Genital herpes. The causative agent of the disease, routes of infection, treatment

Herpes in the intimate area in women or genital herpes in women is one of the most common clinical types of sexually transmitted herpes infection. Genital herpes in women is characterized by the appearance of characteristic rashes on the skin and mucous membranes in the urogenital and/or anal area, characterized by variability in the clinical picture and a tendency towards a persistent recurrent course.

The causative agent of genital herpes is the herpes simplex virus (HSV, Herpes Simplex virus).

Fact Infection with genital herpes in 76% of cases is caused by HSV-2 and in 24% by HSV-1.

In most patients, the causative agent of genital herpes is herpes simplex virus type 2 (HSV-2). There are cases of genital herpes caused by HSV type 1, which reflects the increased prevalence of oral-genital contact in various population groups. In some patients, the disease can be caused simultaneously by two types of herpes simplex virus (HSV-2 and HSV-1).

Symptoms of genital herpes

Herpes virus types 1 and 2 cause classic symptoms of the disease:

• painful rashes in the form of bubbles with clear liquid, which are concentrated in groups on the skin, on the oral mucosa, genitals, pubis, buttocks, and anus;
• when ulcers form, they burst and fluid flows out;
• After the bursting ulcers begin to dry out, severe pain is felt, and the ulcers may bleed.

Often people ignore the initial stage - redness, itching and swelling. It is at this stage that treatment of the disease is most effective.

Clinical picture

Both types of herpes simplex virus can cause primary and recurrent infections. The course of the disease depends on the age and immune status of the person. In addition, it is necessary to take into account the genetic characteristics of the virus. Primary infection with HSV-1 and HSV-2 is characterized by generalized symptoms and a high incidence of complications. In contrast, recurrent genital herpes is characterized by mild symptoms and periodic remissions. A high frequency of relapses is observed in patients with congenital and acquired forms of immunodeficiency.

Primary genital herpes

The pathology is manifested by external pathological signs associated with damage to the mucous membranes and systemic symptoms. If the patient suffered a type 1 herpetic infection before being infected with HSV-2, a milder course of the disease is observed. Early signs of the disease include redness of the mucous membranes of the genital organs, ulcerations, and the appearance of blisters on the skin. Patients also complain of headache, general malaise, myalgia and fever.

Other symptoms and signs:

• Discharge from the vagina and penis.
• Enlargement of nearby lymph nodes.
• Severe itching in the area of ​​the infection gate.
• Swelling of the mucous membranes.
• Painful urination.

In women, the largest accumulation of vesicles is observed in the area of ​​the labia majora and minora. Ulcerations can also occur in the mucous membrane of the cervical canal and urethra. In men, the virus affects the glans penis, foreskin and skin of the scrotum. Ulcers can also form in the anal area. The first complications of genital herpes include inflammation of the urethra and cervicitis in women. Skin changes persist for two weeks, after which tissue re-epithelialization occurs.

Recurrent herpes

Repeated episodes of the disease occur in 50-75% of patients who have had acute genital herpes. Signs of pathology remain, but symptoms may be more subdued. Periods of absence of clinical manifestations of infection (remission) continue for several weeks or months. In severe cases of the disease, monthly relapses are possible.

A day before the formation of ulcers, many patients experience redness of the skin of the genital organs. Another specific sign of recurrent infection is neuralgia of the sacral spine. Vesicles persist for 5-8 days. Women tend to have more ulcerations in the labia majora and labia minora.

The patient’s quality of life decreases due to constant exacerbations of the disease. Patients complain of insomnia, irritability, loss of appetite, depression and apathy. Neurological complications of herpetic infection occur less frequently during relapses, but the prognosis largely depends on the person’s immune status.

Non-standard clinical picture

Atypical genital herpes can be characterized exclusively by a latent course or erased symptoms. The patient is found to have chronic inflammation of the urethra and genital organs, without ulceration. In this case, differential diagnosis based on laboratory tests is necessary.

Spread of atypical infection:

1. The virus affects the external genitalia.
2. The infectious agent gradually moves to the area of ​​the vagina, cervix and urethra.
3. The virus causes inflammation of the prostate gland, uterus, bladder and other organs.

This form of the disease is detected in every third patient. An ascending infection that affects the internal genital organs often causes dangerous complications. True asymptomatic herpes is diagnosed in approximately 1-2% of patients.

Genital herpes in men

In men, the second type of virus is most common. When engaging in oral sex, approximately 24 percent have type 1 herpes. More often it is a combination of two types of herpes simplex.

The disease in men is characterized by rashes in the penis, testicles, and anus.

During the period of weakening of the body, the virus manifests itself in rashes. And in a latent form it occurs as a chronic pathology. It gradually affects the autonomic and central nervous system, the mucous membranes of the urethra. And when the process is generalized - the liver, brain and other organs.

Herpes appears 2-4 days after infection. It could be:

• slight increase in temperature;
• general malaise, weakness;
• pain and aches in the joints and muscles may be observed;
• there may be tingling and burning of the skin in the groin area;
• painful urination;
• the appearance of a pimple or group of pimples on the head of the penis or scrotum.

If no other infection occurs, the symptoms disappear on their own.

The virus is transmitted to a partner through sexual contact - oral, anal or classical. Infection can occur not necessarily when there is a rash on the skin, but also during the asymptomatic period of the disease.

A man also becomes infected from a sick woman, even if she has no symptoms of the disease. The virus is present in vaginal secretions and urine, as well as in saliva. If a woman has herpes on her lips (type 1), it can be transmitted to a man through oral sex, and the rash will appear on the penis.

Answers to frequently asked questions on venereology:

• How to prepare for an appointment with a venereologist?
• How to get tested for sexually transmitted diseases?
• What tests can be done by a venereologist at the clinic?
• What symptoms should you consult a venereologist for?
• What diseases does a venereologist treat?
• What diagnostics can a venereologist perform in your clinic?
• How to call a venereologist at home?
• Venereological care at home
• Venereological care in the clinic
• What equipment does the venereologist use in our clinic?
• How to make an appointment with a venereologist?

