How big are herpes sores in men. What are the main symptoms of genital herpes in males. How is genital herpes transmitted. What treatment options are available for genital herpes in men. How common is genital herpes among males. Can genital herpes be cured completely. What are the differences between HSV-1 and HSV-2.

Understanding Genital Herpes: Prevalence and Transmission

Genital herpes is a widespread sexually transmitted infection caused by the herpes simplex virus (HSV). According to the World Health Organization, approximately 3.7 billion people under 50 have HSV-1, while 491 million individuals aged 15-49 have HSV-2. The Centers for Disease Control and Prevention (CDC) reports that around 776,000 people contract genital herpes annually in the United States.

How is genital herpes transmitted? The virus primarily spreads through sexual activity, including direct oral or genital contact. Importantly, transmission can occur even when no visible sores or lesions are present, making it challenging to prevent without proper precautions.

HSV-1 vs. HSV-2: Key Differences

There are two types of herpes simplex virus:

• HSV-1: Traditionally associated with oral herpes (cold sores), but can also cause genital herpes
• HSV-2: Primarily responsible for genital herpes infections

While both types can cause genital herpes, HSV-2 is more commonly associated with recurring outbreaks in the genital area.

Genital Herpes in Men: Symptoms and Characteristics

Many individuals with genital herpes remain asymptomatic, unaware they have contracted the virus. For those who do experience symptoms, they typically appear about 4 days after exposure and can include:

• Tingling sensations in the genital area
• Small red bumps that develop into blisters
• Swelling in the groin, neck, or under the arms
• Muscle aches and fever
• Headaches and fatigue
• Difficulty urinating

How big are herpes sores in men? The size of herpes sores can vary, but they typically start as small, red bumps that develop into fluid-filled blisters. These blisters can range from 1-3 millimeters in diameter, though they may appear larger when multiple blisters cluster together.

The Herpes Outbreak Cycle

Genital herpes outbreaks often follow a cyclical pattern:

1. Initial tingling or burning sensation
2. Appearance of red bumps or blisters
3. Blisters rupture and form painful sores
4. Sores crust over and heal

The first outbreak is typically the most severe and may last up to two weeks. Subsequent outbreaks are usually shorter and less intense.

Diagnosis and Testing for Genital Herpes

How is genital herpes diagnosed in men? While many cases of genital herpes can be identified through visual examination and symptom assessment, definitive diagnosis often requires laboratory testing. Two primary methods are used:

• Polymerase Chain Reaction (PCR) Tests: These tests amplify small portions of the virus DNA for detection, providing highly accurate results.
• Serologic Tests: Blood analysis to detect antibodies that the body produces to fight the herpes virus. These tests can determine if a person has been infected with HSV, even if they’ve never experienced symptoms.

It’s important to note that early testing during an outbreak can improve the accuracy of diagnosis, particularly for PCR tests.

Treatment Options for Genital Herpes in Men

Can genital herpes be cured completely? Unfortunately, there is currently no cure for genital herpes. However, several treatment options can help manage symptoms and reduce the frequency of outbreaks:

Antiviral Medications

Antiviral drugs are the primary treatment for genital herpes. These medications can:

• Shorten the duration of outbreaks
• Alleviate symptoms
• Reduce the risk of transmission to partners

Common antiviral medications prescribed for genital herpes include:

• Acyclovir
• Valacyclovir
• Famciclovir

Topical Treatments

Topical creams or ointments may be recommended to ease pain and promote healing of sores. These can include:

• Lidocaine-based creams for pain relief
• Zinc oxide ointments to promote healing

Suppressive Therapy

For individuals experiencing frequent outbreaks, daily suppressive therapy may be recommended. This involves taking a low-dose antiviral medication daily to reduce the frequency of outbreaks and lower the risk of transmission to partners.

