Genital herpes in men and women on the genitals
Content:
- What is genital herpes?
- Signs and symptoms
- Causes of genital herpes
- Why is genital herpes dangerous?
- Sex with genital herpes
- Treating genital herpes
- Genital herpes during pregnancy
- Prevention of genital herpes
What is genital herpes?
Genital herpes (HH) is part of an extensive group of diseases of various etiopathogenesis, the causative agents of which are sexually transmitted - STDs. The disease of HH is caused by the herpes simplex virus type II (HSV-II), less often the herpes simplex virus type 1 (HSV-I). The disease is characterized by vesicular eruptions on the skin and mucous membranes in the genitals, waist, thighs and buttocks. Possibly asymptomatic and atypical course of the disease, as well as systemic organ damage.
HSV-II and HSV-I are herpes simplex. They are called simple for their characteristic feature - a vesicular rash on the mucous membranes and skin. For a long time, this symptom was considered the only manifestation of herpes, and the disease was recognized as common and not dangerous. Clinical observations in recent years have largely changed the attitude of doctors to this disease.
Genital herpes is a common infection. In the statistics of confirmed STDs, the diagnosis of HSV-II occupies a leading position, second only to trichomoniasis. The genital form of herpes is also caused by HSV-I. Results from 20% of polymerase chain reaction (PCR) tests confirm the involvement of HSV-I in the formation of anogenital rashes. The influence of HSV-I on the formation of genital pathogenesis has been steadily growing in recent years.
The prevalence of the disease caused by herpes simplex viruses is due to the following factors:
- The persistence of opinion about the safety of herpes simplex among ordinary people;
- A long latent stage of the disease in the nodes (ganglia) of the nerve trunks - a person is infected, but does not suspect about it;
- Practically lifelong carrier - it is impossible to remove herpes from the body with vaccines, serums or chemical preparations;
- The possibility of infection by contact-household means - unfortunately, this factor significantly reduces the age of the first encounter with herpes in children.
In the Russian Federation, since 1993, herpes has been included in the list of diseases subject to mandatory medical statistics. Since the beginning of regular observations, a steady increase in the number of cases of herpes has been recorded. To date, the clinical form of genital herpes is diagnosed in about 80 cases per 100 thousand population. This figure is in line with the global statistics on the detection of sexually transmitted herpes. With the help of statistical observations, some epidemic patterns of GG were established.
The incidence of genital herpes correlates with:
- The socio-economic status of the sick - the maximum number of cases of re-illnesses is recorded in marginal circles, the minimum - in the group with a high social status;
- Sex (men are more resistant to GH infection). The increased sensitivity of women to genital forms of herpes is probably due to the extensive mucous membranes of the external genital organs, and not to a special device of the immune system;
- Age (there is a sharp increase in the incidence of GH infection, coinciding with the age of sexual activity). Detectability reaches a maximum by the age of 30-40, then there is a gradual decrease in the number of diseases to a minimum by the age of 60-70 (exceptions not related to human sexual activity are possible).
HSV and another representative of herpes, cytomegalovirus (both STDs), are significant factors in the etiopathogenesis of gynecological inflammatory diseases of the cervix and appendages. The participation of HSV and cytomegalovirus in the development of radiculitis and inflammation of the membranes of the brain has been proven.
The connection of these diseases with the herpes virus was established only after widespread introduction into diagnostics:
- PCR method used to detect the virus and its fragments in body tissues;
- enzyme-linked immunosorbent assay ELISA or ELISA when typing the antigenic structure of viruses using monoclonal antibodies;
- The emergence of commercial kits for the determination of AG-HSV-II (antigens to HSV-II) and AT-HSV-II (titers of antibodies to HSV-II).
The sensitivity and specificity of these methods reaches 95-100%. The time for obtaining results is from one to two days. Despite the convenience of laboratory methods, their high sensitivity and specificity, they do not always give adequate results suitable for making a definitive diagnosis.
Modern laboratory and immunological methods have limitations due to:
- Cross-reactions in the differentiation of specific antibodies HSV-I and HSV-II;
- Low availability of equipment and a shortage of specialists who own PCR and ELISA techniques in small clinics;
- The high cost of quality commercial diagnostic kits.
Meanwhile, the absolute value of the PCR and ELISA method is shown in neonatal herpes HSV-II or HSV-I, when specific antibodies are represented by almost homogeneous IgM and IgG, and the patterns of serological reactions fit into standard algorithms of the immune response.
