Herpes is a chronic recurrent infection caused by the herpes simplex virus and characterized by a predominant lesion of the integumentary tissues and nerve cells. The main route of transmission of herpes infection is contact, but airborne and transplacental transmission of the virus is possible. A distinctive feature of herpetic infection is the ability of viruses to persist in the nerve ganglia for a long time. This leads to the occurrence of herpes relapses during periods of reduced body defenses. The manifestations of herpes infection include herpes labialis, genital herpes, visceral herpes, generalized herpes, herpetic stomatitis and conjunctivitis.
General information
Currently, there are two types of herpes simplex virus. Type I of the virus mainly affects the mucous membranes and skin of the mouth, nose, eyes, is transmitted mainly by contact and household means, type II causes genital herpes, is transmitted mainly sexually. The reservoir and source of herpes infection is a person: a carrier or a patient. The isolation of the pathogen can last for a very long time.
The mechanism of transmission is contact, the virus is released onto the surface of the affected mucous membranes and skin. In addition to the main transmission routes for type I of the virus, airborne, airborne dust can also be realized, and type II can be transmitted vertically from mother to child (transplacentally and intranatally). Viruses that have entered the body tend to persist for a long time (mainly in ganglia cells), causing relapses of infection during periods of weakening of the body’s defenses (colds, vitamin deficiency). More often, the primary infection proceeds latently, the disease manifests itself later, acute infection is noted only in 10-20% of those infected.
Herpetic infection is classified according to the predominant lesion of certain tissues: herpes of the skin, mucous membrane of the mouth, eyes, ARVI, genital herpes, visceral herpes, herpetic lesion of the nervous system, herpes of newborns, generalized form.
Herpes symptoms
The incubation period of a herpetic infection is usually 2-12 days, the onset can be both acute and gradual, often the primary infection remains unnoticed by the patient at all, the course of the disease becomes recurrent. Relapses can occur both 2-3 times a year, and extremely rarely – 1-2 times in 10 years or less. Relapses tend to develop against the background of weakened immunity, so often the clinical manifestations of herpes are accompanied by acute respiratory infections, pneumonia, and other acute infections.
Herpetic skin lesions are localized mainly on the lips and wings of the nose. At first, itching and burning are subjectively felt in a localized area of the skin, then this area thickens, vesicles are formed on it, filled with transparent contents, gradually becoming cloudy. The bubbles are opened, leaving behind shallow erosion, crusts that heal after a few days without consequences. Sometimes bacterial flora penetrates through damaged integuments, causing secondary suppuration and complicating healing. Regional lymphadenitis may occur (nodes are enlarged, slightly painful). There are no general symptoms, or the disease occurs against the background of other infections that cause an additional clinic.
Herpetic lesions of the oral mucosa are characterized by the occurrence of acute or recurrent stomatitis. The disease may be accompanied by the phenomena of general intoxication, fever. The mucous membrane of the oral cavity is covered with groups of small vesicles filled with transparent contents that quickly open and leave painful erosions. Erosions in the oral cavity can heal up to 2 weeks. The disease can occur in the form of aphthous stomatitis (there is the formation of aphthous single, slowly healing erosions of the oral mucosa). At the same time, general clinical manifestations (intoxication, hyperthermia), as a rule, are absent. Herpetic stomatitis is prone to recurrence.
Herpes by the type of ARVI often occurs without characteristic vesicular rashes on the mucous membranes and skin, reminding the clinic of other respiratory viral diseases. In rare cases, a herpetic vesicular rash forms on the tonsils and the back wall of the pharynx (herpetic sore throat).
Genital herpes usually manifests itself as local rashes (vesicles are mainly formed on the head of the penis and the inner surface of the foreskin in men and on the labia majora and minora in women), and general signs (fever, intoxication, regional lymphadenitis). Patients may notice pain in the lower abdomen and in the lumbar region, burning and itching in the places of localization of the rash.
Rashes with genital herpes can progress, spreading to the mucous membrane of the vagina and cervix, urethra. Chronic genital herpes can cause cervical cancer. In many cases, genital rashes are accompanied by herpes of the mucous membranes of the mouth and eyes.
Ophthalmic herpes is manifested by a rash on the cornea, subsequently causes the formation of ulcerative defects, a decrease in corneal sensitivity, which contributes to the deterioration of vision. Herpes of the posterior parts of the eyeball is rare. Chronic recurrent herpes of the eye can lead to persistent corneal opacity, blindness.
Herpetic infection of the nervous system proceeds according to the type of serous meningitis (expressed in the form of general and meningeal symptoms, proceeds benign), or encephalitis (pronounced intoxication, fever reaches extremely high numbers, convulsive symptoms, various paresis, paralysis and disorders of consciousness are noted). Herpetic encephalitis in 30% of cases leads to death, after healing it leaves severe consequences in the form of persistent paralysis and paresis, dementia.
Visceral forms of herpes occur in accordance with the clinic of inflammatory diseases of the affected organs. These can be herpetic pneumonia, hepatitis, pancreatitis, nephritis, esophagitis, adrenal herpes. With a herpetic lesion of hollow organs available for endoscopy, vesicular rashes and erosions may be noted on the mucous membrane.
