne. Syndrome nouveau ou maladie nouvelle? Documents cliniques","volume":"76","author":"Mollaret","year":"1944","journal-title":"Rev Neurol"},{"key":"2025082623055824000_18.2.e263881.11","doi-asserted-by":"crossref","first-page":"85","DOI":"10.7883\/yoken.JJID.2002.85","article-title":"Recurrent herpes simplex virus type 2 meningitis: a case report of Mollaret\u2019s meningitis","volume":"55","author":"Kojima","year":"2002","journal-title":"Jpn J Infect Dis"},{"key":"2025082623055824000_18.2.e263881.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911043411904"},{"key":"2025082623055824000_18.2.e263881.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00121-X"},{"key":"2025082623055824000_18.2.e263881.14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1206"},{"key":"2025082623055824000_18.2.e263881.15","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/00126334-200404150-00001","article-title":"The Effects of Herpes Simplex Virus-2 on HIV-1 Acquisition and Transmission: A Review of Two Overlapping Epidemics","volume":"35","author":"Corey","year":"2004","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"key":"2025082623055824000_18.2.e263881.16","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2007.01.003"},{"key":"2025082623055824000_18.2.e263881.17","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1002\/bdr2.1409","article-title":"Maternal genitourinary infections and risk of birth defects in the National Birth Defects Prevention Study","volume":"110","author":"Howley","year":"2018","journal-title":"Birth Defects Res"},{"key":"2025082623055824000_18.2.e263881.18","doi-asserted-by":"crossref","DOI":"10.4414\/smw.2017.14534","article-title":"Ultrasound indications for maternal STORCH testing in pregnancy","volume":"147","author":"Voekt","year":"2017","journal-title":"Swiss Med Wkly"},{"key":"2025082623055824000_18.2.e263881.19","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1080\/00016340801898943","article-title":"No association between maternal recurrent genital herpes in pregnancy and higher risk for congenital abnormalities","volume":"87","author":"\u00c1cs","year":"2008","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025082623055824000_18.2.e263881.20","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-38319"},{"key":"2025082623055824000_18.2.e263881.21","article-title":"Recurrent Aseptic Meningitis From Herpes Simplex Virus-2: Mollaret\u2019s Meningitis in a 30-Year-Old Female","volume":"12","author":"Kirkland","year":"2020","journal-title":"Cureus"},{"key":"2025082623055824000_18.2.e263881.22","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/162.2.322"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263881","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:06:22Z","timestamp":1756274782000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,16]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-263881"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263881","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}