The value of laboratory methods increases with studies carried out in dynamics with an interval of five to seven days. Some features of the body should be taken into account, for example, the timing of monthly cycles in women, the drug background of previous treatment and concomitant diseases.
The opinion about the unconditional and comprehensive value of the results of laboratory tests in making a diagnosis is a common myth. The diagnosis is made not by a laboratory assistant, but by a doctor based on the symptoms of the disease, patterns and epidemiology of pathogenesis, identified after a complex of physical, instrumental and laboratory studies.
Non-sterile immunity is formed against HSV. Immunoconversion of the body develops within 14-28 days with the latent and clinical course of the infection.
The body's immune response to the primary penetration of the genital herpes virus includes three main links of defense reactions:
- The primary contact of antigens (AH)-HSV-II with the cells of the immune system is accompanied by the activation of phagocytosis and stimulation of the production of interferon against the background of the natural resistance of the organism;
- The inclusion of the cellular link of immunity is accompanied by an increase in the level of T-killers and T-helpers. An increase in the level of B-lymphocytes activates the complement system;
- The inclusion of the complement system activates the production of specific antibodies (AT) to HSV-II.
Herpes immunity does not reach a protective level (complete protection of the body). The reason for the almost unhindered re-infection or super-infection is not fully understood. One of the many hypotheses is that the HSV-II virus has an immune suppression mechanism. Meanwhile, the full-fledged immune status of the body is still a limiting factor in the development of infection.
Signs and symptoms of genital herpes
The signs and symptoms of HSV are very diverse. There are six clinical types of genital herpes disease associated with:
- Primary infection;
- Secondary infection;
- Relapses of the disease;
- Atypical course;
- Asymptomatic course.
Symptoms of primary herpes infection
The disease occurs after the transmission of the pathogen from the patient to a person who has not previously had genital herpes, who does not have antibodies to HSV-II in the blood. Infection usually occurs during intimate contact, but other routes of transmission are also possible.
The incubation period lasts about seven days (the timing of the onset of symptoms is indicated approximately):
- A vesicular rash, localized on the external genitalia, appears on the 8-10th day;
- Purulent pustules with the subsequent formation of festering ulcers - by about 11-15 days;
- Crusts (scabs) at the site of ulcers form in the period from 15 to 20 days;
- The healing of rashes begins 20-30 days from the onset of the disease.
Signs of genital herpes in men
Signs of HH in men (the above symptoms) are observed on the mucous membrane and / or skin:
- Glans and foreskin of the penis;
- Urethra and coronal groove;
- Perianal region and thighs;
- Scrotum and perineum.
Signs of genital herpes in women
Signs of HH in women (the above symptoms) are observed on the mucous membrane and / or skin:
- The vestibule of the vagina;
- External opening of the urethra;
- Small and large labia;
- Perineum, perianal region, thighs and buttocks;
- The vagina and cervix.
The defeat of the cervix can take the form of inflammation (cervicitis). At the same time, the mucous membrane of the cervix is hyperemic and covered with erosions with purulent discharge.
Symptoms of primary GH infection, characteristic of women and men:
- Difficulty urinating;
- Purulent discharge from the genitals;
- Inflammation of the inguinal lymph nodes.
Symptoms of a Secondary Genital Herpes Disease
The disease occurs after a period of latent infection, when antibodies to HSV-II are detected in the body. Virus activation occurs after re-penetration of infection (development of superinfection) or reactivation of GH viruses persisting in the nerve ganglia against a background of low immune status. Symptoms of a secondary disease are similar to those of primary herpes. As a rule, the disease has a less striking pathogenesis (exceptions are possible).
Symptoms of recurrent type of herpes
A virus that once entered the body makes a person a lifelong virus carrier. Herpes is characterized by periods of latent flow with recurrent recurrences. The frequency of relapses characterizes the state of the immune system and depends on the type of pathogen. HSV-II-induced HH is associated with frequent relapses compared to HSV-I diseases.
There are three types of recurrent genital herpes:
- Arrhythmic type with remissions in a wide range - from two weeks to five months;
- Monotonous type, characterized by frequent relapses and short periods of remission;
- The subsiding type, characterized by long periods of remission and short exacerbations.
