Supplementary Material for: Varicella Zoster Virus Reactivation in the Cervix During Labor in a Vaccinated Pregnant Woman: A Novel Case Report

Introduction
Obstetric and pediatric providers are increasingly challenged by the evolving presentations of perinatal infections. While varicella zoster virus (VZV) reactivation during pregnancy is typically considered benign and poses a low risk for neonatal transmission, this assessment is based on dermatomal, non-genital presentations. Genital involvement, especially when isolated to the cervix, is rare and not addressed in the current guidelines.
Case Presentation
We present the case of a fully vaccinated, immunocompetent 22-year-old woman with cervical VZV infection at the time of delivery. She was suspected to have reactivation of the vaccine strain and was delivered via caesarean section. The infant remained asymptomatic and did not require therapy to prevent or treat the infection.
Conclusion
This case underscores the diagnostic utility of multiplex viral testing and highlights a critical gap in the guidelines for managing genital VZV reactivation during pregnancy. Genital VZV, similar to herpes simplex virus, may warrant special consideration in delivery planning and neonatal care.