Living with Genital Herpes: Management and Prevention

While genital herpes cannot be cured, it can be effectively managed. Here are some strategies for living with genital herpes:

• Maintain open communication with sexual partners about your HSV status
• Use barrier methods (condoms, dental dams) during sexual activity
• Avoid sexual contact during outbreaks
• Consider daily suppressive therapy if outbreaks are frequent
• Practice good hygiene, especially during outbreaks
• Manage stress, as it can trigger outbreaks in some individuals

Genital Herpes in Men vs. Women: Understanding the Differences

How does genital herpes differ between men and women? While the virus itself doesn’t discriminate, there are some notable differences in how genital herpes affects men and women:

• Prevalence: The CDC estimates that genital herpes is more common in women, affecting about 16% of females compared to 8% of males aged 14-49.
• Transmission: The virus is more easily transmitted from men to women during intercourse, which may explain the higher prevalence in females.
• Symptoms: While symptoms are generally similar, women may experience additional complications, such as cervicitis (inflammation of the cervix).
• Pregnancy concerns: Women with genital herpes face additional risks during pregnancy, including the potential for neonatal herpes transmission.

The Psychological Impact of Genital Herpes

Beyond the physical symptoms, genital herpes can have significant psychological effects on those diagnosed. Common emotional responses include:

• Shame and embarrassment
• Anxiety about disclosing to partners
• Fear of rejection
• Depression or mood changes
• Concerns about future relationships

It’s important to address these psychological aspects of living with genital herpes. Support groups, counseling, and education can help individuals cope with the emotional impact of the diagnosis.

Future Directions: Research and Potential Treatments

While there is currently no cure for genital herpes, ongoing research offers hope for improved treatments and potential preventive measures:

Vaccine Development

Several research teams are working on developing vaccines for genital herpes. These fall into two categories:

• Preventive vaccines: Aimed at preventing initial infection in uninfected individuals
• Therapeutic vaccines: Designed to reduce symptoms and viral shedding in those already infected

While no vaccine has yet been approved for general use, several candidates are in various stages of clinical trials.

Gene Editing Approaches

Researchers are exploring the potential of gene editing technologies, such as CRISPR, to target and eliminate the herpes virus from infected cells. While still in early stages, this approach could potentially lead to a cure for herpes infections.

Improved Antivirals

Efforts are underway to develop more effective antiviral medications with fewer side effects and improved efficacy against drug-resistant strains of the virus.

As research progresses, individuals living with genital herpes can look forward to potentially more effective management strategies and, hopefully, a cure in the future.

In conclusion, while genital herpes remains a challenging condition, understanding its symptoms, transmission, and available treatments can help individuals manage the infection effectively. By staying informed, practicing safe sex, and seeking appropriate medical care, those affected by genital herpes can maintain a healthy, fulfilling life despite the diagnosis.

Genital herpes in men: Symptoms, pictures, and treatment

Genital herpes is a common condition that can cause red bumps around the genital area, including the penis, scrotum, and anus. There is no cure for genital herpes, but some antiviral medications can shorten the duration of symptoms and help prevent future occurrences.

The herpes simplex virus causes genital herpes, while the condition usually does not trigger symptoms. Many people can have the virus without knowing it.

Keep reading to learn more about genital herpes in males, including the symptoms, causes, and possible treatments.

Genital herpes is an acquired infection with the herpes simplex virus. It primarily transmits through sexual activity.

The herpes simplex virus is widespread. There are two types: type 1 and type 2. According to the World Health Organization (WHO), around 3.7 billion people under the age of 50 have the type 1 virus, while 491 million people aged 15–49 years have type 2.

Most people who acquire the herpes virus do not experience symptoms and are often unaware they have contracted it.

However, some experience symptoms that may include genital herpes. Both types of herpes viruses can trigger this condition.

Those with symptoms of genital herpes can encounter blisters or lesions around the genitals. The symptoms may occur in cycles.

In contrast, oral herpes trigger sores around the mouth, teeth, or gums, often known as cold sores or fever blisters. The herpes type 1 virus usually causes this condition.

