Genital herpes is a viral lesion of the mucous membrane of the genital organs, characterized by the appearance of a group of bubbles, and then erosions and ulcers. It is accompanied by a local burning sensation, swelling, hyperemia, an increase in inguinal lymph nodes and intoxication phenomena. It is prone to relapses and can subsequently lead to serious complications: a decrease in local and general immunity, the development of bacterial infections of the genitals, damage to the nervous system, the development of cervical and prostate cancer. Especially dangerous in pregnant women, because increases the likelihood of spontaneous miscarriage, pathology and even death of a newborn. It is included in the group of sexually transmitted diseases (STDs).
Meaning
Genital herpes is a viral lesion of the mucous membrane of the genital organs, characterized by the appearance of a group of bubbles, and then erosions and ulcers. It is accompanied by a local burning sensation, swelling, hyperemia, an increase in inguinal lymph nodes and intoxication phenomena. It is prone to relapses and can subsequently lead to serious complications: a decrease in local and general immunity, the development of bacterial infections of the genitals, damage to the nervous system, the development of cervical and prostate cancer. Especially dangerous in pregnant women, because increases the likelihood of spontaneous miscarriage, pathology and even death of a newborn. It is included in the group of sexually transmitted diseases (STDs).
The causative agent is a type of herpes simplex virus (HSV). Infection with herpes infection among the world’s population is about 90%.
There are several types of herpes virus that cause lesions of the skin, mucous membranes, central nervous system and other organs (herpes simplex viruses of types 1 and 2, cytomegalovirus, chickenpox virus, Epstein–Barr virus, shingles, etc.). Herpes simplex viruses of types 1 and 2 cause oral and genital forms of the disease, and HSV type 1 mainly affects the face, lips, nose wings, and HSV type 2 is most often the cause of genital herpes. HSV is often detected in association with ureaplasma and cytomegalovirus.
The disease has a sexual transmission pathway, with various forms of sexual contact it easily penetrates through damaged skin and the epithelium of the mucous membrane. After infection, it migrates to the nerve ganglia, remaining there for life. The reproduction of HSV in the epithelial cells of the skin and mucous membranes leads to their dystrophy and death. The infection is characterized by a chronic course and manifests itself cyclically: periods of activity or relapses (2-21 days), accompanied by the appearance of rashes in the form of bubbles, alternate with periods of remission when clinical symptoms disappear. Often the disease is asymptomatic, but patients are still a source of infection.
Causes
Primary infection usually occurs by airborne droplets in childhood (in the population of children aged 6-7, the incidence rate is already 50%). The reasons for this are high population density, low socio-economic standard of living, non-compliance with hygiene rules.
Secondary infection occurs, as a rule, as a result of sexual contact. A high percentage of the incidence of genital herpes is observed among people aged 20-30 years. This is due to the early onset of sexual activity, promiscuous sexual relations, frequent change or the presence of several partners, unprotected sexual contacts. Venereology also includes internal causes as risk factors for genital herpes:
- reduction of the body’s immune defense;
- presence of STDs;
- gender of a person (it is noticed that women suffer from genital herpes much more often than men);
- surgical termination of pregnancy, the use of intrauterine devices.
The human immune system reacts to the penetration of HSV by the production of specific antibodies, and at a normal level of immune reactions, clinical manifestations of infection are not observed. Under the influence of a number of adverse factors that reduce the immune reactivity of the body, HSV is activated, which is manifested by rashes on the skin and mucous membranes, neuralgic pain. Episodes of relapses often occur against the background of chronic stress, lack of vitamins, hypothermia, overheating, climate change, colds.
Ways of transmission
Infection most often occurs through the mucous membranes of the genitals, rectum, urethra or damage to the skin during genital, oral – genital and anal – genital contacts.
HSV transmission is also possible:
- by airborne droplets;
- vertically from the sick mother to the fetus (during childbirth in contact with the birth canal of the mother, transplacentally, ascending from the external genitalia of the mother through the cervical canal into the uterine cavity);
- with self-infection – autoinoculation (a sick person himself transfers the infection from infected areas of the body to uninfected – from the face to the genitals);
- by household means – rarely (through wet hygiene items).
Usually, infection with genital herpes occurs when the infected partner does not even know about the disease, since he does not have clinical manifestations of the disease (in the case of asymptomatic viral transmission).
Forms and manifestations
According to the clinical course, there are primary (the first episode of the disease) and recurrent (all subsequent episodes of the disease).
