Contents
Genital herpes is a lesion of the skin and / or mucous membranes in the genital area of an infectious nature (and in some episodes and other systems and organs), the causative agent of which is the herpes simplex virus. A feature of this disease is a tendency to a relapsing course. Carriers of the virus are approximately 20% of the total population, while signs of genital herpes are detected only in 5%, while the rest of the symptoms are erased or completely absent.
Causes of infection
The causative agent of the disease is a representative of the group of human herpesviruses. Herpes simplex virus, abbreviated as HSV, type 1 mainly affects the face, head and neck, for the first time manifestations of pathology are noted in infancy in the form of gingivostomatitis (damage to the inflammatory nature of the oral cavity) and by the age of 10, infection reaches 90%. At the same time, type 2 “prefers” the genital area and the perigenital zone. Therefore, infection with genital herpes occurs sexually through the transmission of HSV-2 (up to 80% of all episodes). However, due to the prevalence of oral-genital contact, exposure to HSV-1 or both types is possible.
The risk of transmission of genital herpes through contact with an infected partner averages up to 10% per year (in men, the risk of such “acquisition” is somewhat lower than in women). In the presence of manifestations (specific rashes), the risk of infection reaches 75% during traditional sexual contact. After the virus enters the body through the skin or mucous membranes, it enters the ganglia (nodes, clusters) of nerve cells, where it remains until the moment of exacerbation when exposed to provoking factors.
The herpes virus is also localized and multiplies in the lymph nodes, spreads through the bloodstream throughout the body. HSV is able to infect specific cells of the immune system (lymphocytes, neutrophils, macrophages) and thereby seriously reduce cellular immunity. The virus remains in the human body for life. Transmission to an uninfected partner is also possible during the absence of rashes.
Risk Factors
Factors that provoke an exacerbation or contribute to infection include: • psycho-emotional stress; • diseases occurring with high temperature; • mucosal/skin injuries; • the presence of other infectious pathologies, including those transmitted mainly through sexual contact (syphilis, HIV, hepatitis, etc.); • exposure to UV, laser radiation; • overheating/hypercooling; • surgical/cosmetic procedures; • dermatitis; • promiscuous sexual activity, etc.
Symptoms and types of disease
Genital herpes in men can occur in several stages / stages: • primary infection (that is, infection of a person who has not been infected before) is: o asymptomatic (otherwise called a subclinical infection); o with a limited area of damage – the virus is introduced into the local zone; o with the defeat of several sites – there are several “entrance gates”. • latent (hidden) infection, in which the virus itself is present in the nerve nodes, but is not detected in the analyzes; • relapse, the development of signs of pathology after the previous stage (herpes is considered recurrent when the number of exacerbations per year is equal to or exceeds 6 episodes). Signs of genital herpes vary depending on the type of disease.
In a typical form, the disease goes through three stages: • prodromal period (lasts about a day or two), accompanied by itching, tingling, burning, soreness; • rash period (from three days to a week), with the formation of groups of characteristic vesicles, the so-called vesicles, turning into erosion, with swelling and redness of the skin; • regression period, with the formation of crusts, and then temporarily pigmented areas (2 – 7 days).
Genital herpes in men most often affects the skin and / or mucous membranes of the foreskin, head. To date, in most episodes, the disease proceeds in atypical or oligosymptomatic forms, when characteristic formations (vesicles) are not noticeable. Puffiness, redness, discomfort in the affected area, cracks, small spots are revealed. Sometimes there is quite a strong pain, radiating to nearby organs and skin areas. Occasionally, the disease manifests itself only as a mild inflammatory redness (erythema). Since the period of the presence of the problem is shorter in duration than in the typical form, the patient may not even notice signs of illness in himself.
In difficult cases, the prostate gland (prostatitis), testicles (orchitis) and / or their appendages (epididymitis), urinary canal (urethritis), bladder (cystitis), seminal vesicles (vesiculitis) and other organs may be additionally affected. With herpetic urethritis, vesicles appear on the urethral mucosa, with urination, pain, burning are noted. It is possible to develop herpetic urethroprostatitis (in addition to the urethra, the virus also affects the prostate gland), proctitis (rectum / sigmoid colon).
In general, in healthy people, the recurrence of the disease proceeds easily and often disappears without any treatment, while in the presence of serious problems in the immune system (HIV, blood pathologies, lymphoma, leukemia, etc.), extensive skin areas, internal organs, etc. can be affected. d.