According to the Centers for Disease Control and Prevention (CDC), around 776,000 people contract genital herpes each year in the United States.

Genital herpes is a result of acquiring an infection with the herpes simplex virus.

People pass the virus through sexual activity, including direct oral or genital contact. For example, someone may acquire the virus by receiving oral sex from someone with herpes.

People usually pass on type 1 viruses through touching or kissing. In contrast, people typically transmit type 2 viruses during sexual intercourse.

It is possible to contract herpes from someone with no visible sores or lesions. Not everyone will be aware if they have acquired or transmitted the virus.

Genital herpes is less common in males than in females. The CDC estimate that around 16% of females and 8% of males aged 14–49 years contract the infection each year.

The virus that causes the infection is more easily passed on from males to females during intercourse, which may explain the difference. In addition, people can also acquire the virus from anal intercourse.

The symptoms are the same for males and females. However, females who experience genital herpes during pregnancy can experience complications.

Most cases of herpes do not cause symptoms, and many people have the condition without knowing it. Others may experience symptoms that present at a later date if the virus reactivates.

Symptoms of genital herpes can include:

• tingling sensations in the genital area, including the penis, scrotum, anus, buttocks, or thighs
• small red bumps that turn into blisters around the genital area
• swelling in the groin, neck, or under the arms
• muscle aches
• fever
• headaches
• tiredness
• trouble urinating

People with symptoms typically experience them around 4 days after exposure. They can last a couple of weeks and may re-emerge again in future occurrences.

The first episode is typically longer and more likely to include body-wide symptoms, such as fever or aches. People who experience future occurrences usually experience red bumps or blisters for a shorter period.

People rarely require a doctor for genital herpes. Most cases are mild or cause no symptoms. Symptoms that do occur usually go away within a couple of weeks in the first instance.

However, some people may experience body-wide symptoms that cause discomfort. Doctors can prescribe antiviral medications to speed up recovery and reduce the risk of future occurrences in these cases.

To check for genital herpes, a doctor may use polymerase chain reaction tests. These tests amplify small parts of the virus DNA for detection.

Other tests include serologic tests, a blood analysis used to detect the antibodies that the body uses to fight the virus.

The sooner a person starts on medication following an occurrence of herpes symptoms, the more effective it is.

There is currently no cure for genital herpes. However, most people experience zero or mild symptoms, with no long-term complications from the virus.

Doctors can prescribe antiviral medications to those who experience symptoms. These drugs may shorten the duration of symptoms or prevent future occurrences. Topical creams could also help ease the pain.

Daily suppressive therapies can reduce the chance of transmission to partners.

There are currently no vaccines to prevent a person from contracting a genital herpes virus. However, people can reduce their risk of acquiring or passing on genital herpes through practicing safe sexual practices, such as:

• avoiding sexual activities when a person is experiencing symptoms
• using a condom
• limiting the number of new sexual partners
• talking with a doctor about treatments to preventing future occurrences

These practices can reduce the risk of contracting genital herpes but cannot prevent symptoms from flaring up.

It is also important to note that if a person touches the fluid from the herpes sores, or the sores themselves, they can transfer herpes to another part of the body, such as the eyes.

Therefore, avoid touching these where possible to prevent spreading herpes elsewhere on the body. People should also wash their hands thoroughly if they do touch these sores or fluids.

Genital herpes is a commonly acquired infection with the herpes simplex virus.

It typically triggers mild symptoms or no symptoms at all. However, genital herpes can cause small red bumps to develop, which turn into blisters.

There is no cure for genital herpes, although antiviral medications can help with symptoms and prevent future occurrences.

Herpes in females: Symptoms, diagnosis, and treatment

The symptoms of herpes in females are similar to those in males. Blisters, ulcers, or sores usually appear first at the site where the virus entered the body. For females, this may be around the mouth, vagina, cervix, urinary tract, or anus.

According to the Office on Women’s Health (OWH), herpes affects 1 in 5 females between the ages of 14 and 49 years.