In newborns and patients with severe immune insufficiency, a generalized form of herpetic infection may develop, characterized by a high prevalence of skin manifestations, lesions of the mucous membranes and internal organs against the background of general intoxication and fever. The generalized form in AIDS patients often occurs in the form of Kaposi’s herpetiform eczema.
Shingles
One of the forms of herpes infection is shingles. The onset of the disease is often preceded by prodromal phenomena – general malaise, headaches, a rise in temperature to subfebrile figures, dyspeptic symptoms. There may be burning and itching in the projection area of the peripheral nerve trunks. The prodromal period lasts from one day to 3-4 days, may differ in different intensity of signs depending on the state of the patient’s body. In many cases, an acute onset is noted: the temperature rises sharply to febrile numbers, general intoxication is noted, herpetiform rashes appear on the skin during the innervation of the spinal ganglia.
The process can spread within one or more nerve trunks. Most often, rashes are localized along the projection of intercostal nerves or branches of the trigeminal nerve on the face, less often there is a lesion of the extremities, genitals. Rashes are groups of vesicles with serous contents located on areas of hyperemic compacted skin. In the area of rashes there is a burning sensation, intense pain of a vegetative nature. The pain occurs paroxysmally, more often at night. There may be disorders of tactile sensitivity in the area of innervation of the affected nerves, radicular paresis of the facial and oculomotor nerves, sphincter of the bladder, abdominal wall muscles and extremities. Fever is noted for several days, after which it subsides, along with it the symptoms of intoxication disappear.
The abortive form of herpes zoster infection occurs in the form of a short-term papular rash without the formation of vesicles. In the bullous form, herpetic vesicles merge, forming large bubbles – bulls. Bullous form can often progress into bullous-hemorrhagic, when the contents of the bull becomes hemorrhagic in nature. In some cases, the bulls merge along the course of the nerve fiber, forming a single bubble extended in the form of a ribbon, leaving a dark necrotic scab after opening.
The severity of the course of shingles depends on the localization of the lesion and the state of the body’s defenses. Lichen is especially severe in the area of innervation of the nerves of the face and head, while the eyelids and cornea of the eye are often affected. The duration of the course can range from several days (abortive form), up to 2-3 weeks, in some cases, dragging on for up to a month or more. After the transfer of shingles, relapses of herpes infection in this form are quite rare.
Diagnostics
Diagnosis of herpetic infection is carried out using virological analysis of the contents of vesicles and erosion scraping. In addition, the pathogen can be isolated from blood, urine, saliva, semen, flushes from the nasopharynx, cerebrospinal fluid. In the case of postmortem diagnosis, the pathogen is isolated from tissue biopsies. Isolation of the herpes simplex virus does not provide sufficient diagnostic data on the activity of the process.
Additional diagnostic methods include smear-fingerprint RNIF (giant multinucleated cells with type A Coudry inclusions are detected), RSC, PH, ELISA in paired sera. Study of immunoglobulins: an increase in the titer of immunoglobulins M indicates a primary lesion, and immunoglobulin G indicates a relapse. Recently, PCR (polymerase chain reaction) has been a common method of diagnosing herpes infection.
Herpes treatment
The variety of clinical forms of herpes infection causes a wide range of specialists who are engaged in its treatment. Treatment of genital herpes is carried out by venereologists, in women – gynecologists. Neurologists are engaged in the treatment of herpetic infection of the nervous system. The tactics of treatment of herpes infection is chosen depending on the clinical form and course of the disease. Etiotropic therapy can include acyclovir, other antiviral drugs. In mild cases, local treatment is used (ointments with acyclovir, Burov fluid). Glucocorticosteroid ointments are contraindicated.
General treatment with antiviral drugs is prescribed in courses, with primary herpes – up to 10 days, chronic recurrent herpes is an indication for long-term treatment (up to a year). Generalized, visceral forms, herpes of the nervous system are treated with intravenous administration of antiviral drugs, it is advisable to start the course of treatment as early as possible, its duration is usually 10 days.
In case of recurrent herpes, immunostimulating therapy for the period of remission is recommended. Immunomodulators, adaptogens, immunoglobulins, vaccination, intravenous laser irradiation of blood are prescribed. Physiotherapy is widely used: UVI, infrared radiation, magnetotherapy, EHF, etc.
Prognosis and prevention
An unfavorable prognosis has a herpetic infection with a lesion of the central nervous system (herpetic encephalitis has a high risk of death, after it there are severe persistent disorders of innervation and the work of the central nervous system), as well as herpes in people suffering from AIDS. Herpes of the cornea of the eye can contribute to the development of blindness, herpes of the cervix – cancer. Herpes zoster often leaves behind for a while various disorders of sensitivity, neuralgia.
Prevention of herpes type I corresponds to general measures for the prevention of respiratory diseases, herpes type II – prevention of sexually transmitted diseases. Secondary prevention of herpes relapses consists in immunostimulating therapy and specific vaccination with an inactivated herpes vaccine.