Forms of the disease

There are two forms of genital herpes: primary and recurrent. Primary genital herpes is said to occur when clinical signs appear for the first time after infection, which can happen after a couple of weeks or in some cases months. Recurrent herpes is a periodic exacerbation of the disease with the slightest weakening of the immune system. Depending on the number of exacerbations of relapses of genital herpes throughout the year, 3 degrees of severity are distinguished:

• mild degree – the number of relapses is 3 or less per year;
• moderate – exacerbations occur 4–6 times a year;
• severe - relapses occur monthly.

During the course of the disease:

All factors that suppress immunity in genital herpes are also causes of exacerbation.

Genital herpes in women

Infection occurs mainly through unprotected sexual contact with a sick man. Moreover, it is possible to get the virus through oral and anal sex. It is possible that the virus can be transferred by hands to the genitals.

If a woman has herpes, rashes are observed on:

• labia, groin area, buttocks;
• in the vestibule of the vagina;
• in the perineum;
• on the walls of the vagina, on the cervix;
• on the rectal mucosa.

Women become infected with herpes more often than men, since there are more accessible areas covered with mucous membrane. It is not necessary that the man have clinical manifestations of the disease in the form of rashes. The virus is found in semen and urine.

Herpes in women can cause early and late miscarriages and damage to the fetus during pregnancy.

Herpes of the bladder and urethral canal is also found. When the disease worsens, urination is very painful and bloody. May be accompanied by bladder pain and fever.

The pathological process may involve the mucous membrane of the rectum (cracks form), pain in the pelvis and in the area of ​​the projection of the uterus, damage to the ovaries (symptoms of irritation of the pelvic nerve coupling). More often, such manifestations occur before or immediately after menstruation.

The nature of the disease is not always determined and recognized. Sometimes women are treated with antiviral and antibacterial drugs to no avail and for a long time.

Atypical form

The atypical form of the pathological process is characterized by an erased abortive course, which affects not only the external genitalia, but also the internal genital organs. As a rule, this form of infection is characteristic of chronic recurrent herpes, but at the same time, it can also occur with primary lesions.

It's no secret that many chronic pathologies of the genital organs are diagnosed as diseases of unknown etiology. This is due to the inability to identify the cause of the disease, and therefore the prescribed treatment is very often ineffective. It is in such cases that good specialists suspect the development of an atypical form of herpesvirus infection.

Genital herpes in children

Children are very susceptible to herpes. A child born from a sick mother runs the risk of contracting herpes at birth. The child's eyes, mouth, and nose are most susceptible. Infection at birth occurs in 40 percent of cases.

Intrauterine infection of the fetus, which more often ends in the death of the child, cannot be ruled out.

The child is at risk of infection during kisses from adults, as well as when they lick the baby's pacifier.

A child is susceptible to the disease both in kindergarten and at school if there are sick children. It has been proven that the herpes virus can even be transmitted through airborne droplets.

Still, genital herpes spreads more often through sexual contact, and the household contact route is not very common. Although the virus easily tolerates low temperatures, it lives in the external environment, outside the human body, for no more than 6 hours.

Teenagers are at risk of becoming infected through unprotected sex.

If herpes is not treated, it causes damage to internal organs.

Herpes in a child manifests itself mainly as rashes on the nose, lips, and neck. But it can also become widespread during an exacerbation, causing myocarditis, meningitis, chronic bronchitis and other inflammatory pathologies of internal organs.

It is possible that herpetic rashes may appear on the genitals of children. In boys - on the penis and scrotum, in girls - on the labia and vagina.

In children under one year of age, herpes occurs in three forms:

• Generalized - the genitals are affected, rashes are observed on the genitals and in the area of ​​the inguinal folds, body temperature rises. There is a high probability of death, urgent medical attention is required.
• Localized. Possible rash in a separate area, swelling of the affected area. Bubbles can be on the genitals, on the cornea of ​​the eye. If the eye is affected, blindness may occur.
• Brain damage. During the first weeks of life, this form of the disease can cause body temperature up to 40 degrees, severe vomiting and convulsions. Next - loss of consciousness and coma. Up to 50 percent of babies die. If help is provided on time, treatment can take up to 6 months; the signs of genital herpes disappear.

Genital herpes in children often manifests itself as rashes in the nasolabial area, but also on the genitals.

Asymptomatic course of the disease

The first infection with the herpes simplex virus is often called the primary infection. Such an infection can cause symptoms of the disease, but this does not occur in all cases. After the primary infection, the virus is not eliminated from the body; it lives in it in the form of an inactive form (in sleep mode).

In some people, the virus “wakes up” from time to time and enters the surface of the skin. This, in turn, causes a relapse of the viral disease on both the genitals and lips.

For most people, infection with the herpes virus in intimate areas is not a cause for concern. At least 8 out of 10 people with genital herpes don't even know they have it. Sometimes only very mild symptoms may appear that are difficult to associate with genital herpes. Such symptoms may include a slight burning sensation or slight redness that quickly disappears.

In such people, the virus remains dormant and never causes a wave of symptoms to return. However, even those who develop the disease asymptomatically are dangerous to their sexual partners. It is in such cases that infection with the herpes virus occurs.

What does genital herpes look like?

Genital herpes is characterized by rashes on the penis, on the head of the penis, in the vagina, on the urethra, on the cervix, in the anus, on the rectal mucosa.

The incubation period lasts from 2 to 14 days. And then the characteristic herpes blisters are visible:

• small in size, grouped together;
• filled with a clear liquid that contains a huge number of viruses;
• after opening the bubbles, an ulcer forms, which dries out with a crust.

Itching and burning occur during the period of redness and swelling of the skin or mucous membrane. Then the pain intensifies with the formation of erosions and ulcers. The size of the affected skin can vary from 0.5 to 3 centimeters.