Recurrent genital herpes can occur in typical, atypical clinical forms and in the form of asymptomatic viral transmission.
Primary genital herpes
The earliest symptoms include swelling, redness, pain, burning in the area of the entrance gate of infection. Local manifestations are often accompanied by fever, malaise, headache and muscle pain. A few days later, herpetic rashes appear – small bubbles with transparent contents. The rupture of the bubbles is accompanied by the formation of painful erosive and ulcerative elements. When ulcers are localized on the genitals, painful urination is noted. The healing of rashes occurs within two weeks.
Genital herpes in women usually affects the external genitalia, the perineum and anus, the urethra, and the inner surfaces of the thighs. In men, rashes are most often localized on the head of the penis and foreskin, less often in the urethra, sometimes accompanied by the development of herpetic urethritis or prostatitis.
Recurrent genital herpes
It occurs in 50-70% of patients who have had a primary infection. Depending on the frequency of repeated episodes, several forms of recurrent genital herpes are distinguished:
- a mild form (exacerbations no more than 3 times a year)
- moderate form (exacerbations from 4 to 6 times a year)
- severe form (monthly exacerbations)
The course can be arrhythmic, monotonous and subsiding.
The arrhythmic course is characterized by alternating remissions from 2 weeks to 5 months. At the same time, the longer the periods of remission, the more intense and prolonged the relapses of genital herpes, and vice versa.
With a monotonous course, frequent episodes of the disease are noted after little-changing periods of remission. This type includes menstrual herpes, which has a persistent course and is poorly treatable.
Genital herpes of the subsiding type has a more favorable course. It is characterized by a decrease in the intensity of relapses and an increase in remission periods.
The development of relapses occurs under the influence of various factors: hypothermia, sexual intercourse, stressful situations, fatigue, the occurrence of other pathology (influenza, ARVI).
Symptomatically, relapses are weaker than the primary disease, however, their consequences can be much more serious.
Rashes with genital herpes are accompanied by extreme soreness, making it difficult for the patient to move, visit the toilet, disturbing sleep. The psychological state of a person often changes: irritability appears, fear of new rashes, fear for the health of loved ones, suicidal thoughts, etc.
Atypical forms
Atypical forms occur obliterated, in the form of chronic inflammation of the external and internal genitalia (vulvovaginitis, colpitis, endocervicitis, urethritis, cystitis, prostatitis, etc.). The diagnosis is based on laboratory confirmation of the presence of herpes infection. Atypical forms of genital herpes account for more than half of clinical cases – 65%.
The atypical form is characterized by mild swelling, areas of erythema, small-point vesicles, persistent burning and itching, abundant, not amenable to therapy, white. With a prolonged course, there is an increase and soreness of the inguinal lymph nodes.
According to the localization of herpetic rashes , there are 3 stages:
- Stage I – affects the external genitalia;
- Stage II – affects the vagina, cervix, urethra;
- Stage III – affects the uterus, appendages, bladder, prostate.
The higher the herpetic infection penetrates the genitourinary tract, the more serious the prognosis. An advanced form of genital herpes can lead to a state of immunodeficiency, and in women it increases the risk of infertility, cervical cancer. HSV is dangerous for people with weakened immunity (HIV-infected), and who have undergone organ transplantation surgery.
Genital herpes and pregnancy
During pregnancy, genital herpes is most dangerous in the case of primary infection, if there have been no previous manifestations of the disease. There is a possibility of malformations if the mother’s disease occurred at an early stage of pregnancy, when the fetus is laying all organs and tissues. HSV can be transmitted through the placenta, affecting mainly the nervous tissue of the fetus. The disease increases the threat of spontaneous miscarriage, premature birth, fetal deformities and its death.
Pregnant women with atypical forms in the last 6 weeks of pregnancy are examined twice for HSV. When the herpes virus is detected, a caesarean section operation is performed as planned to exclude possible infection of the fetus when passing through the birth canal.
The best option is to examine women for HSV at the stage of preparation for pregnancy, as well as during pregnancy during each trimester.
Genital herpes in newborns
Most often, fetal infection occurs in the first 4-6 hours of labor after rupture of the fetal membranes, or during the passage of the fetus through the birth canal of an infected mother. Usually HSV in newborns affects the eyes, oral mucosa, skin, respiratory tract. After the initial infection of a newborn, HSV spreads in the body by hematogenic or contact route. The probability of infection of newborns increases when the mother is infected with genital herpes in the last trimester of pregnancy.