Symptoms of atypical genital herpes
HH is often disguised as other diseases with similar symptoms. The atypicality of the pathogenesis of HSV-II is established on the basis of laboratory detection of the pathogen by PCR or cell culture growth. It has been noticed that approximately 5-15% of gynecological infections are caused by atypical herpes with the participation of HSV-II or HSV-I.
Asymptomatic course of genital herpes
The complete absence of symptoms is recorded in 60% of cases of herpes. It is only possible to recognize the infectious stage of the virus using laboratory methods. This type of pathogenesis can cause serious epidemiological consequences when the disease spreads.
Causes of genital herpes
Factors promoting the spread of genital herpes infection include:
- The presence of a sick virus carrier Herpes simplex virus 2 (international designation GG and abbreviated Latin - HSV-2d) in the active phase of infection, regardless of clinical manifestations (asymptomatic, atypical or other course of the disease);
- The presence of a susceptible healthy or previously ill person with a violation of homeostasis - a defect in the immune system and a decrease in natural resistance (as a result of a previous illness, hypothermia, overheating and other stress factors);
- Conditions conducive to infection (unprotected promiscuous sex, close household contact with a virus carrier).
Why is genital herpes dangerous?
Herpes is a sluggish viral infection, the fatal outcome of the disease is rare, but it is possible with immunodeficiency syndrome. In people with high immune status, the disease is possible, but the course is mild. This largely served as the basis for the erroneous opinion about the triviality of herpes.
The danger of genital herpes is that:
- An active carrier of an asymptomatic infection spreads it without realizing it;
- The first and second types of herpes simplex can complement and modify the pathogenesis of HH during primary contact in children;
- Herpes can give rise to a kind of "vicious circle", when the illness creates the basis for the development of the pathogenesis of a concomitant infection and thereby depletes the immune system;
- The danger of herpes is very high for people with imperfect immunity (in early childhood) and people with acquired immunity defects (after organ transplants, chemotherapy), as well as for people leading a marginal lifestyle (drug addicts, prostitutes, etc.). In these groups, herpes is a possible cause of death.
Sex with genital herpes
Genital herpes and cytomegalovirus are among the sexually transmitted diseases. Naturally, in the active phase of genital herpes, sex is immoral, as it contributes to the infection of an unsuspecting partner.
The danger of sex with HH is that:
- Barrier contraception does not protect against infection; transmission of the virus can occur through contact with the body and hands;
- Direct-acting drugs (acyclovir and others in the form of solutions, gels and sprays) are effective only at the stage of replication (division of the virus in tissue cells) and do not guarantee direct elimination of herpes;
- The drug Miramistin, according to the instructions for its use, is a means of individual prophylaxis, including for genital herpes. However, he will not be able to completely eliminate the risk of infection due to the multiplicity of transmission methods for this virus.
In the remission stage of herpes, sex is certainly possible, but promiscuous unprotected sex should be avoided.
Treating genital herpes
A feature of the treatment of slow latent infections, which include HSV, is that:
- It is impossible to completely eliminate (destroy) the HSV pathogen;
- Etiotropic therapy is advisable only in the active phase of the virus;
- Antibiotics are ineffective for viral diseases;
- The available vaccine against HSV is used only in the latent phase of the disease and does not have full protective (protective) properties.
The pathogenesis of genital herpes caused by HSV-II, in comparison with the pathogenesis of labial herpes, is more aggressive, often causes relapses, and gives serious complications. Therefore, if a slight relapse of labial herpes in persons with a slightly altered immune status allows the absence of treatment procedures, then genital herpes must always be treated, regardless of the form, severity of pathogenesis and the state of the patient's immune system.
Three principles of therapeutic therapy
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Limiting pathogenesis until the main symptoms of HH are eliminated:
- itching at the site of localization of the lesion;
- papular and vesicular rash (single and widespread);
- local and total pain;
- fever.
- Reducing the period of exacerbation of the disease to the minimum possible (7-14 days).
- An increase in the period of the latent course of the disease (the ideal result is lifetime latency).
Since the elimination of the herpes virus is not possible, the goal of therapy is not complete recovery, but to establish a state of relative health based on the principles of prevention:
- Recurrences of HH disease by normalizing the immune status of the human body;
- Infection of sexual partners and further spread of infection;
- Intrauterine infection of the fetus and newborn during its passage through the genital tract during childbirth, natal and postnatal complications.
Treatment methods
There are five therapeutic methods used to treat genital herpes:
- Etiotropic therapy. Antiviral drugs that suppress the replication of the herpes virus.