This article will look at the symptoms, diagnosis, and treatment of herpes in females.

There are two types of herpes infection: the herpes simplex virus type 1 (HSV-1) and the herpes simplex virus type 2 (HSV-2).

According to the World Health Organization (WHO), across the world, HSV-1 affects 3.7 billion people under the age of 50 years. HSV-2 affects 417 million people between the ages of 15 and 49 years.

Herpes infections are typically asymptomatic, but they can produce symptoms in some cases.

The sections below will discuss each type of herpes in more detail.

HSV-1

According to the WHO, HSV-1 is highly contagious and often appears as oral herpes, affecting the mouth and the area around it.

A person may come into contact with HSV-1 through nonsexual contact with another person’s saliva during their childhood and teenage years.

Sometimes, HSV-1 infections can cause genital herpes, which affects the genital or anal areas. HSV-1 can spread to the genitals through oral sex.

HSV-2

Some people refer to HSV-2 as genital herpes. HSV-2 typically spreads during anal, vaginal, or oral sex.

The WHO note that HSV-2 affects more females than males. The reason for this is that the transmission from males to females is more efficient.

Herpes will last a person’s lifetime. However, many people have either mild symptoms or no symptoms at all.

If herpes is asymptomatic, some people may not know that they have it. However, even in these cases, the virus can still spread.

Initial flare

The symptoms of an initial flare will depend on the type of herpes the person has.

Genital herpes

According to the OWH, when a female first contracts herpes, the symptoms tend to occur within 2–12 days. They typically appear at the site where the virus entered the body.

The following symptoms typically last for 2–4 weeks:

• pressure in the abdomen
• flu-like symptoms, sometimes including fever
• pain in the legs or the anal or genital area
• swollen glands
• itching or burning in the genital or anal area
• unusual vaginal discharge

Following these symptoms, females may develop blisters, ulcers, or sores at the site where the virus entered the body. These blisters, or lesions, can resemble insect bites or small pimples. In time, they usually crust over and form a scab.

These lesions may appear in the following areas of the body:

• the mouth
• the cervix
• the anus
• the buttocks
• the thighs
• in or around the vagina
• the urinary tract

They can also affect any other area where the virus entered the body.

Although the initial symptoms often develop within a couple of weeks, it could take several months or years before a person experiences the next flare.

Oral herpes

The initial symptoms of oral herpes may include:

• severe flu-like symptoms
• headaches
• swollen lymph nodes
• lesions on or around the lips
• lesions inside the mouth

Recurring flares

With later flares, a person may experience symptoms for a shorter period of time. Although the symptoms are often milder, they are typically similar to those of the initial outbreak.

Over time, a person is likely to experience fewer outbreaks, and they tend to be less severe.

Genital herpes

The initial set of symptoms is often the worst.

However, during a flare, a female may experience:

• sores
• a burning sensation when urinating, if sores are present
• difficulty urinating, if sores cover the urethra
• itching and pain around the genitals

Oral herpes

Recurrent oral herpes outbreaks are common in the first year of having the infection. They tend to lessen as time goes on because the body creates antibodies to fight the virus.

The sores typically erupt on the edges of a person’s lips.

Some common symptoms include:

• skin flushing, swelling, heat, itching, or pain on the affected area
• painful, fluid-filled blisters
• leaking blisters that turn into sores

The sores typically crust over and heal after about 4–6 days.

Possible triggers of outbreaks may include:

• fever
• menstruation
• injury
• prolonged exposure to sunlight
• surgery
• stress

Herpes can spread as a result of coming into skin-to-skin contact with a person who has the virus. This can happen even if the person does not know that they have it.

According to the OWH, herpes can spread through:

• having vaginal, oral, or anal sex with someone who has the virus
• touching the genitals of a person who has the virus
• breastfeeding, if the baby comes into contact with a sore
• childbirth, with the pregnant person transmitting it to the baby

There is currently no cure for herpes. However, there are treatment options available that can help reduce the severity of future flares.

