Contents
What is genital herpes?
Genital herpes (GH) is included in an extensive group of diseases of various etiopathogenesis, the pathogens of which are sexually transmitted – STDs. HH disease is caused by the herpes simplex virus type XNUMX (HSV-II), less often the herpes simplex virus type XNUMX (HSV-I). The disease is characterized by vesicular rashes on the skin and mucous membranes in the genital area, lower back, thighs and buttocks. Perhaps asymptomatic and atypical course of the disease, as well as systemic organ damage.
HSV-II and HSV-I are herpes simplex. They are called simple for a characteristic feature – a vesicular rash on the mucous membranes and skin. For a long time, this symptom was considered the only manifestation of herpes, and the disease was recognized as ordinary and harmless. Clinical observations of recent years have largely changed the attitude of doctors to this disease.
Genital herpes is a widespread infection. In the statistics of confirmed STDs, the diagnosis of HSV-II occupies a leading position, second only to trichomoniasis. The genital form of herpes is also caused by HSV-I. The results of 20% of tests conducted using polymerase chain reaction (PCR) confirm the involvement of HSV-I in the formation of rashes in the anogenital zone. The influence of HSV-I on the formation of genital pathogenesis has been steadily growing in recent years.
The prevalence of the disease caused by herpes simplex viruses is due to the following factors:
Persistence of opinion about the safety of herpes simplex among the townsfolk;
A long latent stage of the disease in the nodes (ganglia) of the nerve trunks – a person is infected, but does not suspect it;
Almost lifelong carriage – it is impossible to remove herpes from the body with vaccines, serums or chemicals;
The possibility of infection through household contact – unfortunately, this factor significantly reduces the age of the first encounter with herpes in children.
Since 1993, herpes has been included in the list of diseases subject to mandatory medical statistics in the Russian Federation. Since the beginning of regular observations, a steady increase in the number of cases of herpes has been recorded. To date, the clinical form of genital herpes is diagnosed in about 80 cases per 100 thousand of the population. This figure corresponds to the global statistics of the detection of herpes, sexually transmitted. With the help of statistical observations, some epidemic patterns of HH have been established.
The incidence of genital herpes is correlated with:
Socio-economic status of patients – the maximum number of cases of illness is recorded in near-marginal circles, the minimum – in a group with a high social status;
Gender (men are more resistant to HH infection). The increased sensitivity of women to sexual forms of herpes is probably due to the extensive mucous membranes of the external genital organs, and not to the special structure of the immune system;
Age (there is a sharp increase in cases of HH infection, coinciding with the age of sexual activity). The detection rate reaches a maximum by the age of 30-40, then there is a gradual decrease in the number of diseases to a minimum by the age of 60-70 (exceptions not related to human sexual activity are possible).
HSV and another representative of herpes, cytomegalovirus (both STDs), are significant factors in the etiopathogenesis of gynecological inflammatory diseases of the cervix and appendages. The participation of HSV and cytomegalovirus in the development of radiculitis and inflammation of the meninges has been proven.
The connection of these diseases with the herpes virus was established only after widespread introduction into diagnostics:
The PCR method used to detect the virus and its fragments in body tissues;
enzyme immunoassay diagnostic method ELISA or ELISA when typing the antigenic structure of viruses using monoclonal antibodies;
The emergence of commercial kits for the determination of HSV-II antigens (antigens to HSV-II) and AT-HSV-II (antibody titers to HSV-II).
The sensitivity and specificity of these methods reaches 95-100%. The turnaround time for results is one to two days. Despite the convenience of laboratory methods, their high sensitivity and specificity, they do not always give adequate results suitable for making a final diagnosis.
Modern laboratory and immunological methods have limitations due to:
Cross-reactions in the differentiation of specific antibodies of HSV-I and HSV-II;
Low availability of equipment and shortage of specialists who know PCR and ELISA techniques in small clinics;
The high cost of high-quality commercial diagnostic kits.
Meanwhile, the absolute value of the PCR and ELISA method is shown in neonatal herpes HSV-II or HSV-I, when specific antibodies are represented by almost homogeneous IgM and IgG, and the patterns of serological reactions fit into the standard algorithms of the immune response.
