What is Genital Herpes?
Herpes is one of the most common viral infections of a person. The infection with the herpes simplex virus (HSV) is 90%; 20% of the world’s population have clinical manifestations of infection. Genital herpes is a sexually transmitted chronic recurrent viral disease.
Causes of Genital Herpes
The causative agent of the disease is the herpes simplex virus HSV-1 and HSV-2, most often HSV-2. HSV is large enough (200 nm in diameter), DNA-containing, unstable in the external environment and rapidly dies when it dries, heats, the action of disinfectant solutions.
Infection occurs during sexual contacts from infected partners who do not always know about their infection. HSV is excreted with sperm, so transmission of an agent during artificial insemination is possible. Recently, an important epidemiological significance is the oral-genital way of infection. Contagiousness for women reaches 90%. The household way of transmission of infection (through toilet articles, underwear) is unlikely, although it is not excluded. Herpetic infection can be transmitted from a sick mother to the fetus transplacental and intrapartum. During pregnancy, HSV can lead to miscarriage, intrauterine fetal death and malformations (microcephaly, heart defects, retinal dysplasia, microphthalmia, etc.).
The virus penetrates the body through the damaged mucous membranes of the genital organs, urethra, rectum and skin. At the site of introduction, where there are bubble rashes, HSV enters the bloodstream and the lymphatic system, settling in the internal organs, the nervous system. The virus can also penetrate the nerve endings of the skin and mucous membranes in the ganglion of the peripheral and central nervous system, where it remains for life. Periodically migrating between the ganglia (with genital herpes it is the lumbar and sacral sections of the sympathetic chain) and the skin surface, the virus causes clinical signs of recurrence of the disease. The manifestation of herpes infection is facilitated by a decrease in immunoreactivity, hypothermia or overheating, chronic diseases, menstruation, surgical intervention, physical or mental trauma, alcohol intake. HSV, possessing neurodermotropism, affects the skin and mucous membranes (face, genital organs), central (meningitis, encephalitis) and peripheral (gangliolitis) nervous system, eyes (keratitis, conjunctivitis).
Pathogenesis of Genital Herpes
Clinically, the first episode of the disease and relapses of genital herpes are distinguished, as well as the typical course of infection (with herpes rash), atypical (without rash) and virus carrying.
Symptoms of Genital Herpes
The incubation period is 3-9 days. The first episode of the disease is more violent than the subsequent relapses. After a short prodromal period, accompanied by local itching and hyperesthesia, a clinical picture unfolds. A typical course of genital herpes is accompanied by extragenital symptoms (viremia, intoxication) and genital (local manifestations of the disease) signs. Extragenital symptoms include headache, fever, chills, myalgia, nausea, malaise. Usually these symptoms disappear with the appearance of bubble rashes on the perineum, the skin of the external genitalia, the vagina, the cervix (genital symptoms). Vesicles 2-3 mm in size are surrounded by a region of hyperemic edematous mucosa. After 2-3 days of existence, they are opened with the formation of ulcers, covered with a greyish-yellow purulent (due to secondary infection) by a touch. Patients complain of pain, itching, burning in the place of defeat, heaviness in the lower abdomen, dysuria. When the manifestations of the disease are marked subfebrile temperature, headache, an increase in peripheral lymph nodes.
The acute period of herpetic infection lasts 8-10 days, after which the visible symptoms of the disease disappear.
Currently, the incidence of atypical forms of genital herpes has reached 40-75%. These forms of the disease have an erased course without herpetic eruptions and are accompanied by a lesion of not only the skin and mucous membranes, but also the internal genital organs. There are complaints of itching and burning in the area of lesions, whites, antibiotic-resistant, recurrent erosion and leukoplakia of the cervix, habitual miscarriage, infertility. Herpes of the upper genital tract is accompanied by symptoms of nonspecific inflammation. Patients are concerned about periodic pain in the lower abdomen; Common therapy does not give the desired effect.
With all forms of the disease, the nervous system suffers, which manifests itself in neuropsychiatric disorders – drowsiness, irritability, bad sleep, depressed mood, reduced efficiency.
