- Ways of transmitting the virus
- Diseases caused by herpevirus
- 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
- Prevention of genital herpes
This is one of the most common diseases of viral nature, sexually transmitted and is a rather important medico-social problem. It differs from other herpes virus infections by life-time carrier 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 increasing. According to statistics, almost 90% of the world's population is infected with the virus.
The causative agent of the disease is I and II type of filtered herpes simplex (HSV-1 and HSV-2). This is a large, coated virion of the genus Herpesvirus, family Herpetoviridae, containing double-stranded DNA and reaching 180 nm. A virion (a full-fledged viral particle) consists of a nucleocapsid (DNA core), which allows integrating and causing a malignant transformation of the host's genetic apparatus, and of a protein capsid (viral envelope). The capsid of the virion consists of 162 capsomers, an outer membrane and an inner envelope. It also contains lipids, glyco- and lipoproteins, spermidine and spermine, which are essential for vital activity.
The herpes virus in 30 minutes is inactivated at a temperature of + 50-52 degrees, and in 10 hours at a temperature of +37 degrees Celsius. The pathogen can retain its pathogenicity at low temperatures (up to -70 degrees) and is very resistant to the effects of ultrasound. It dies under the influence of ultraviolet and X-rays, alcohol, organic solvents and proteolytic enzymes. Genital herpes virus is also sensitive to formalin, phenol and potassium permanganate. HSV types I and II belong to the subfamily alpha-fever viruses that have a pronounced cytotoxic effect and persist in humans for the rest of their lives in various parts of the nervous system. The causative agent needs a very short period of time for full development, and it is also able to quickly spread through the cells of its host’s body.
Ways of transmitting the virus
The source of herpes virus infection is a sick person or a virus carrier. The main transmission routes include:
- Transfusion (through blood or its components);
- With the transplantation of tissues and organs;
- Transplacental (through the placenta from mother to fetus);
- Intranatal (during childbirth).
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 herpes infection.
The main links of pathogenesis:
- The ability of the genital herpes virus to infect epithelial and nerve cells, which causes a variety of clinical manifestations of herpes infection.
- The defeat of the causative agent of immune cells (this leads to secondary immunodeficiency).
- Infection of the sensory nerve nodes of the autonomic nervous system and the ability of the virus to remain there for life.
Entrance gates of infection in genital herpes are the mucous membranes of the genital organs and oral cavity, conjunctiva, red border of the lips and skin. After the introduction of the pathogen in the affected areas there are typical rashes in the form of watery blisters. Further, the infectious agent penetrates the bloodstream and the vessels of the lymphatic system. At the earliest stages of the pathological process, the virions are capable of infiltrating the nerve endings of the skin and mucous membranes. Then they move centripetally along the axoplasm to the peripheral and segmental regional sensory ganglia of the central nervous system.
Diseases caused by herpevirus
“Genital herpes” is a term that at the beginning of the 20th century was called lesions that occur on the skin and mucous membranes of the urogenital organs. However, with the development of virology appeared information about atypical forms of the disease. Currently, such a diagnosis is made to patients with chronic inflammatory process of the internal genital organs (endocervicitis, vulvovaginitis, colpitis , etc.), of course, if there is laboratory confirmation of the viral nature of the disease. However, with the typical form of genital herpes, vesicular-erosive lesions are found on the mucous membranes of the genital organs and the anogenital area of patients.
In clinical practice, genital herpes is classified into primary and recurrent. In turn, recurrent HG may have a typical and atypical clinical form, and the virus may exist in the active phase in the absence of any signs and clinical symptoms (asymptomatic virus release).
According to the international classification, herpes infection is divided into:
- GUI male and female urogenital organs;
- GUI of the rectum and perianal skin;
- Unspecified anogetital GUI.
Characteristic symptoms of the disease
It should be noted that the clinical signs of genital herpes directly depend on the area of damage, the patient's gender (women suffer from this disease more often), age, intensity of the pathological process, virulence of the causative agent strain and the body's immune forces.
It is characteristic that in almost 20% of infected people the disease occurs with relapses. In this case, the pathological process initially proceeds more rapidly than subsequent relapses. However, 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 a future rash. Then there appears a rash, represented by individual or grouped vesicles, reaching 2-3 mm in size and localized on the inflamed erythematous base. And most often in the same place there is a relapse. This condition may be accompanied by subfebrile condition, general weakness, headache and sleep disturbance. After a while, the elements of the rash open up, leaving behind irregularly shaped erosive surfaces.
