This article presents various aspects of maternal genital and neonatal herpes simplex virus (HSV)-1 and HSV-2 infection for hospitals in two cities in the USA - Seattle and Atlanta - to serve as models for the different subpopulations within developed and developing countries. Reasons are given for the disparity between the increasing rates of genital HSV-1 and HSV-2 infections observed in several areas of the world and the general low rates of newborn herpes noted in sites other than some hospitals in Seattle, Atlanta, Cincinnati and Helsinki. A key reason for the disparity appears to be the continuing difficulty in diagnosing maternal genital herpes and neonatal herpes. Contributing factors include the variability in different communities in sexual behaviour patterns, and in the rates of maternal genital HSV infection, caesarean sections and postmortem procedures. Unresolved challenges in the obstetric management of genital herpes aimed at preventing neonatal herpes are also presented.