There may be many bubbles, or there may be just a few. If bacterial flora joins the ulcers, the wounds become covered with purulent plaque.

No blisters form on the mucous membrane of the vulva, but an ulcer immediately appears.

If herpes rashes form on the cervix or vagina, sexual intercourse becomes impossible due to severe pain.

Symptoms of sexually transmitted diseases:

• Discharge from the urethra
• Vaginal discharge
• Itching in the vagina
• Discharge from the genitals
• Pain in the scrotum
• Pain when urinating
• Itching in the urethra
• Blood in sperm
• Itching of the vulva
• Pus on the labia
• Burning in the urethra
• Perineal pain
• Redness of the glans penis
• Frequent urination
• Itching of the glans penis
• Itching of the scrotum
• Rectal prolapse
• Foreskin rupture

Recurrent herpes

Recurrences of genital herpes are observed in 50-70% of women and men after the disappearance of the primary signs of the disease.

The frequency of relapses and the duration of remissions are very variable - from once every 2-3 years to monthly exacerbations. The frequency of relapses and the severity of the clinical picture can be criteria for the severity of the process. With a mild form of chronic herpetic infection, exacerbations occur no more than 1-3 times a year, with a moderate form - 4-6 times a year. Severe course is characterized by monthly exacerbation of the disease.

How does genital herpes become infected?

Infection with genital herpes occurs mainly during sexual contact, less often through kissing, during childbirth, and breastfeeding.

All types of sex - oral, anal and vaginal - can cause the disease. A condom cannot always protect against infection. Latex sometimes does not cover all areas of herpes rashes. Even if the sick partner does not have rashes, infection can occur through saliva or semen.

You cannot become infected with genital herpes if you:

• using a public toilet;
• pastel accessories of the patient;
• sharing soap, washcloths, towels, cutlery and dishes;
• when swimming in the pool and coming into contact with objects.

The partner may not know about his illness and pass it on to others. And if he knows, he can take medications to suppress the virus. In this case, the risk of transmitting the infection to a sexual partner is reduced to a minimum. In any case, it is worth discussing the degree of risk with your doctor.

Risk factors

Certain conditions and symptoms may contribute to viral invasion.
Risk factors may be associated with primary diseases and a person's lifestyle. Predisposition factors for genital herpes:

• gender (Women are much more likely to be diagnosed with the disease);
• unprotected sex. (using a polyurethane or latex condom helps reduce the chance of infection);
• promiscuity;
• the presence of other infections affecting the genital organs;
• dysfunction of the immune system, including acquired immunodeficiency;
• carrying out various surgical interventions in non-sterile conditions.

Preventive measures help reduce the risk of viral invasion.

Incubation period of genital herpes

The insidiousness of the disease genital herpes is that it can remain in a “dormant” state for years and even a lifetime. But at the same time, the patient is able to transmit it to others.

The incubation period of the disease depends on the type of herpes and the state of the person’s immune system.

It can be primary or secondary:

With primary genital herpes, the latent period is up to 10 days. In the primary form, the disease usually occurs with more severe symptoms than subsequent relapses. But only 10 percent of those infected develop rashes on the genitals in the form of small blisters after the initial infection.

After 2-4 days, the clear liquid inside the pimples becomes cloudier, they burst and weeping ulcers form. All the time, from the beginning of skin redness to ulcers, the affected area itches, itches and hurts. The temperature may rise to 38 degrees and the lymph nodes may enlarge. Even if left untreated, all symptoms disappear within 2-3 weeks. A red spot remains at the site of the ulcers, and then the color of the skin returns to normal. Relapse may occur after several weeks or even years.

Chronic or recurrent herpes disrupts the normal functioning of the reproductive and urinary systems and is difficult to treat. Within 3-5 days, rashes may appear on the genitals, or swelling, soreness, or a burning sensation will simply appear. General health worsens, the person feels weak and tired. The inguinal lymph nodes usually enlarge on one side.

A recurrent form of herpes occurs in 30-50 percent of those infected.

Development of disease relapses

Some people sometimes experience recurrences of genital herpes. Scientists are unable to explain why, after the latent stage, the virus is activated from time to time, that is, the reasons for the relapse have not been established. Factors that contribute to the development of the virus and relapse of the disease are known:

• influenza, ARVI, other diseases with high body temperature;
• local damage to the external genitalia, as well as the mouth and lips;
• decreased defense mechanisms, immunodeficiency;
• ultraviolet radiation, a side effect of radiation therapy;
• changes in a woman’s immune system during menstruation;
• hypothermia;
• stress;
• excessive alcohol consumption.

ARVI

Stress

Relapses are often milder and last shorter than the first wave of the disease. In case of relapses, symptoms usually occur within 7 to 10 days. Most people do not complain of either elevated body temperature or poor health. A relapse of the disease may be indicated by a slight tingling sensation or itching of the genitals for 12-24 hours.

Over time, relapses of genital herpes appear less frequently. The frequency of their occurrence may vary. For some people they occur six or more times during the year, for others much less often. As a rule, during the first 2 years from the first wave of symptoms, relapses occur 4 to 5 times. Some people do not relapse at all.

The causative agent of genital herpes

The causative agent of herpes simplex is the herpes virus type 1 (HSV), which is characterized by painful rashes on the skin and mucous membranes in the form of blisters (vasicles). They most often affect the face and upper extremities. But they can also occur on the genitals.

Genital herpes is most often simple herpes of the second type. The virus affects the genitals and manifests itself as itchy rashes.

The pathogen enters the body of a healthy person, mainly through sexual contact, but also through blood transfusions and organ transplants. It is transmitted in 40 percent of cases during childbirth - from a sick mother to the child, as well as through the placenta during pregnancy.

The virus is small in size, penetrates through microtraumas, enters the bloodstream and lymph and immediately integrates into healthy cells, causing their death. Viral particles remain inactive for life in the nerve ganglia of the central nervous system.