In women, genital herpes is localized in the region of the labia minora and labia, vulva, clitoris, vagina and cervical canal. In men, it can occur in the foreskin and glans penis, as well as in the urethra.
Stages of genital herpes
- I - lesion of the external genitalia;
- II - development of herpetic colpitis, urethritis and cervicitis;
- III - viral lesion of the endometrium, fallopian tubes and bladder.
Types of Herpesvirus Infection
- Complete absence of antibodies to the pathogen in the blood (first clinical episode).
- The appearance of antibodies to one of the types of the virus, the development of superinfection (infection that occurs when a secondary type of virus is not fully eliminated by another type of virus in the absence of a herpevirus infection in the patient's history).
- Recurrent GUI.
- Asymptomatic or atypical type.
Typical form of genital herpes
This form of the disease occurs with the appearance of a vesicular rash on a swollen, reddened background. After a couple of days, the vesicles are opened and in place of them become moist erosion, epithelized without scar formation. The disease occurs in a form characteristic of genital herpes. Patients in the affected area develop itching and burning, systemic affections and inguinal syndrome are observed. In this case, the pathogen is secreted most often within three months after infection, and then the disease enters a latent stage, mistakenly interpreted as recovery. In the period of relapse, occurring during the reactivation of a herpevirus, the course of the disease is not as severe as the first time, but the lesions are located in the same place where they first appeared.
Note: Many experts admit that it is very difficult to distinguish between the primary clinical episode and the recurrent form of genital herpes, but it is possible. Some authors recommend that the primary form of infection be determined by the following features:
- Headache, fever, muscle aches and nausea;
- The presence of multiple symmetrical genital lesions, hyperemia and local pain, which is observed for more than 10 days;
- Lesions of sites remote from the primary focus of infection (oropharynx, buttocks, fingers, etc.).
Recurrences of genital herpes, as a rule, are observed in 50% of patients after the disappearance of the signs of the primary episode of herpes infection. The duration of periods of remission and the frequency of relapses of the disease is very variable (from monthly to occurring no more than once every two to three years).
The acute and chronic form of recurrent genital herpes is very often combined with keratoconjunctivitis, gingivostomatitis, and various herpetic lesions of the face and trunk.
Patients with severe genital herpes may develop Elsberg syndrome (acute urinary retention), and they may experience various neuropsychic manifestations (depression, drowsiness, irritability, headache). It should be noted that the involvement in the pathological process of the nervous tissue is accompanied by itching, burning and soreness that occur in the places of innervation of the peripheral nerves or in the course of their movement.
Sexual contact, hypothermia, stress, overwork, and the presence of respiratory infections can provoke relapse.
Atypical form of genital herpes
The atypical form of the pathological process is characterized by an erased abortive course, in which not only the external genitalia, but also the internal genital organs are affected. As a rule, this form of infection is characteristic of chronic recurrent herpes, but, at the same time, it can also occur in primary lesions.
It's no secret that many chronic genital pathologies 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 herpevirus infection.
Genital herpes in pregnant women
A herpesvirus infection is a serious enough and dangerous disease that, if the cervix, endometrium and fallopian tubes are affected, can cause infertility. However, pregnant women infected with the virus of genital herpes may develop clinical symptoms of the disease, which is practically no different from the symptoms of herpes infection in the non-pregnant. In this case, approximately 5% of mothers with primary infection have intrauterine infection of the fetus, which is carried out in three ways:
- Transplant, providing for the penetration of the virus of genital herpes through the placenta from mother to fetus;
- Transcervical (penetration of infection from the vagina and cervical canal into the fetal membranes, and further into the amniotic fluid);
- Transvarial (when GUI penetrates from the abdominal cavity).
Manifestations of a herpes virus infection depend on the period at which the infection occurred, and how the pathogen penetrated the fetus. In the case when the infection occurred in the first trimester, the fetus may develop micro- and hydrocephalus, intracranial calcification, cataracts, 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 growth retardation syndrome 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, viral infection develops in localized or disseminated forms.
In the disseminated form of infection, the disease manifests itself on days 9-11 after birth. At the same time, herpetic damage of the skin, liver and other internal organs, brain, CNS, eyes and oral cavity is noted. With inadequate or complete absence of treatment, almost 80% of newborns die. The baby loses weight rapidly, develops vomiting, respiratory disorders, fever, jaundice, bleeding, vascular collapse and shock, which can be fatal.