Diagnosis and detection of the disease
To confirm the herpes nature of the disease, any biomaterial is analyzed: semen, vesicles, urine, blood, saliva, etc. Diagnostic methods include: • PCR (polymerase chain reaction) – the most accurate method; • cultural study – when the virus itself is isolated directly (long, expensive, therefore more important in scientific research); • electron microscopy, cytological diagnostics – with the analysis of a smear-imprint from the area of rashes (stained and examined under a microscope); • ELISA (enzyme-linked immunosorbent assay) – applicable to a limited extent, as it allows you to determine only antibodies, which does not carry diagnostic value (the majority of the adult population has been in contact with herpesvirus throughout their lives and has the corresponding antibodies).
Antibodies to the herpes virus are determined only: • to confirm the primary infection; • with negative results of PCR / culture study and the simultaneous presence of symptoms; • if the partner has genital herpes; • in HIV-infected people; • in persons with occasional frequent sexual intercourse, homosexuals (ie those who are at increased risk of HIV infection).
Treatment of herpes
Existing methods of treatment do not allow to completely eliminate the herpes simplex virus from the body. The objectives of therapeutic intervention are to accelerate the healing of rashes, reduce the risk of recurrence, and reduce the release of the pathogen. Therefore, the answer to the question of how to treat genital herpes and whether it should be treated at all can only be given by a doctor.
The only group of drugs that are effective for therapy are abnormal nucleosides, which inhibit the production of viral RNA/DNA. Such antiviral drugs include systemic, oral, acyclovir-based agents or more modern (and expensive) ones containing valaciclovir, famciclovir. Only local treatment (creams / ointments) for the disease is ineffective, but can be used as an additional measure to alleviate the patient’s condition.
Taking drugs begins in the early stages of the disease (in the first two days). When the rash has not yet appeared, but only burning, soreness is felt, medications can prevent the formation of a rash. At later stages, these antiviral agents somewhat reduce the healing time. The dosage of the drug, the scheme of its use is determined / adjusted by the doctor, in most cases, starting with the appointment of acyclovir for a period of 10 days (5 times a day) in a situation with an initial episode of infection. In the presence of immunosuppressive (causing a decrease in immunity) conditions, dosages can be doubled against the standard ones.
With frequent relapses (recurrent course), they resort to the so-called “suppressive (otherwise suppressive) therapy” with the same drugs. Medications are taken daily for six months or more. Usually, after a year, the effectiveness of treatment is evaluated, monitoring the manifestation / absence of relapses after discontinuation of the drug. Patients with immunodeficiency states, some serious chronic pathologies are forced to undergo such therapy almost on an ongoing basis.
The doctor may recommend the use of drugs such as amixin, cycloferon, viferon, etc. However, these drugs do not have evidence of safety and efficacy in genital herpes and are not used in foreign medical practice (although some patients report relief of symptoms during therapy with these drugs).
Also, sometimes general strengthening agents, physiotherapy treatment are additionally prescribed. Traditional healers also offer their own methods in the fight against genital herpes, however, such measures can be resorted to only after consultation with the attending urologist and only in addition to the main treatment. Traditional medicine recommends: • daily use of green onions with olive oil for “vitamin” strengthening of the body; • drink echinacea tincture diluted with water; • make compresses on the affected area from a mixture of essential oils (lavender, eucalyptus, etc.) with water or from infusion of chamomile and propolis; • take baths with violet elixir; • apply a cut leaf of aloe to the rash area; • make lotions from decoctions of oak bark, lemon balm, etc.
Complications
Complications of genital herpes in men are due to the development of bacterial inflammatory processes against the background of a decrease in the body’s defenses provoked by herpes infection: prostatitis (prostate lesions), urethritis (urethra), vesiculitis (seminal vesicles) and others.
It is important to understand that due to the fact that genital herpes is most often infected sexually, there is a risk of simultaneous infection with pathogens and other pathologies, such as ureaplasma (ureaplasmosis), mycoplasma (mycoplasmosis), chlamydia (chlamydia), fungi (mycosis), gonococci (gonorrhea ), etc. According to the latest medical research, the presence of HSV-2 in the body increases the risk of infection with the immunodeficiency virus. The influence of HSV infection on the development of male infertility is discussed.
However, the most formidable situation in this disease is the transmission of the virus (primary infection) to a pregnant woman. The causative agent is able to provoke both the termination of the pregnancy itself and cause various fetal pathologies. In case of primary infection of a pregnant woman, the risk of infection of the fetus is 50% (with relapse – less than 4%). In addition, herpes infection of newborns (infants become infected during childbirth) is fraught with death.
Prevention
There is no specific prevention of genital herpes. The main measures to prevent infection, in some cases – exacerbation of the disease, include: • use of condoms; • exclusion of casual sexual relations; • refusal of oral sex (especially when the partner is pregnant); • general strengthening measures; • identification and elimination of foci of chronic infection; • normalization of the psycho-emotional state; • healthy lifestyle.
An experimental vaccine “Gerpevac” has been developed, which has demonstrated a high level of protection for women from infection with genital herpes.