- Ways of transmission of the virus
- Diseases that cause herpesvirus
- Symptoms of genital herpes
- Stages of genital herpes
- Types of herpesvirus infection
- Genital Herpes in Pregnant Women
- Genital herpes in newborns
- Diagnosis of genital herpes
- Treatment of genital herpes
- Prophylaxis of genital herpes
This is one of the most common diseases of the viral nature, sexually transmitted and representing a rather important medical and social problem. It differs from other herpesvirus infections with lifelong carriage and is characterized by frequent relapses. Due to the fact that recently undiagnosed and asymptomatic forms of pathology have become very common, the incidence of genital herpes is constantly growing. According to statistics, nearly 90% of the world's population is affected by the virus.
The causative agent of the disease is type I and type II of the filtering virus-simple herpes (HSV-1 and HSV-2). It is a large, enveloped virion from the genus Herpesvirus, the Herpetoviridae family, containing double-stranded DNA and reaching 180 nm. Virion (a full-fledged viral particle) consists of nucleocapsid (DNA core), which allows to integrate and cause malignant transformation of the genetic apparatus of the host, and from the protein capsid (virus envelope). The virion capsid includes 162 capsomers, an outer membrane and an inner membrane. Also in its composition are necessary for life, lipids, glycoprotein and lipoproteins, spermidine and spermine.
The herpes virus is inactivated for 30 minutes at a temperature of + 50-52 degrees, and for 10 hours at a temperature of + 37 degrees Celsius. The causative agent can maintain its pathogenicity at low temperatures (up to -70 degrees) and is very resistant to ultrasound. It dies under the influence of ultraviolet and x-rays, alcohol, organic solvents and proteolytic enzymes. Also, the genital herpes virus is sensitive to formalin, phenol and potassium permanganate. HSV types I and II belong to the subfamily of alfaherpeviruses, which have a pronounced cytotoxic effect and persist in a person for the rest of his life in various parts of the nervous system. The causative agent requires a very short period of time for full development, and also it is able to spread quickly enough to the cells of the organism of its host.
Ways of transmission of the virus
The source of herpesvirus infection is a sick person or a virus carrier. The main ways of transfer include:
- Transfusion (through the blood or its components);
- When transplanting tissues and organs;
- Transplacental (through the placenta from mother to fetus);
- Intranatal (during labor).
According to experts, primary infection with the virus of genital herpes occurs in early childhood by airborne droplets from adult family members with severe signs of herpesvirus infection.
The main links of pathogenesis:
- The ability of the genital herpes virus to affect epithelial and nerve cells, which causes a variety of clinical manifestations of herpesvirus infection.
- The defeat of the causative agent of immunocompetent cells (this leads to secondary immunodeficiency).
- Infection of sensory nerve nodes of the autonomic nervous system and the ability of the virus to remain there for life.
The entrance gates of infection in genital herpes are mucous membranes of the genital organs and oral cavity, conjunctiva, red lip rim and skin. After the introduction of the pathogen on the affected areas, typical eruptions appear as watery vesicles. Then the infectious agent penetrates the bloodstream and the vessels of the lymphatic system. At the earliest stages of the pathological process, virions are able to penetrate into the nerve endings of the skin and mucous membranes. Then they centripetally move along the axoplasma to the peripheral and segmental regional sensory ganglia of the central nervous system.
Diseases that cause herpesvirus
"Genital herpes" is a term that at the beginning of the XX century called lesions that occur on the skin and mucous membranes of urogenital organs. However, with the development of virology, there were reports of atypical forms of the disease. Currently, such a diagnosis is given to patients with chronic inflammatory process of internal genital organs (endocervicitis, vulvovaginitis, colpitis , etc.), of course, if there is laboratory confirmation of the viral nature of the disease. However, with a typical form of genital herpes on the mucous membranes of the genital organs and the anogenital region of patients, vesiculose-erosive lesions are found
In clinical practice, genital herpes is classified into primary and recurrent. In turn, recurrent HG can have a typical and atypical clinical form, and the virus can exist in the active phase in the absence of any signs and clinical symptoms (asymptomatic viral excretion).
According to the international classification, herpes infection is divided into:
- GPI of male and female urogenital organs;
- GUI of the rectum and perianal skin;
- Not specified anogenetic GUI.
Characteristic signs of the disease
It should be noted that the clinical signs of genital herpes directly depend on the area of the lesion, the sex of the patient (women suffer from this disease more often), the age, the intensity of the pathological process, the virulence of the pathogen strain and the body's immune forces.
It is characteristic that almost in 20% of infected the disease occurs with relapses. In this case, at first the pathological process passes more violently than the subsequent relapses. At the same time in many patients the symptoms of the disease are completely absent, or very short.
In the early stages, patients complain of soreness, burning and itching at the site of the future rash. Then there appears a rash, represented by separate or grouped vesicles, reaching 2-3 mm in size and localized on the inflamed erythematous base. And most often in this place there is a relapse. This condition can be accompanied by a subfebrile condition, general weakness, headache and sleep disturbance. After a while, the elements of the rash are opened, leaving behind an irregularly shaped erosive surface.