With a localized form of herpetic infection, redness, vesicles, hemorrhages of the skin and oral mucosa may appear in newborns, meningoencephalitis, keratoconjunctivitis and chorioretinitis (inflammation of the vessels and retina of the eye), clouding of the lens may develop. Children infected with genital herpes often suffer from persistent neurological disorders.
The disease can cause the development of generalized infection of newborns. Signs of generalized herpes infection appear 1-2 weeks after the birth of the child. Local symptoms include refusal to eat, vomiting, fever, jaundice, respiratory disorders, bleeding, shock. The death of a child can occur from acute blood loss and vascular insufficiency.
Diagnosis
When diagnosing, the venereologist takes into account complaints, anamnesis data and objective research. Diagnosis of typical cases, as a rule, is not difficult and is based on clinical manifestations. Herpetic ulcers that exist for a long time should be distinguished from syphilitic ulcers.
Laboratory methods for the diagnosis of genital herpes include:
- methods for detecting HSV in the material of the affected organs (scrapings from the vagina and cervix, a smear from the urethra, histological material of the fallopian tubes, etc.). For this purpose, the method of growing HSV on tissue culture and subsequent study of its properties is used, the method of virus recognition under an electron microscope is used;
- methods for detecting antibodies to HSV in blood serum (immunoglobulins M and G). They can detect the disease even with an asymptomatic course and determine antibodies to HSV type 1 or type 2. These include ELISA, a method of immuno-enzyme analysis.
Genital herpes treatment
Currently existing medications for HSV can reduce the severity and duration of the course, but are not able to completely get rid of the disease.
In order to avoid the development of HSV resistance to classical antiviral drugs intended, among other things, for the treatment of genital herpes (acyclic nucleosides – Valacyclovir, Acyclovir, Famciclovir), their alternate use is recommended, as well as combination with interferon preparations. Interferon has a powerful antiviral effect, and its deficiency is one of the main causes of recurrent genital herpes.
A ready-made drug containing both acyclovir and interferon is Herpferon ointment. It also includes lidocaine, which provides a local anesthetic effect, which is extremely important for painful manifestations of the disease. The use of Herpferon provides healing of rashes already on the 5th day and significant relief of local symptoms.
Prevention
The way to prevent primary infection is the use of condoms during casual sexual intercourse. However, even in this case, the probability of HSV infection through microcracks and lesions on the mucous membranes and skin that are not covered with a condom remains high. It is possible to use antiseptic agents (miramistin, etc.) to treat areas where the virus may enter.
The recurrent course is noted with a decrease in the protective reactions of the body: diseases, overheating, hypothermia, the arrival of menstruation, pregnancy, taking hormonal drugs, stress. Therefore, to prevent relapses, a healthy lifestyle, proper nutrition and rest, taking vitamin preparations are important. Measures for the prevention of genital herpes are also the observance of intimate hygiene and hygiene of sexual life, timely detection and treatment of sexually transmitted diseases.
A patient infected with HSV should warn his sexual partner about this, even if he does not have symptoms of genital herpes at the moment. Since infection during sexual contact is possible even in the absence of herpes rashes, in this case, the use of a condom is also necessary.
After a dubious unprotected sexual contact, you can resort to the method of emergency prevention with a locally acting antiviral drug in the first 1-2 hours after intimacy.
To prevent self-infection, when the virus is transferred by dirty hands from the lips to the genitals, it is necessary to fulfill basic hygienic requirements: thorough and frequent hand washing (especially if there is fever on the lips), the use of separate towels for hands, face and body, as well as for each family member.
In order to reduce the risk of infection with HSV in newborns, pregnant women are shown operative delivery (cesarean section). With planned natural childbirth, women with a recurrent course are prescribed a preventive course of taking acyclovir.
After unprotected sexual intercourse, during pregnancy planning, as well as during sexual relations with an HSV carrier, it is recommended to be examined for genital herpes and other STDs.
Literature
- Bradley H., Markowitz L., Gibson T., et al. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999–2010 // J Infect Dis, 2014; 209 (3): 325-333.link
- Kimberlin D. W., Balely J., Committee on Infectious Diseases, Committee on Fetus and Newborn. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions // Pediatrics, 2013; 131 (2): e635-46.
- Barnabas R. V., Celum C. Infectious co-factors in HIV-1 transmission. Herpes simplex virus type-2 and HIV-1: new insights and interventions // Curr HIV Res, 2012; 10(3): 228–237.link
- Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines // MMWR Morb Mortal Wkly Rep Recomm Rep, 2015; 64(RR-3): 27-32.link