In case of facial herpes, the virus lives in the ganglia of the trigeminal nerve, in case of genital herpes - in the ganglia of the lumbosacral spine. From there, the virus spreads to all other areas as the outbreak of infection grows.

The virus is characterized by its multifocality. The causative agent of herpes can concentrate in lymphocytes (blood cells) and lead to disruption of immune mechanisms. This is expressed in frequent colds, decreased performance, and enlarged lymph nodes. Herpes also affects the membranes of the brain, can contribute to the occurrence of meningitis, and causes nervous disorders and vegetative-vascular manifestations.

Diagnostics

The diagnosis is made by a doctor based on the patient’s complaints and examination, during which a characteristic rash and enlarged lymph nodes can be detected. If an external examination does not reveal a rash, the doctor takes material for laboratory tests.

In addition, you need to know how to detect genital herpes using laboratory methods. Can:

1. Determine the disease using the PCR method during the period of relapse (the most effective), which determines not only the presence of the virus in the body, but also its type. Subject to sterility and temperature conditions, material taken from the site of the rash allows you to obtain results within 5 hours;
2. Identify antibodies to the virus by conducting blood tests;
3. Identify the virus by examining material taken from the location of the rash;
4. Conduct an enzyme-linked immunosorbent assay, which determines the presence of antibodies and evaluates the patient's immunity.

Since there are diseases similar to genital herpes in their manifestations (ulcers and erosions on the genitals), self-medication should not be done.

Herpes or so-called stomatitis on the genitals resembles:

1. Chancroid, sexually transmitted but rare in Europe and Asia;
2. Erosion resulting from trauma;
3. Syphilis.

Since the presence of antibodies alone cannot serve as a basis for the diagnosis of “genital herpes” (in women, the presence of antibodies to type 2 herpes is more likely, and antibodies are formed by 6-12 weeks after infection), it is additionally necessary to isolate the virus or use the PCR method.

Factors that provoke genital herpes

The virus does not manifest itself until the human body restrains it due to its protective forces - immunity. The trigger for the growth of the virus are factors such as:

• emotional and physical exhaustion;
• hypothermia;
• period;
• surgical interventions;
• infectious diseases.

There are cases where the provoking factor was ultraviolet exposure to sunlight.

With good immunity, the virus may not detect itself at all throughout life. In this case, the person acts as a virus carrier and is able to infect others.

Treatment of herpes in the intimate area with folk remedies: will traditional medicine help?

Traditional medicine existed in all periods of human history, and the experience of traditional healers multiplied over the millennia and was passed on from generation to generation. True, one cannot help but admit that today many of the recipes that our ancestors used have been lost and forgotten, and the assessment of traditional medicine by specialists is still ambiguous. What happens when treated with traditional medicine methods

Today, traditional medicine offers both rational methods, which, under certain conditions, can really help cope with various diseases, and irrational ones, which deserve critical evaluation by doctors. But this does not stop those who, instead of turning to a specialist, decided to help themselves on their own by testing the effectiveness of traditional medicine recipes. As a rule, such people will be disappointed - no decoctions, infusions, applications of medicinal herbs and other drugs prepared at home can help get rid of the manifestations of herpes in the intimate area. It must be remembered that refusal to see a doctor and lack of adequate treatment can lead to unpredictable consequences and the development of life-threatening complications.

Only antiviral drugs that not only relieve symptoms, but also fight the root cause of the disease can help reduce the severity and shorten the course of the disease.

Diagnosis of genital herpes

Despite the characteristic rash of herpes, other diagnostic data are also necessary to clarify the diagnosis. These tests also make it possible to determine the type of virus.

The doctor must refer the patient to:

• general blood analysis;
• blood testing for the presence of hidden infections, primarily herpes viruses;
• ultrasound diagnostics of the pelvic organs;
• diagnosis of vaginal microflora by examining a vaginal smear.

Sometimes you may need to consult other specialists - a urologist, gynecologist, cardiologist, neurologist.

Manifestations and symptoms of herpes in the intimate area in women and men

Herpetic cystitis of women

Herpetic cystitis is a pathology characterized by inflammatory processes in the bladder caused by the herpes virus. This disease manifests itself as discomfort when urinating and hyperemia of the skin and mucous membranes. Women are especially often bothered by the urge to urinate at night. If left untreated, herpetic cystitis can lead to complications, including herpetic salpingoophoritis. In this case, the inflammation affects the ovaries and fallopian tubes.

Herpes of the urethra and bladder

The disease makes itself felt by painful sensations and pain when urinating. There is a frequent urge to go to the toilet, there may be blood in the urine and discomfort in the bladder area. In men, detection of the herpes simplex virus in the urine may indicate inflammation of the prostate gland.

If you suspect herpetic prostatitis, which is characterized by frequent relapses, the patient must undergo a special examination for sexually transmitted infections of a viral nature.

Herpetic lesions of the anal area and rectum

The disease manifests itself with itching, burning and pain in the affected area. Bleeding may occur during bowel movements. As the disease develops, erosions and cracks form on the mucous membrane, which are often attempted to be treated only surgically, without the use of drug antiviral treatment.

What tests need to be taken for genital herpes

A reliable diagnosis and identification of the type of herpes can be made through laboratory and diagnostic tests.

The analyzes can be divided into two main groups:

• isolation and identification of the herpes virus from scrapings from ulcers and blisters, from blood and urine;
• determination of antibodies (protective proteins) to the herpes virus in blood serum.

Our laboratory uses a culture method - liquid is taken from herpetic eruptions for examination. She is hooked up to a chicken embryo. By the characteristic lesions of the embryo, one can judge the presence of HSV. The study lasts for two weeks and gives an accurate result about the herpetic nature of the disease.

To determine the type of herpes virus, a proven method is used - polymerase chain reaction. Biomaterial is taken from the rash sites. Within a day or two, a test is carried out, which gives an accurate result of 95-100 percent. The virus can be detected during a relapse. During the period of remission, this method is not used.