- Pathogenetic therapy. Immunomodulators, including agents that increase and decrease the immune status and its individual links in the form of native substances (natural, unpurified biological products), individual fractions and synthetic stimulants of immunogenesis.
- Symptomatic therapy. Drugs that relieve pain, itching and fever.
- Specific prophylaxis is vaccination.
- Physiotherapy (sometimes).
In the medical arsenal of drugs that can directly affect the virus, there is a limited set of drugs. Direct-acting antiviral therapy is based on drugs from the group of synthetic analogs of acyclic purine nucleosides. The basic drug in this group of drugs is acyclovir.
The pharmacological action of acyclovir on viruses is:
- The similarity of the chemical structure of acyclovir (purine nucleoside) with deoxyguanosine, a key agent in the synthesis of the genetic material of the herpes simplex virus DNA and some other viruses of this family;
- Competition of chemical components. The opposition "acyclovir vs deoxyguanosine" inhibits and suppresses the replication (division and increase in the number of virions) of HSV in the body;
- Inhibition of the growth and division of viruses is the main pharmacological action of acyclovir.
The high selectivity of acyclovir for the only key molecule in the DNA of the herpes virus made this drug low-toxic in general in relation to the human body. Since the seventies of the last century, strains of viruses resistant to acyclovir began to appear. This prompted the pharmacological science and industry to develop and put into practice new drugs - modified analogues of acyclovir.
The first analogue is valacyclovir. It is the metabolic precursor of the acyclic purine nucleoside (acyclovir). Introduced into the body, valacyclovir, when moving along the gastrointestinal tract, is metabolized to acyclovir, which, unchanged in a therapeutic dose, affects the DNA of the herpes simplex virus. Somewhat different mechanisms for enhancing the activity of the active substance are used in the drug Pharmciclovir and in other similar drugs for herpes in order to enhance their bioavailability.
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Several treatment regimens for patients with typical genital herpes:
- Treatment regimen for genital herpes at first contact. By choice: Acyclovir, Valacyclovir, Pharmciclovir and other medications in a clinical dosage, which is determined based on individual sensitivity (drug tolerance, patient weight, doctor's recommendations) inside up to five times a day for ten days or until symptoms disappear. The effect is increased if treatment is started in the early stages of the disease;
- Preventive treatment regimen for genital herpes. Treatment is prescribed in the stage of remission if there is a suspicion of an early activation of the virus. This option of therapy is used for frequent (more than 6 times a year) relapses in order to prevent their development. Shown are drugs that stimulate the general immune status of the body. By choice: Cycloferon, Ribotan, Gradeks, Vegetan, Immunofan and other drugs, the dosage and frequency of use is determined by the doctor. B vitamins are also shown (B 1, B 6), improving the overall resistance of the body. Interferon stimulants are used during this period due to their almost complete uselessness at this stage. It makes no sense to use antiviral drugs (acyclovir and others) - the virus is in an inactive phase, inaccessible to drugs. It is advisable to start treatment with acyclovir, zovirax and other drugs of this group only after an active herpes virus is detected in the blood;
- Treatment regimen for recurrent genital herpes. It is used during the period when the precursors of re-disease appear. The choice of therapies, their combination and formulations (ointments, solutions, tablets) depend on how often herpes recurrence occurs, as well as on the recommendations of the attending physician. The universal regimen includes a combination of treatment for herpes with acyclovir (and analogues) using immunostimulants, vitamins and other restorative agents. At the very beginning of the appearance of the precursors of the disease (itching in the area of the future lesion), interferon preparations are shown. They are most effective in the early stages of pathogenesis. In the midst of the disease, the use of interferon or its stimulants does not make sense.
The above schemes include means of etiotropic, pathogenetic and symptomatic therapy (to eliminate the symptoms of herpes - pain, itching, fever). The herpes vaccine is prescribed by the attending physician based on therapeutic feasibility. Treatment of atypical forms of genital herpes is carried out taking into account the symptoms of pathogenesis and the results of laboratory tests.
Treatment of genital herpes in men
The therapy is carried out according to traditional schemes. The indication for starting treatment of genital herpes in men is the presence of herpes virus DNA in the blood and antibodies to HSV-II in the form of immunoglobulin M (at the onset of the disease) and immunoglobulin G (at the height of the disease), confirmed by laboratory methods, against the background of signs of genital herpes (itching, pain, burning and rash on the external genitals). The prognosis of relapses of the disease depends on the state of the immune system of the man, his age, the presence of bad habits, the well-being of the socio-economic living conditions.
