If a neonate is asymptomatic at birth after a mother with recurrent genital herpes, what is the next step?

When a neonate is born asymptomatic after a mother with recurrent genital herpes, obtaining specimens for culture and PCR assay 24 hours after delivery is the most appropriate next step. This approach allows healthcare providers to monitor for any potential infection without immediate intervention, as the infant shows no symptoms.

Assessing for herpes simplex virus (HSV) is crucial because while the infant may appear healthy, there remains a risk of asymptomatic viral shedding from the mother and potential neonatal herpes infection. By performing cultures and PCR assays, clinicians can safely determine whether the neonate is infected, thereby guiding further management based on results.

Initiating immediate treatment, such as starting IV acyclovir, isn't warranted at this point since the neonate is asymptomatic, and there's no evidence of infection that would require aggressive intervention. Similarly, admitting the infant to the neonatal ICU is premature given their stable condition. Starting symptomatic treatment is also unnecessary when the baby shows no clinical signs of herpes or any distress.

Thus, obtaining specimens for culture and a PCR assay aligns with best practices in properly evaluating and monitoring the newborn's health in relation to maternal herpes history while ensuring timely management should any issues arise.