Serodiagnosis - the presence of specific antibodies in the blood serum can be determined 4-7 days after infection. After 2-3 weeks the virus reaches its peak. The test gives an idea of ​​the growth of the focus of infection, and also allows you to determine which class of herpes viruses the pathogen belongs to. A similar analysis is carried out twice with an interval of several days.

Complications

Genital herpes itself does not cause serious illness. However, its complications, which are often observed in people with weak immune systems (especially those with HIV infection), can pose a serious threat to health and even life.

1. Herpetic eczema is a skin lesion that leads to the appearance of a rash similar to that of eczema;
2. Herpetic keratoconjunctivitis is a lesion of the cornea and mucous membrane of the conjunctiva of the eye. Manifested by photophobia, burning, lacrimation, redness of the eye. Small white spots appear on the surface of the cornea, causing itching and pain. Without treatment, vision loss is possible;
3. Herpetic encephalitis is an inflammation of the brain caused by the HSV type 2 virus. Without treatment, the complication leads to death. The virus infects nerve cells in the cerebral cortex, leading to focal and general brain symptoms. Complete cure is possible with adequate and timely therapy;
4. Intrauterine herpes is the transmission of infection from mother to child. Primary infection is dangerous, which leads to damage to the fetal nervous system;
5. Herpetic meningitis is an inflammation of the meninges caused by the HSV type 2 virus. A severe complication leading to a number of neurological symptoms, including convulsions, severe headaches, and disturbances in the circulation of cerebrospinal fluid.

In people with normal immune status, complications are rare. On average, the acute phase of infection during primary infection lasts several weeks. During this period, the infected person releases a large number of viral particles with biological fluids. Carriage lasts up to 1 year. In most cases, the immune system controls the infection and suppresses its activity. This occurs due to the production of antibodies directed against the virus. During the period of remission, the virus remains only in the nerve cells of the sensitive nerve plexuses.

In patients with immunodeficiency, the herpes simplex virus often causes complications. Infection is especially dangerous in patients with AIDS. Herpetic lesions in such patients are extensive and often occur in the form of severe meningoencephalitis with a fatal outcome.

Treatment of genital herpes

Herpes cannot be cured completely. But it is possible to suppress the growth of the pathogen quite effectively. Medicine has in its arsenal a list of various drugs that allow not only to successfully fight viruses, but also to achieve lasting clinical results. Medicinal effects make it possible to keep the virus under control and prevent it from becoming more active.

There are two main directions in treatment:

• use of antiviral drugs based on acyclovir-containing drugs;
• complex therapy, including immunotherapy and antiviral effects.

During outbreaks of the disease, creams Zavirax, Vatrex, Acyclovir-Acri, Virolex are usually used. They also come in tablet form.

If the herpes virus has caused immunodeficiency, then means are used to increase the body's defenses. The virus provokes colds, so during the season of respiratory viral infections, drugs are used that promote the production of interferon in the body. These are herbal immunostimulants Immunal, synthetic drugs ArbidolA, ViferonA, Kipferon. It is advisable to use them before the start of the cold season - in autumn weather or spring hypovitaminosis.

For patients suffering from a recurrent form of herpes, the doctor usually prescribes Taktivin, Timalin, Timogen, Myelopid, and so on. In this case, the immunogram is monitored.

Tablet forms of medications are best combined with creams, gels and ointments.

Treatment

Drug therapy for genital herpes involves the use of antiviral drugs. The most commonly used drugs are equally effective against HSV-1 and HSV-2, but the treatment regimen also depends on the location and clinical course of the infection. Since even the most modern antiviral drugs are not able to destroy all pathogens in the patient’s body, the main goal of treatment is to relieve symptoms and prevent relapses.

Prescribed medications:

• acyclovir, valacyclovir and other drugs that block viral DNA replication;
• ointments for topical use based on antiviral drugs;
• non-steroidal anti-inflammatory drugs;
• local anesthetics to relieve itching and pain.

If a life-threatening complication (for example, encephalitis) is detected in patients with reduced immunity, intravenous administration of acyclovir in high doses is indicated. This treatment is most often required by HIV-infected patients. If resistance to acyclovir is detected, patients are prescribed cidofovir and foscarnet.

Other therapies

Some treatments are still in development or simply have not undergone all the necessary trials. Today, the most promising method of treating herpes is gene therapy. According to research, the use of CRISPR technology for genome editing will make it possible in the future to completely remove the virus from the body of patients.

There are also alternative medications, the effectiveness of which has only been proven in isolated studies. These are lysine-based nutritional supplements, as well as ointments containing zinc oxide, aloe vera extract and propolis. The use of such agents helps eliminate the inflammatory process and accelerate tissue regeneration. The use of any additional medications in the treatment of herpes should be discussed with your doctor first.

Ointments for genital herpes

Ointments are always used to treat herpes. Some of the most effective are:

• Acyclovir
  , it is prescribed most often, it quickly suppresses the reproduction of the virus, the rash goes away in a short time.
• Valtrex
  has approximately the same effect as Acyclovir. But it allows Acyclovir to remain in the body longer. Used in more complex situations.
• Zovirax
  is the same Acyclovir, only its original version. The mechanism of action of the drug is based on breaking the DNA helix of the virus.
• Famvir
  is a new drug. It is prescribed for recurrent herpetic infections, including in people who have reduced immunity.
• Erazaban
  . It has a unique antiviral effect, not only destroys the virus, but also prevents it from entering a healthy cell. The cream is applied to the rash, as well as to the area of ​​skin around it. The product prevents the formation of bubbles if applied during the period of skin redness.
• Virgan
  is a special gel that is used for ophthalmoherpes. It disrupts the formation of viral hereditary material. Its action is similar to Acyclovir.
• Oxolinic ointment
  is an excellent antiviral agent. It is widely used, including for the fight against herpes.
• Herpferon ointment
  can be used both for the treatment and prevention of genital herpes. This ointment contains acyclovir, an antiviral agent, as well as interferon, an antiviral protein, the deficiency of which is believed to lead to relapses of the disease.