The value of laboratory methods increases with studies conducted in dynamics with an interval of five to seven days. Some features of the organism should be taken into account, for example, the timing of the monthly cycles in women, the medical background of the previous treatment and concomitant diseases.
The opinion about the unconditional and exhaustive value of the results of laboratory tests in making a diagnosis is a common myth. The diagnosis is made not by a laboratory assistant, but by a doctor based on the symptoms of the disease, patterns and epidemiology of pathogenesis, identified after a complex of physical, instrumental and laboratory studies.
In relation to HSV, non-sterile immunity is formed. Immunoconversion of the body develops within 14-28 days with a latent and clinical course of infection.
The immune response of the body to the primary penetration of the genital herpes virus includes three main links of protective reactions:
The primary contact of antigens (AG)-HSV-II with the cells of the immune system is accompanied by the activation of phagocytosis and stimulation of the production of interferon against the background of the body’s natural resistance;
The inclusion of the cellular link of immunity is accompanied by an increase in the level of T-killers and T-helpers. An increase in the level of B-lymphocytes activates the complement system;
The inclusion of the complement system activates the production of specific antibodies (AT) to HSV-II.
Immunity with herpes does not reach the protective level (complete protection of the body). The reason for the almost unimpeded re-infection or superinfection is not completely clear. One of the many hypotheses is that the HSV-II virus has an immune suppression mechanism. Meanwhile, the full-fledged immune status of the body is still a limiting factor in the development of infection.
Signs and symptoms of genital herpes
The signs and symptoms of HSV are very diverse. There are six clinical types of genital herpes disease associated with:
Primary infection;
secondary infection;
Relapses of the disease;
Atypical course;
Asymptomatic course.
Symptoms of primary herpetic infection
The disease occurs after the transmission of the pathogen from the patient to a person who has not previously had genital herpes and who does not have antibodies to HSV-II in the blood. Infection usually occurs during intimate contact, but other routes of transmission are possible.
The incubation period lasts about seven days (the timing of the onset of symptoms is approximate):
Vesicular rash, localized on the external genital organs, appears on the 8-10th day;
Purulent pustules followed by the formation of festering sores – by about 11-15 days;
Crusts (scabs) at the site of ulcers are formed in the period from 15 to 20 days;
Healing of rashes begins at 20-30 days from the onset of the disease.
Signs of genital herpes in men
Signs of HH in men (the above symptoms) are observed on the mucous membrane and / or skin:
The glans and foreskin of the penis;
Urethra and coronal groove;
Perianal area and thighs;
Scrotum and perineum.
Signs of genital herpes in women
Signs of HH in women (the above symptoms) are observed on the mucous membrane and / or skin:
vestibule of the vagina;
External opening of the urethra;
Small and large labia;
Perineum, perianal region, thighs and buttocks;
Vagina and cervix.
Damage to the cervix can take the form of inflammation (cervicitis). The mucous membrane of the cervix is hyperemic and covered with erosions with purulent discharge.
Symptoms of primary infection with HH, characteristic of women and men:
Difficulty urinating;
Purulent discharge from the genitals;
Inflammation of the inguinal lymph nodes.
Symptoms of a secondary disease of genital herpes
The disease occurs after a certain period of latent infection, when antibodies to HSV-II are detected in the body. Activation of the virus occurs after re-penetration of the infection (development of superinfection) or reactivation of HH viruses persisting in the nerve ganglia against the background of a low immune status. Signs of a secondary disease are similar to those of primary herpes. As a rule, the disease has a less vivid pathogenesis (exceptions are possible).
Symptoms of a recurrent type of herpes
A virus that once enters the body makes a person a lifelong virus carrier. For herpes, the characters are periods of latent course with occasional relapses. The frequency of relapses characterizes the state of the immune system and depends on the type of pathogen. HH caused by HSV-II gives frequent relapses in comparison with diseases caused by HSV-I.
There are three types of recurrent course of genital herpes:
Arrhythmic type with wide remissions – from two weeks to five months;
Monotonous type, which is characterized by frequent relapses and short periods of remission;
Subsiding type, characterized by long periods of remission and short exacerbations.