In women, genital herpes is localized in the area of large and small labia, vulva, clitoris, vagina and cervical canal. In men, it can occur on the foreskin and glans penis, as well as in the urethra.
Stages of genital herpes
- I - defeat of the external genitalia;
- II - development of herpetic colpitis, urethritis and cervicitis;
- III - viral damage of the endometrium, fallopian tubes and bladder.
Types of herpesvirus infection
- Complete absence of antibodies to the pathogen in the blood (the first clinical episode).
- The appearance of antibodies to one of the types of the virus, the development of superinfection (infection that occurs when the secondary infection is not completely eliminated by another type of virus in the absence of a history of the patient herpes virus infection).
- Recurrent GUI.
- Asymptomatic or atypical type.
The typical form of genital herpes
This form of the disease occurs with the occurrence of a vesicular rash on a swollen reddened background. After a couple of days, the vesicles are opened and in their place eruptive erosions are formed, epithelizing without the formation of scars. The disease occurs in a form characteristic of genital herpes. In patients in the affected area, itching and burning develops, systemic affects and inguinal syndrome are observed. In this case, the causative agent is released most often within three months after infection, and then the disease passes into a latent stage, erroneously interpreted as a recovery. During the recurrence that occurs when reactivating herpesvirus, the course of the disease is not as severe as the first time, but the lesions are localized in the same place where they appeared for the first time.
Note: many specialists admit that it is very difficult to distinguish the primary clinical episode and the recurring form of genital herpes, but it is possible. The primary form of infection, some authors recommend to determine by the following symptoms:
- Headache, fever, pain in the muscles and nausea;
- The presence of multiple symmetrical genital lesions, hyperemia and local pain, observed for more than 10 days;
- The defeat of sites distant from the primary focus of infection (oropharynx, buttocks, fingers, etc.).
Relapses of genital herpes are usually observed in 50% of patients after the disappearance of signs of a primary episode of herpesvirus infection. The duration of remission periods and the frequency of recurrences of the disease is very variable (from monthly to occurring no more often than once every two to three years).
The acute and chronic form of recurrent genital herpes is very often combined with keratoconjunctivitis, gingivostomatitis, as well as various herpetic lesions of the face and trunk.
In patients with severe form of genital herpes, Elsberg syndrome (acute urinary retention) may develop, and they may have various neuropsychic manifestations (depression, drowsiness, irritability, headache). It should be noted that the involvement of the nervous tissue in the pathological process is accompanied by itching, burning and soreness that occur in the innervation of the peripheral nerves or in the course of their movement.
Provoke the development of relapse may be sexual contact, hypothermia, stress, fatigue, and the presence of respiratory infections.
Atypical form of genital herpes
For the atypical form of the pathological process, the eroded abortive flow is characteristic, in which not only the external genitalia, but also the internal genital organs are affected. As a rule, this form of infection is typical for chronic recurrent herpes, but, at the same time, it can also occur during primary lesions.
It's not a secret for anyone that many chronic pathologies of genital organs are diagnosed as diseases of unclear etiology. This is due to the inability to identify the cause of the disease, and therefore the prescribed treatment is often ineffective. It is in such cases that good experts have a suspicion of developing an atypical form of herpesvirus infection.
Genital Herpes in Pregnant Women
Herpesvirus infection is a serious enough and dangerous disease, which, if the cervix, endometrium and fallopian tubes damage, can cause infertility. However, in pregnant women infected with the genital herpes virus, the clinical symptoms of the disease can develop, which practically does not differ from the symptoms of herpesvirus infection in nonpregnant cases. In this case, approximately 5% of the primary infected mothers have intrauterine infection of the fetus, which occurs in three ways:
- Transplacentric, which involves penetration of the genital herpes virus through the placenta from mother to fetus;
- Transcervical (penetration of infection from the vagina and cervical canal into the membranes, and then into the amniotic fluid);
- Transviral (when the GUI penetrates from the abdominal cavity).
The manifestations of herpesvirus infection depend on the period of pregnancy at which infection occurred, and by what route the pathogen penetrated the fetus. In the case of infection in the first trimester, the fetus may develop micro- and hydrocephalus, intracranial calcification, cataract, and other congenital anomalies. However, during this period the number of spontaneous abortions reaches 15-34%.
If the fetus is infected in the second or third trimester of pregnancy, anemia, jaundice, hepatosplenomegaly, chorioretinitis, pneumonia, meningoencephalitis and fetal development retardation may develop.
: при гематогенном заражении генитальным герпесом исход беременности неблагоприятный. Note : with hematogenous infection with genital herpes, the outcome of pregnancy is unfavorable.
Genital herpes in newborns
In newborns, a viral infection develops in a localized or disseminated form.
With disseminated form of infection, the disease manifests itself on the 9-11 day after delivery. Herpetic lesions of the skin, liver and other internal organs, brain, CNS, eyes and oral cavity are noted. With inadequate or complete absence of treatment, almost 80% of newborns die. Infant sharply grows thin, it develops vomiting, respiratory disorders, fever, jaundice, bleeding, vascular collapse and shock, which can result in death.