The frequency of relapses depends on the immunobiological resistance of the macroorganism and ranges from 1 time in 2-3 years to 1 time every month.
Diagnosis of Genital Herpes
Diagnosis of genital herpes is based on history, complaints, data of objective examination. Recognition of typical forms of the disease usually presents no difficulties, since the vesicle rash has characteristic features. However, it is necessary to distinguish ulcers after the opening of herpetic vesicles from syphilitic ulcers, dense, painless, with even margins. Diagnosis of atypical forms of genital herpes is extremely complicated.
Highly sensitive and specific laboratory diagnostic methods are used: culturing the virus on a chicken embryo cell culture (“gold standard”) or detecting a viral antigen by immunoassay, immunofluorescent, immunoperoxidase, polymerase chain reaction (PCR). The material for investigation serves as a detachable from herpetic vesicles, vagina, cervical canal, urethra. The simple determination of antibodies in serum to the virus is not an accurate diagnostic criterion, because it reflects only the infection of HSV, including not only genital. The diagnostic value for the first episode of the disease has a fourfold increase in specific IgG titres in the patient’s paired sera at an interval of 10-12 days, as well as the detection of IgM. The diagnosis, established only on the basis of serological reactions, may be erroneous.
Treatment of Genital Herpes
Sexual partners of patients with genital herpes should be examined for HSV, and for clinical signs of infection, they should be treated. Before the disappearance of the manifestations of the disease, it is necessary to abstain from sexual intercourse or use condoms.
Since currently there are no methods for eliminating HSV from the body, the goal of treatment is to suppress the reproduction of the virus during the period of exacerbation of the disease and the formation of a stable immunity for the prevention of recurrences of herpetic infection.
Recommended antiviral therapy regimens for the first clinical episode:
- Acyclovir 200 mg orally 5 times a day for 5-10 days;
- Valaciclovir 500 mg orally 2 times a day for 5-10 days.
If the disease recurs, acyclovir or valacic-lovin is prescribed according to the same schemes, but lasting 10 days.
- glycyrrhizic acid in the form of a spray intravaginally 2-3 times a day for 6-10 days, on the skin of the vulva 6 times a day for 5-10 days;
- vidarabine 10% gel on the affected areas 4 times a day for 7 days;
- rhyodoxol 0,25-1% ointment for 5-10 days;
- acyclovir 3-5% ointment 5 times a day for 5-10 days.
Complex approach implies the use of non-specific (T-activin, thymalin, thymogen, myelopide according to standard schemes) and specific (antiherpetic gamma globulin, herpetic vaccine) immunotherapy. An extremely important link in the treatment of herpes is the correction of disturbances in the interferon system as the main barrier to the introduction of viral infections into the body. A good effect is given by inducers of the synthesis of endogenous interferon: semi-dense in the form of applications on the affected mucous membranes; tsikloferon 0.25 g intramuscularly or 0,3-0,6 g orally on 1-2-4-6-8-11-14-17-20-23 day; neovir 250 mg intramuscularly every 48 hours, 5-7 injections; amixin 250 mg once a day for 2 days, then 125 mg every other day for 3-4 weeks. As substitution therapy, interferon preparations are used – viferon in rectal suppositories, reaferon intramuscularly, etc.
In addition, the local use of antiseptics is recommended to prevent secondary purulent infection.
To prevent recurrence, a herpetic vaccine, immune preparations, interferonogens are used, as well as:
- acyclovir 400 mg orally 2 times a day;
- valaciclovir 500 mg once a day;
- glycyrrhizic acid 2 times a day in the morning on the skin of the vulva and intravaginally for 8-10 days before the onset of menstruation.
The duration of therapy is determined individually.
Treatment of pregnant women is mandatory for these schemes. Caesarean section as a prophylaxis of neonatal herpes is indicated only with herpetic eruptions on the genitals or at the first clinical episode with the mother during the last month before the birth. In other cases, delivery through natural birth can be possible.
Criteria for the effectiveness of treatment are the disappearance of clinical manifestations of the disease (relapse), positive dynamics of the titer of specific antibodies.