Symptoms of atypical genital herpes
HH is often disguised as other diseases with similar symptoms. The atypicality of the pathogenesis of HSV-II is established on the basis of laboratory detection of the pathogen by PCR or cell culture. It has been noted that approximately 5-15% of gynecological infections are due to the atypical course of herpes involving HSV-II or HSV-I.
Asymptomatic course of genital herpes
The complete absence of symptoms is recorded in 60% of cases of herpes. Recognizing the infectious stage of the virus is possible only with the help of laboratory methods. This type of pathogenesis can cause serious epidemiological consequences during the spread of the disease.
Causes of genital herpes
Factors that ensure the spread of genital herpes infection include:
The presence of a sick virus carrier Herpes simplex virus 2 (international designation HG and abbreviated Latin – HSV-2d) in the active phase of infection, regardless of clinical manifestations (asymptomatic, atypical or other course of the disease);
The presence of a susceptible healthy or previously ill person with impaired homeostasis – a defect in the immune system and a decrease in natural resistance (as a result of an illness, hypothermia, overheating and other stress factors);
Conditions conducive to infection (unprotected promiscuous sex, close household contact with a virus carrier).
How dangerous is genital herpes?
Herpes is a sluggish viral infection, the fatal outcome of the disease is rare, but it is possible with immunodeficiency syndrome. In people with a high immune status, the disease is possible, but mild. This largely served as the basis for the erroneous opinion about the triviality of herpes.
The danger of genital herpes is that:
An active virus carrier of an asymptomatic infection spreads it without being aware of it;
The first and second types of herpes simplex can complement and modify the pathogenesis of HH during primary contact in children;
Herpes can give rise to a kind of “vicious circle” when the disease sets the stage for the development of the pathogenesis of a concomitant infection and thereby depletes the immune system;
The danger of herpes is very high for people with imperfect immunity (in early childhood) and people with acquired immunity defects (after organ transplants, chemotherapy), as well as people leading a marginal lifestyle (drug addicts, prostitutes, etc.). In these groups, herpes is a possible cause of death.
Sex with genital herpes
Genital herpes and cytomegalovirus are included in the group of sexually transmitted diseases. Naturally, in the active phase of genital herpes, sex is immoral, as it contributes to the infection of an unsuspecting partner.
The danger of sex with GG is that:
Barrier contraceptives do not protect against infection, transmission of the virus can occur during contact with the body and hands;
Direct-acting drugs (acyclovir and others in the form of solutions, gels and sprays) are effective only at the stage of replication (virus division in tissue cells) and do not guarantee direct elimination of herpes;
The drug Miramistin, according to the instructions for its use, is a means of individual prevention, including for genital herpes. However, he will not be able to completely eliminate the risk of infection due to the multiplicity of ways this virus is transmitted.
In the stage of remission of herpes, sex is certainly possible, but promiscuous unprotected sex should be avoided.
Genital herpes treatment
A feature of the treatment of slow latent infections, which include HSV, is that:
It is impossible to completely eliminate (destroy) the pathogen of HSV;
Etiotropic therapy is advisable only in the active phase of the virus;
Antibiotics for viral diseases are ineffective;
The available HSV vaccine is used only in the latent phase of the disease and does not have a full protective (protective) property.
The pathogenesis of genital herpes caused by HSV-II, in comparison with the pathogenesis of labial herpes, is more aggressive, more often causes relapses, and gives serious complications. Therefore, if a mild recurrence of herpes labialis in persons with a slightly altered immune status allows the absence of medical procedures, then genital herpes must always be treated, regardless of the form, severity of pathogenesis and the state of the patient’s immune system.
Three principles of medical therapy
Limitation of pathogenesis until the main symptoms of HH are eliminated:
itching at the site of the lesion;
papular and vesicular rash (single and widespread);
local and total pain;
fever.
Reducing the period of exacerbation of the disease to the minimum possible (7-14 days).
An increase in the period of latent course of the disease (the ideal result is lifelong latency).