The absence or ineffectiveness of treatment for genital herpes in men increases the risk of complications in the form of concomitant diseases:
- The genital area, in particular the prostate;
- Nervous system;
- Eye.
In addition, genital herpes is a proven provocateur of the development of malignant neoplasms, and not only in the genital area.
Treatment of genital herpes in women
Women are more likely than men to contract genital herpes HSV-II. This means that contact of a man or woman with a carrier of herpes is not fatal for any of them in 100% of cases, but women are at greater risk. Meanwhile, a frivolous attitude towards herpes can be costly for a woman while carrying a fetus. Therapy for female herpes infection is carried out according to the same schemes as for men.
Genital herpes during pregnancy
The consequences of genital herpes during pregnancy are dramatic. Primary infection of the expectant mother with the HSV-II virus, depending on the gestational age, results in the following complications:
- First-second trimester - delay and fetal malformations, pregnancy fading;
- Second-third trimester - oligohydramnios and polyhydramnios, hydrocephalus and other defects of the fetal nervous system.
All detailed information about herpes during pregnancy
Treatment of a pregnant woman for herpes is carried out taking into account:
- Detection of immunoglobulins M or G in the blood and the presence of virions in the cells of the body;
- The state of health of the pregnant woman and the stage of fetal development;
- The presence / absence of a threat of miscarriage;
- The limited range of drugs acceptable for use during pregnancy.
For the treatment of women during pregnancy, it is possible to use etiotropic antiviral therapy. The dosage is selected individually, taking into account the characteristics of the body of a particular woman. Below is a list of the drugs most commonly used to treat genital herpes in expectant mothers. Conditions for use during pregnancy are taken from the instructions for the medication.
So, the list of acceptable medications for herpes for pregnant women:
- Panavir, taking into account individual tolerance externally without restrictions. Attention! Solution for intravenous administration and rectal suppositories during pregnancy should be used with caution and only in cases where the expected benefit outweighs the possible risk of side effects (determined in consultation with your doctor). During the period of use of the drug, breastfeeding must be suspended;
- Acyclovir (any method of use) only in exceptional cases, in addition, the drug should also not be taken during lactation;
- Acigerpine (analog of acyclovir) in the form of a cream or ointment. The effect of the drug on the gestation process is not fully understood. Pregnant women can use it with caution, and only when the expected benefit outweighs the possible risk to the fetus;
- Zovirax (analogue of acyclovir) in the form of tablets, powder for the preparation of solutions and eye ointment. Use with caution during pregnancy and always assess the risk-benefit ratio. During the forced treatment of pregnant women from herpes with Zovirax in a therapeutic dose, this drug in a residual amount is detected in breast milk. It should be borne in mind that a baby can receive it in an amount of up to 0.3 mg / kg per day;
- Vivorax (an analogue of acyclovir) is used for local and systemic use. During pregnancy, the treatment of herpes with this drug is allowed with great care.
Taking into account individual tolerance, fortifying agents are carefully used:
- Eleutherococcus recommended in some sources is contraindicated in pregnancy, during menstruation and in arterial hypertension;
- Talk to your doctor before using ginseng products during pregnancy and lactation.
- Fir, sea buckthorn oil, chamomile and calendula solutions can be used externally without restriction.
The absence or ineffective therapy of HH in pregnant women causes complications and provokes diseases of the genitourinary and nervous systems, as well as the organs of vision. Herpes is a possible provocateur of gynecological dysplasias and oncology in women.
Prevention of genital herpes
Prevention - the basis of maintaining health - consists of two main links
Specific prevention of herpes
Specific prevention is the use of vaccinations. However, with herpes, vaccines do not manage to obtain a persistent protective effect. This is due to the special device of the virus, which counteracts the influence of the immunogenic properties of the vaccine antigen and the adjuvant (enhancer of the protective properties of the vaccine).
On the subject: folk remedies for herpes
Nonspecific prevention of herpes
Non-specific prophylaxis includes:
- Healthy lifestyle, monogamous intimate relationships;
- Use of barrier contraception methods for all types of sex;
- Preventive therapy to improve immunity after casual relationships, even if a condom was used.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