The sections below will look at some of the treatment options for genital and oral herpes.

Genital herpes

A doctor will typically prescribe antiviral medication to treat genital herpes.

A person can take antiviral medication either during a flare, to help reduce the severity and length of the symptoms, or daily, to help prevent future flares.

A person should talk to their doctor about which medications are likely to work best for them.

During a flare, it is important to take some steps to help reduce the risk of passing the virus to others and minimize the severity of the flare.

Such steps include:

• keeping any sores or ulcers clean and dry
• avoiding sexual contact
• not touching the sores
• washing the hands or any other objects that come into contact with the sores

Oral herpes

When determining the best treatment for oral herpes, a healthcare professional will take into consideration the person’s age, overall health, and tolerance for medication.

Some treatment options for oral herpes may include:

• keeping the area clean and dry
• taking oral antiviral medications
• using over-the-counter anesthetics or anti-inflammatory agents

The process of diagnosing herpes is similar for both types. The following sections will look at these processes in more detail.

Genital herpes

A healthcare professional can make an initial diagnosis by carrying out a physical examination and checking any sores or ulcers on or near the genitals, anus, or mouth.

They may use a cotton swab or another similar device to take a fluid sample from a sore, which they will then send to a laboratory. At the laboratory, a technician will check the sample for herpes.

Between flares or before symptoms are present, it may be difficult for a doctor to diagnose herpes. However, if a person thinks that they may have herpes, a doctor can run a blood test to look for antibodies to the herpes virus.

Oral herpes

To diagnose oral herpes, a doctor can examine the location and appearance of the blisters that have appeared.

They may also perform a blood test or biopsy to confirm the diagnosis.

If a person with herpes becomes pregnant, they should let their doctor know, as it is possible that herpes will pass to the baby during delivery. A doctor can take steps to help protect the baby.

If herpes passes to the baby during the birth, the baby will have neonatal herpes. Neonatal herpes is a serious condition. A baby with neonatal herpes may develop eye conditions or brain injuries. It can even be fatal.

According to the Centers for Disease Control and Prevention (CDC), during the third trimester of pregnancy, a person should avoid having sexual activity with anyone who has genital herpes or suspected herpes.

A doctor may prescribe antiviral medication later on in the pregnancy to reduce the risk of a herpes outbreak. However, antiviral prophylaxis may not decrease the risk.

A healthcare professional may perform an examination before labor. If there are any symptoms of herpes, a cesarean delivery may be necessary.

The only guaranteed way to prevent the spread of herpes is to avoid having any physical contact with a person who has the infection.

However, there are other steps that a person can take to reduce the risk, including:

• avoiding skin-to-skin sexual contact, particularly when herpes lesions are present
• using condoms or dental dams, as other forms of birth control do not prevent herpes
• taking care when having multiple sexual partners
• undergoing regular testing and asking sexual partners to, as well

People who are sexually active should see a doctor regularly to undergo screenings for sexually transmitted infections (STIs).

A person who suspects that they may have come into contact with herpes should see a doctor to get a test.

A person should also see a doctor if they experience any symptoms of genital or oral herpes. A doctor can confirm a diagnosis and discuss the treatment options.

If someone who has genital herpes becomes pregnant, they should see a healthcare provider to prevent passing the virus to the baby.

It is possible for pregnant people with genital herpes to deliver a baby safely, but a doctor needs to be aware of the situation to do this effectively.

Herpes is a virus that currently has no cure. However, treatment options are available to reduce the symptoms.

Females with herpes may not experience any symptoms of the infection, but even if this is the case, the virus can still spread to others.

Symptomatic herpes typically presents with open, painful sores or ulcers on or around the genitals, anus, or mouth.

People should practice protected sex and undergo frequent testing to reduce their risk.

Pregnant people should let their doctor know if they have herpes to help prevent passing the infection to the baby.

90,000 expert comments, live connections with participating cities.