Since the elimination of the herpes virus is impossible, the goal of therapy is not a complete recovery, but the establishment of a state of relative health based on the principles of prevention:
Recurrence of HH disease by normalizing the immune status of the human body;
Infection of sexual partners and further spread of infection;
Intrauterine infection of the fetus and newborn during its passage during childbirth through the genital tract, natal and postnatal complications.
Therapies
Five therapeutic methods are used to treat genital herpes:
Etiotropic therapy. Antiviral drugs that inhibit the replication of the herpes virus.
pathogenic therapy. Immunomodulators, including agents that increase and decrease the immune status and its individual links in the form of native substances (natural, crude biological products), individual fractions and synthetic immunogenesis stimulants.
Symptomatic therapy. Drugs that relieve pain, itching and fever.
Specific prophylaxis – vaccination.
Physiotherapy (sometimes).
In the medical arsenal of drugs that can directly affect the virus, there is a limited set of drugs. Direct-acting antiviral therapy is based on drugs from the group of synthetic analogues of acyclic purine nucleosides. The basic drug of this group of drugs is acyclovir.
The herpes vaccine is prescribed by the attending physician, based on therapeutic expediency. Treatment of atypical forms of genital herpes is carried out taking into account the symptoms of pathogenesis and the results of laboratory tests.
Features of genital herpes in men
The therapy is carried out according to traditional schemes. The indication for the start of treatment of genital herpes in men is the laboratory-confirmed presence of herpes virus DNA in the blood and antibodies to HSV-II in the form of immunoglobulin M (at the beginning of the disease) and immunoglobulin G (at the height of the disease) against the background of signs of genital herpes (itching, pain , burning and rashes on the external genitalia). The prognosis of recurrence of the disease depends on the state of the immune system of a man, his age, the presence of bad habits, the well-being of the socio-economic living conditions.
The absence or ineffectiveness of the treatment of genital herpes in men increases the risk of complications in the form of concomitant diseases:
The genital area, in particular the prostate;
nervous system;
Eye.
In addition, genital herpes is a proven provocateur of the development of malignant neoplasms, and not only in the genital area.
Features of genital herpes in women
Women are more likely than men to become infected with genital herpes HSV-II. This means that the contact of a man or woman with a carrier of herpes is not fatal for any of them in 100% of cases, but women are more at risk. Meanwhile, a frivolous attitude to herpes can cost a woman dearly during gestation. Therapy of female herpetic infection is carried out according to the same schemes as in men.
Genital herpes during pregnancy
The consequences of genital herpes during pregnancy look dramatic. The primary infection of the expectant mother with the HSV-II virus, depending on the gestational age, results in the following complications:
First-second trimester – delay and malformations of the fetus, fading of pregnancy;
The second or third trimester – oligohydramnios and polyhydramnios, hydrocephalus and other defects in the fetal nervous system.
Treatment of a pregnant woman for herpes is carried out taking into account:
Detection of immunoglobulins M or G in the blood and the presence of virions in the cells of the body;
The health status of the pregnant woman and the stage of fetal development;
The presence / absence of a threat of miscarriage;
Limited spectrum of drugs allowed for use during pregnancy.
For the treatment of women during pregnancy, it is possible to use etiotropic antiviral therapy. The dosage is selected individually, taking into account the characteristics of the body of a particular woman.
So, the list of acceptable medicines for herpes for pregnant women:
The absence or ineffective therapy of HH in pregnant women causes complications and provokes diseases of the genitourinary and nervous systems, as well as organs of vision. Herpes is a possible provocateur of gynecological dysplasia and oncology in women.
Prevention of genital herpes
Prevention – the basis of maintaining health – consists of two main links
Specific prevention of herpes
Specific prevention is the use of vaccinations. However, in case of herpes with the help of vaccines, it is not possible to obtain a lasting protective effect. This is due to the special device of the virus, which counteracts the influence of the immunogenic properties of the vaccine antigen and adjuvant (enhancer of the protective properties of the vaccine).
Nonspecific prevention of herpes
Non-specific prophylaxis includes:
Healthy lifestyle, monogamous intimate relationships;
Use of barrier contraceptive methods for all types of sex;
Preventive therapy to increase immunity after casual relationships, even if a condom was used.