Creams and ointments are best used at the first manifestations of herpes - at the stage of formation of redness and swelling, when the rash has not yet formed.

Do not touch herpes rashes with your hands. Otherwise, it’s easy to spread the virus into your eyes later.

There will be a risk of severe damage to the cornea. If immunity is greatly reduced, then ophthalmoherpes can cause herpetic encephalitis with a high probability of death.

Diagnosis of sexually transmitted diseases:

• Calling a venereologist to your home
• Diagnosis of sexually transmitted diseases
• Prevention of casual sex
• Urethral swab
• Cervical smear
• Anal swab
• Vaginal smear
• Sexually transmitted diseases
• Tests for STIs
• Mushroom tests
• Diagnosis of prostate diseases
• Prostate massage
• Treatment of sexually transmitted diseases
• Diagnosis of scrotal diseases
• Testing for STIs at home
• Ultrasound of the prostate
• Ultrasound of the penis
• Tests for syphilis
• Make an appointment with a venereologist

Prevention

In order to prevent genital herpes, experts recommend constantly taking measures to strengthen the immune system, as well as directing your efforts to preventing possible infection.

usually occurs sexually) from a sick person to a healthy person. Manifested by the following symptom complex: rash (vesicles) on the genitals – purulent pustules – purulent ulcers – scabs. The duration of the disease is 30 days. Discharge, problems with urination, and enlarged or inflamed lymph nodes in the groin are also observed.

Currently, many developed countries are actively developing preventive herpetic vaccines that protect against infection, and therefore we can hope that in a few years humanity will be able to receive an effective vaccine against herpes.

Prevention of genital herpes

The main preventive method is personal sexual abstinence, exclusion of casual sexual contacts, and the use of condoms:

• If casual sex occurs, it is necessary, without delaying for long, to undergo a full examination for the presence of hidden sexually transmitted infections.
• If signs of herpes or other suspicious symptoms appear, you should immediately visit a medical facility, get tested and begin timely treatment.
• It is worth excluding situations when you have to use other people’s hygiene products - towels, washcloths; everyone should have their own set of hygiene products, including in the family.
• It is not recommended to kiss children on the lips or use someone else's lipstick.
• If infection occurs, the patient must take medications to contain the virus and prevent the spread of infection.

Considering that the virus can be in the body undetected, it is worth regularly undergoing preventive tests to make sure that you are not carrying the virus.

It is also worth supporting the body and its immunity. Lead a healthy lifestyle, eat right, maintain intimate hygiene.

There is no 100% guarantee against infection. However, risky factors should be avoided. If casual sex occurs, herpferon ointment should be used for prevention within the next hour or two. And then be sure to get tested for antibodies.

Infection in newborns

Typically, infection of a child occurs after rupture of the membranes or directly during childbirth. HSV-2 primarily affects the mucous membrane of the mouth and respiratory tract. The virus can subsequently spread through the body through the bloodstream and cause more severe complications. The independent transfer of the pathogen to other anatomical areas should not be ruled out.

Features of the disease in newborns:

• ulceration of the mucous membranes with the formation of foci of hemorrhage;
• eye damage. (pathology causes inflammation of the cornea, conjunctiva and choroid of the organ);
• prolonged fever;
• inflammation of the brain and its membranes;
• neurological disorders;
• breathing problems;
• vascular insufficiency.

The complications listed above most often occur 10-14 days after the manifestation of the disease, when the infectious process becomes generalized.

Complication of genital herpes

Genital herpes leads to serious consequences. Once in the body, it causes not only skin rashes and itching. It can cause:

• Alzheimer's disease;
• meningitis, inflammation of the membranes of the brain;
• damage to the pelvic nerves;
• miscarriage, fetal death, premature birth;
• damage to organs and systems in a newborn child;
• blindness;
• neuralgic manifestations;
• frequent colds, chronic bronchitis, pneumonia;
• inflammation of the genitourinary system;
• infertility;
• inflammation of the gastrointestinal tract;
• provokes cystitis, vasiculitis, thrush.

Complications of herpes are difficult to treat. The herpes nature of the disease is difficult to diagnose. Sometimes people do not associate these illnesses with herpes infection.

In order to correctly diagnose the causes of the disease, it is recommended to undergo a herpes test.

If herpes appears frequently and in large numbers, this indicates serious disruptions in the immune system. In such cases, you will need the help of an immunologist.

What happens after infection?

One of the characteristics that distinguishes viruses from the herpes virus family from other types of viruses is latency. HSV and other herpes viruses have the ability to create small but permanent colonies of viral particles inside the body. These colonies are often completely inactive (or dormant), but they remain in the body for life.

As soon as HSV gains a foothold in the body, it begins to create copies of itself and spread. This can lead to a clinical picture of the infection ranging from mild and unnoticed symptoms to severe illness. In response to this, the immune system mobilizes its forces and limits the spread of HSV. Regardless of the severity of symptoms, the virus remains in the body. To avoid the immune system, HSV “retreats” along the nerve fibers and hides in the nerve ganglia. In the case of genital herpes, the virus is located in the sacral plexus of ganglia, located at the base of the spine. In the ganglia, the virus remains inactive (latent) for an indefinite period of time.

The phenomenon of latency is similar to the sleep cycle. Basically, the virus remains dormant in a safe place, sometimes for a very long time. Unfortunately, various biological events can activate HSV, after which the virus spreads along nerve fibers back to the skin. This may cause the symptoms and signs of genital herpes to reappear.

It is difficult to answer the question of how often the virus can be activated. Previously, it was believed that all cases of HSV activation lead to the development of a clinical picture of the disease. Research then revealed that the virus can become active without causing noticeable symptoms or signs—no itching, no pain, no rash. This phenomenon is called "asymptomatic reactivation."

Asymptomatic reactivation refers to the following situations:

1. Some herpetic eruptions may appear in places that are difficult or impossible to see.
2. Some herpetic lesions can be mistaken for something else, such as an ingrown hair.
3. Some manifestations of herpes cannot be seen with the naked eye.