Note: When conducting antiviral therapy, infant mortality rates are also quite high (15-20%).
The localized form of herpes virus infection is a neurological form of the disease. It manifests itself in newborns 14–17 days after delivery, and the third part of the children does not show skin manifestations of the disease. In this case, if untreated, the mortality rate reaches 17%. However, 60% of children further complications of a neurological nature.
In the case of the development of a localized form of herpes virus infection, vesicles, skin and mucous hemorrhages, erythema, choreoretinitis, keratoconjunctivitis, encephalitis occur in the lesions of the newborn.
Diagnosis of genital herpes
Diagnosis is carried out after conducting clinical and laboratory tests:
1. Microscopy of smear prints. This study involves taking scrapings from the area of damage. If giant cells with multiple nuclei are detected in smears and nuclear chromatin changes, the presence of genital herpes in the body is confirmed.
2. MFA (fluorescent antibody method). With its help, the number of antigen-containing cells is determined, and the UIF method is used to identify viral antibodies.
3. ELISA (ELISA) allows to detect the virus of genital herpes in the blood, urine, saliva, cervical mucus, as well as in the discharge from vesicles.
4. The most reliable in the diagnosis of hepatovirus infection is a virological method. In this case, the material for research is placed on various cultures, where the herpes virus manifests itself for 3-5 days, forming giant multinucleated cells.
5. Also, as a diagnostic technique, PCR (polymerase chain reaction) and the reaction of hybridia are used. However, these highly specific methods may give false positive results due to the fact that the material under study may 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 a herpevirus infection is not informative, since almost 90% of the adult population of the globe has antibodies to herpevirus in the blood.
For all persons, a diagnostic study is not prescribed once, but at least 2-4 times during the week.
Differential diagnosis of genital herpes
Sometimes it is difficult to make a diagnosis. The reason for this is the development of an atypical form of GUI, or the presence of manifestations of other diseases that are localized in the urogenital tract.
Thus, in the phase of formation of ulcers and erosions, it can resemble a herpes virus chancroid (soft chancre). Therefore, it should be differentiated from genital herpes. Multiple hard chancre arising from primary syphilis can also resemble a herpesvirus infection. It is mandatory to conduct differential diagnosis of this disease with contact dermatitis, scabies, pemphigus Haley-Haley, streptococcal impetigo, and some other diseases. In particularly difficult cases, with difficult diagnosis histomorphological studies are conducted.
Treatment of genital herpes
Patients suffering from genital herpes, 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 of treatment of this pathology has been developed, which includes several stages:
1. Treatment, which is carried out in the acute period of primary genital herpes or with the development of a relapse of the disease, involves the use of antiherpetic drugs (topical, oral and intravenous). When a patient has dysbacteriosis and chronic bacterial infections, he is prescribed etiotropic treatment (if necessary, extracorporeal antibacterial 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 the 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 supportive therapy, in cases of severe immunodeficiency, a second course of hemocorrection can be recommended, which neutralizes toxic substances and removes infectious agents from the bloodstream. As a result, the pathological process is interrupted and the general condition of the patient is significantly improved. In parallel, reception of adaptogens and immunomodulators is shown.
3. The third stage of treatment is carried out two to three months after the subsidence of clinical signs of recurrence of the disease. During this period, immunomodulators and herpes culture polyvaccine are used, which has anti-relapse effect. Thanks to vaccination, cellular immunity is activated and the body’s hypersensitivity to the re-introduction of the allergen is eliminated.
4. The fourth stage is the rehabilitation and follow-up of patients with genital herpes. It is carried out under constant laboratory control. At the same time, patients, if necessary, are given supportive immunocorrective therapy and rehabilitation of existing chronic foci of infection.
Prevention of genital herpes
In order to prevent genital herpes, experts recommend constantly conducting activities to strengthen the immune system, as well as to direct their efforts to prevent possible infection. A healthy active lifestyle, a balanced diet, hardening, protection from stress, timely and adequate treatment of all existing pathologies are the main measures that help strengthen the immune system. At the same time, one should not neglect the means of individual protection, especially to those people who often change their sexual partners.
Currently, many developed countries are actively developing preventive antiherpetic vaccines that protect against infection, and therefore it can be hoped that within a few years, humanity will be able to receive an effective herpes vaccine.
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