Note: when performing antiviral therapy, infant mortality rates are also quite high (15-20%).
The localized form of herpesvirus infection refers to neurological forms of the disease. It manifests itself in newborns 14-17 days after delivery, and the third part of children does not show skin manifestations of the disease. In this case, in the absence of treatment, the mortality rate reaches 17%. However, 60% of children subsequently develop neurological complications.
In the case of the development of a localized form of herpesvirus infection in lesions in neonates, vesicles, cutaneous and mucocutaneous hemorrhages, erythema, choreoretinitis, keratoconjunctivitis, encephalitis occur.
Diagnosis of genital herpes
The diagnosis is made after clinical and laboratory tests:
1. Microscopy of smears-prints. This study involves taking scrapings from the area of damage. When detecting in the smears of giant cells with multiple nuclei and changing the nuclear chromatin, the presence of genital herpes in the body is confirmed.
2. MFA (fluorescent antibody method). With its help, the amount of antigen-containing cells is determined, and for the detection of viral antibodies, the method of UIF is used.
3. ELISA (enzyme immunoassay) can detect the virus of genital herpes in the blood, urine, saliva, cervical mucus, as well as in vesicles.
4. The most reliable diagnosis of heprevirus infection is the virological method. In this case, the material for the study is placed on different cultures, where the herpes virus manifests itself on day 3-5, forming giant multinucleate cells.
5. Also as a diagnostic technique, PCR (polymerase chain reaction) and hybridization reaction are used. However, these highly specific techniques can produce false positive results because the test material can be contaminated with extraneous DNA
: у взрослых серологическая диагностика герпевирусной инфекции не информативна, так как почти у 90% взрослого населения земного шара в крови имеются антитела к герпевирусу. Note : in adults, serological diagnosis of herpesvirus infection is not informative, since almost 90% of the adult population of the globe has antibodies to herpesvirus.
For all individuals, the diagnostic examination is not administered once, but at least 2-4 times during the week.
Differential diagnosis of genital herpes
When making a diagnosis, sometimes there are difficulties. The reason for this is the development of an atypical form of GIP, or the presence of manifestations of other diseases that are localized in the area of the urogenital tract.
So, in the phase of formation of ulcers and erosions can resemble a herpesvirus infection of chancroid (soft chancre). Therefore, it should be differentiated from genital herpes. Multiple solid chancres arising from primary syphilis can also resemble herpesvirus infection. It is mandatory to conduct differential diagnosis of the disease with contact dermatitis, scabies, pemphigus Haley-Haley, streptococcal impetigo and some other diseases. In particularly difficult cases, with difficult diagnosis, histomorphological studies are carried out.
Treatment of genital herpes
Patients suffering from genital herpes, the treatment is prescribed in accordance with the clinical form of the pathological process, as well as the stage and severity of the disease.
In medical practice, a comprehensive program for the treatment of this pathology has been developed, which includes several stages:
1. Treatment, which is performed in the acute period of primary genital herpes or in the development of relapse of the disease, involves the use of antiherpetic drugs (topically, orally and intravenously). If a patient is diagnosed with dysbacteriosis and chronic bacterial infections, etiotropic treatment is prescribed (if necessary, extracorporeal antibiotic therapy and immunopharmacotherapy). In parallel, the introduction of natural antioxidants (vitamins C and E) is shown.
2. The second stage of treatment of genital herpes is carried out after suppression of the main clinical manifestations of the disease, that is, during the achieved remission. During this period, the patient is prescribed antibacterial and antiviral maintenance therapy, with a pronounced immunodeficiency, a repeated course of hemocorrection that neutralizes toxic substances and removes infectious agents from the bloodstream can be recommended. As a consequence, the pathological process is interrupted and the general condition of the patient is significantly improved. In parallel, the reception of adaptogens and immunomodulators is shown.
3. The third stage of treatment is carried out two to three months after the clinical signs of recurrence of the disease subsided. During this period, immunomodulators and herpetic culture polivaccin are used, which has an anti-relapse effect. Thanks to vaccination, cellular immunity activates and the increased sensitivity of the body to repeated administration of the allergen is eliminated.
4. The fourth stage is the rehabilitation and dispensary observation of patients with genital herpes. It is carried out under constant laboratory control. At the same time, patients, if necessary, are undergoing maintenance immunocorrective therapy and sanation of existing chronic foci of infection is performed.
Prophylaxis of genital herpes
In order to prevent genital herpes, experts recommend that they constantly carry out measures to strengthen immunity, as well as direct their efforts to prevent possible infection. A healthy active lifestyle, a balanced diet, hardening, protection from stress, timely adequate treatment of all existing pathologies are the main measures that allow to strengthen the immune system. At the same time, it is not necessary to neglect the means of individual protection, especially to those people who often change their sexual partners.
Currently, many developed countries are actively developing prophylactic antiherpetic vaccines that protect against infection, and therefore it is hoped that in a few years, mankind will be able to get an effective vaccine against herpes.
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