The fact is that when the herpes virus is activated and moves to the surface of the skin or mucous membranes, it is difficult for even a doctor to notice. In addition, even for a person with symptoms and signs of genital herpes, several days pass before the full clinical picture develops, during which he will not be aware of the reactivation of the virus.

Which doctor treats genital herpes

Genital herpes is treated by a venereologist. A venereologist is a specialized specialist who deals with the treatment, diagnosis and prevention of sexually transmitted diseases. Herpes is a sexually transmitted disease, as it is transmitted primarily through sexual contact.

In our clinic, the venereologist has extensive experience and specialization in treating adults and children from genital herpes.

In case of existing complications of herpes, he can refer the patient for additional consultation with a neurologist, gastroenterologist, gynecologist, urologist, or proctologist.

A dermatologist, a doctor who treats diseases of the skin and mucous membranes, can also provide assistance. The dermatologist at our clinic has gained extensive experience in treating all major types of herpes.

Diet

When doing treatment at home, you must follow a diet. This will help prevent the herpes from getting worse. The principle of the diet is a high content of lysine, a small amount of arginine.

1. Allowed foods include low-fat dairy products, beef, chicken, various fish and seafood.
2. For dessert you can eat ice cream or drink coffee with cream.
3. Blackberries, black currants, peaches, apples, bananas help cleanse the body.
4. Additionally, your daily diet should include garlic and brewer's yeast (you can use pharmaceutical preparations in the form of capsules).
5. You can eat a little green onion salad dressed with olive oil three times a day. The dish is rich in retinol and ascorbic acid, which helps strengthen the body.

Alcohol should be avoided completely. Minimize consumption of sugar, sweets and nuts.

Where to go for genital herpes

It is necessary to seek diagnosis and treatment of genital herpes at a specialized medical institution. Advantages of seeking help from our clinic:

• We accept appointments any day, seven days a week, which is very convenient for working citizens;
• There is a service to call a doctor at home (diagnosis, treatment, monitoring of recovery);
• an individual approach to each client is carried out;
• comfortable and favorable conditions for patients have been created;
• has its own laboratory to conduct the necessary laboratory and instrumental studies;
• doctors and all medical personnel work in a single team and jointly manage the patient, any issues during treatment are resolved, and if necessary, a medical council is created;
• always friendly attitude;
• confidentiality.

All clinic services are certified. We are responsible and provide guarantees. Calling a dermatologist to your home for genital herpes

In some cases, the patient cannot visit the clinic in person. Or for some reason he doesn’t want to do this. Our clinic offers a doctor's home call. You can contact us on any convenient day and discuss the doctor’s arrival time.

The service is popular due to a number of advantages:

• a doctor’s visit to your home is very convenient for people with limited mobility – pensioners, frail people, disabled people, blind people, post-operative people;
• Complete anonymity of treatment is maintained;
• at home, the doctor provides the same services as within the walls of the medical institution;
• all types of tests can be taken at home, they will be sent to the laboratory in special containers;
• a doctor at home can conduct instrumental diagnostics if necessary (ECG, ultrasound, x-ray);
• the doctor will talk about prevention methods, recommend what to do to avoid infecting household members through contact, and how to prevent relapse of the disease.

A doctor can come to your home on the same day of treatment.

Forecast

Even after the use of modern antiviral agents, viral DNA remains in the nuclei of nerve cells. In this case, the disease becomes latent because viral replication stops. It is impossible to prevent the persistence of the herpes pathogen in the body, but drug therapy can reduce the risk of reactivation of the pathogen.

The first relapse of the disease can occur within a year after infection. The development of characteristic symptoms is preceded by a prodromal period, manifested by burning of the mucous membrane of the genital organs and impaired sensitivity of the skin in the sacrolumbar region. At this stage, it is recommended to begin antiviral therapy to shorten the duration of relapse.

On average, patients experience 2 to 5 relapses annually. The exact reasons for reactivation are unknown. It is assumed that an exacerbation of the infection may occur due to a cold, hypothermia, menstruation or severe stress. In this case, the main mechanism of relapse is a general and local decrease in immunity.

The incidence of complications has not been sufficiently studied. Brain damage most often occurs in newborns and patients with reduced immunity. Since the most dangerous complications occur during primary infection, it is important to diagnose the disease in time and use antiviral agents.

Sex with genital herpes

If a person knows that he is infected with the genital herpes virus, he, due to moral requirements, should not infect sexual partners and warn about this in advance.

During sexual contact, the risk of infection is highest. If there is an oral form, then it is enough to transmit the virus even through kissing or oral sex. In the vaginal form, the virus is transmitted during sexual vaginal contact. If the patient has rashes in the anus and rectum, there is a high risk of infection during anal sex.

A condom does not always guarantee 100% protection, since the rash area includes areas not covered by latex.

If sexual partners decide to take risks consciously, they should first undergo treatment for the virus and discuss the risks with their doctor. During remission, suppression of the source of infection, infection is unlikely.

If sexual contact occurs without the use of protective equipment, it is recommended to use herpferon, a drug that destroys the virus, within the next 1-2 hours.

Pathology during pregnancy

As mentioned earlier, the herpes virus can enter fetal tissue through the placenta. Infection during childbirth is also possible, since the causative agent of the disease affects the mucous membranes. In this regard, screening for genital herpes should definitely be done when planning pregnancy. If the infection is diagnosed late, a caesarean section is recommended to prevent infection of the baby.

Primary genital herpes is the most dangerous. Intrauterine development involves the active formation of organs and systems of a new organism, so any pathological effects can cause birth defects. In the early stages of pregnancy, the virus can actively penetrate the nervous tissue of the fetus and disrupt the development of the central nervous system. Other negative consequences of infection include a high risk of miscarriage and premature birth.

How to prevent getting genital herpes

No one is immune from herpes infection. Most people get the virus in childhood - from their mother and other family members through kissing. This is the herpes simplex virus type 1. It was believed that it could not affect the genitals. However, practice has shown that such a development of events is possible.

It is impossible to prevent infection one hundred percent, but you can try to protect yourself by following a few rules:

• during pregnancy planning, undergo a full examination of the body for the presence of herpes of the first and second types;
• remain faithful to your sexual partner, do not have casual sexual contacts;
• in case of casual sexual intercourse, you should be examined for hidden infections;
• do not use other people’s lipsticks, manicure accessories, towels, or razors;
• wash hands after contact with rashes;
• monitor intimate hygiene;
• keep the bathroom clean:
• do not kiss a child on the lips, especially during an exacerbation of herpes on the lips.

You should take care of your health, increase your immunity through an active life and good nutrition, and give up bad habits.

Publication date 2019-11-10

Pathophysiology

Herpes virus type 2 (HSV-2) is the main causative agent of the disease. The genetic material of the pathogen is represented by a double-stranded DNA molecule. After penetration into the mucous membranes of the genital organs, the pathogen migrates to the cells of the nervous system, therefore many complications of genital herpes are associated with the functioning of the central nervous system. The virus can remain in neurons for a long time even with drug therapy. In the external environment, the causative agent of the disease persists for several hours, but high temperature quickly destroys the virus.

The causative agent of genital herpes has the following properties.

1. Significant neurovirulence. The immune system does not stop the virus from invading cells of the nervous system.
2. Latency. Herpes gets into the nerve ganglia close to the gate of infection and does not manifest itself symptomatically for a long time.
3. Reactivation. Re-replication of the virus can occur even after long-term remission. Relapses are observed with fever, injury, stress, menstruation and other conditions.

Cellular immunity is capable of fighting the pathogen, however, in patients with HIV infection and other diseases that affect the body's protective properties, the virus quickly spreads in the tissues. HSV-2 enters susceptible cells through special receptors, inserts its own genetic information into DNA and reproduces new viral particles, which subsequently migrate to other areas. Lymphocytes are capable of synthesizing specific antibodies against the causative agent of the pathology, however, even after an HSV-1 infection, the development of another type of herpes cannot be ruled out.

Epidemiology

Genital herpes, being a special case of herpetic infection, is one of the most common sexually transmitted diseases, and differs from other diseases of this group in the lifelong carriage of the pathogen in the human body, which determines the high percentage of formation of recurrent forms of the disease.

Transmission routes

Transmission usually occurs through close contact with a sick person or a virus carrier. The virus penetrates through the mucous membranes of the genital organs, urethra, rectum or microcracks in the skin.

In couples where one partner is infected, the probability of infection of the second partner within a year is 10%. In most cases, infection occurs when the infected partner has not had a clinically significant recurrence of genital herpes. Asymptomatic and unrecognized forms of infection play an important role in the spread of the virus. The virus can be excreted in sperm; cases of infection of women during artificial insemination have been described. Speaking about the routes of transmission of the virus, it is necessary to note the important epidemiological significance of oral-genital contacts, which are associated with an increase in the frequency of isolation of herpes type 1 from the genitourinary system.

Who gets sick more often?

Among college students, antibodies to the herpes virus type II are detected in 4% of those examined, among university students - in 9%, among representatives of the middle strata of society - in 25%; among patients in dermatovenerological clinics with heterosexual orientation – 26%; among homosexuals and lesbians – 46%, among prostitutes – 70–80%. Antibodies to genital herpes are more often detected in representatives of the Negroid race than in whites. Women are infected more often than men, with the same number of sexual partners during their lifetime. In developed countries, the virus affects 10–20% of the adult population.

Numerous studies on the general population have shown that the incidence rate increases with age: isolated cases are detected in a group of patients aged 0–14 years; the highest incidence is recorded in the age group 20–29 years; the second peak incidence occurs at 35–40 years of age.

The main risk factors for developing the virus are a large number of sexual partners throughout life, early onset of sexual activity, homosexuality in men, belonging to the black race, female gender and a history of sexually transmitted infections.

Mandatory registration of genital herpes was introduced in the Russian Federation in 1993. During the period 1993–99, the incidence of this virus in Russia increased from 8.5 cases to 16.3 per 100 thousand population. The incidence in Moscow increased from 11.0 to 74.8 cases per 100 thousand population and almost reached the level of European countries.

Prevention of genital herpes virus infection

To prevent infection, you must remember to use a condom during casual sexual intercourse, as well as the use of antiseptics to treat areas of the skin where the virus can get. Relapses of the disease are observed with a decrease in immune defense, various diseases, stress, and even with frequent overheating and hypothermia. Therefore, in order for the clinical signs of herpes to make themselves felt as rarely as possible or not to appear at all, you must try to lead a healthy lifestyle, eat well and get enough rest, as well as regularly take vitamin supplements recommended by your doctor.

To prevent self-infection, in order to prevent the virus from being transferred from the face in the presence of rashes on the lips to the genital area, it is necessary to adhere to the rules of personal hygiene and wash your hands more often. Each family member should have separate towels for different parts of the body.

After unprotected sexual intercourse, during sexual relations with a carrier of the herpes simplex virus, and when planning pregnancy, it is necessary to undergo regular examinations with a doctor.

Reference and information material

Author of the article

Belyaev Dmitry Alexandrovich

General doctor

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Isolation and identification of HSV

In specialized virology laboratories, HSV is isolated using the culture method. Its essence lies in the fact that the material for research (the contents of herpetic eruptions, human secretions) is placed on specially grown cells in which the virus begins to multiply. Then, after 5 days, the presence of HSV is determined by characteristic changes. Thus, we can say for sure that this disease is of a herpetic nature.

To identify the causative agent of HSV, the polymerase chain reaction (PCR) method is widely used, which makes it possible to find out what type of herpes virus is present in the body. The material for research is taken with a special brush from the rash sites. The PNR method is highly sensitive and is performed within 24–48 hours.