Aleksey Anatolyevich Khaldin , professor, doctor of medical sciences:

– Hepatotoxicity with pulsed therapy. There is practically no hepatotoxicity with pulse therapy, it’s not even worth talking about. What is the role of comorbid pathology in primary herpes virus infection? Is primary herpes observed in cirrhotic liver disease? Yes, with primary herpes, liver damage is observed, but I can’t say how cirrhotic it is.

Vladimir Trofimovich Ivashkin Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

– But I think our listener is asking, is there a herpes infection in cirrhosis of the liver? I can answer for you. It definitely does, yes.

Khaldin A.A. :

– Does a certain level of immunodeficiency indicate the presence of a herpes virus infection? Yes, we can clearly tell by the frequency of relapses what kind of immunodeficiency we are dealing with, if a recurrence is 1-2 times a year, this is a transient immunodeficiency, and it makes no sense to conduct any examinations here, if relapses are frequent, then this is already a deeper immunodeficiency, well, of course, not primary, but secondary.

Do the proportions of herpes transmission routes change depending on the country, what is the proportion in Russia, is the role of the vertical route of infection significant? I’ll start with the last one, the role of the vertical route of infection transmission is almost minimal, this can only be if primary herpes has developed in a pregnant woman, this is an extreme situation, that is, a rare one. The proportion of transmission routes of the virus is changing today, because in most cases the transmission of genital herpes is by urogenital contact, if we talk about this route, but the most common route is airborne. Therefore, if we say whether it changes here, no, it changes only in terms of transmission with not true genital contacts, but with urogenital contacts. I think there is no difference between Russia and the other world, it’s all pretty much the same.

Can the herpes simplex virus cause autoimmune thyroiditis? I devoted a whole slide to this, talking about gluteal herpes, saying that, yes, this is a proven thing, and gluteal herpes is just a marker of thyroid damage, including autoimmune thyroiditis. The only thing I want to say is that autoimmune thyroiditis develops after 3-4 years from the onset of gluteal herpes.

What can be used as an ambulance in the first hours? As an ambulance in the first hours, acyclic nucleosides should be used and nothing more. And all these tales that ointments help with herpes simplex are an illusion, they are symptomatic help, and local preparations have nothing to do with treatment.

Welcome to Chita. How stable is the herpes virus in the environment? The herpes simplex virus dies quite quickly outside the body and no preventive recommendations should be followed here. Of course, the only thing is that if you are examining a patient, gloves must be thrown away, the instrument must be processed, but the virus dies very quickly in the external environment.

A group of doctors from Khabarovsk welcomes you. What is your attitude towards non-direct-acting drugs? As far as I understand, we are talking about immune preparations, probably, first of all, about interferon inducers, I think that today this is a premature conversation. In my opinion, immune preparations, first of all, interferon inducers, should be forgotten and we should talk about acyclic nucleosides. Interferon inducers are the future, we need to study, we need to look, today we don’t know what parts of the immune system these drugs affect, yes, we know the end result – about increasing the production of interferon, but we don’t know what happens in the cascade of immune reactions. And we also do not know the consequences of the long-term effects of these drugs. There is a possibility of developing autoimmune processes. We also cannot predict today with these drugs, so it is probably premature to talk about it today.

What are the methods of prevention, protection of others from HSV? Prevention methods are a rather complicated issue, because, given the spread of infection by airborne droplets, it is impossible to insure against this. The body protects these 123 strains from the penetration of the virus, yet we rarely encounter virulent strains. The body protects with protective immunity, immunoglobulins, which every person has, since we received the virus in childhood, and if antibodies are produced, then this is protection against the penetration of the virus even during an epidemic in the spring, autumn, when bursts of the same labial herpes.

Evgeny Lvovich Nasonov , Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

– Is it possible to reduce the need for non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis? I have already said that the problem of osteoarthritis is a very complex problem. I can tell you how to reduce the need for NSAIDs. Weight, if a patient with osteoarthritis is overweight, in principle, no drugs, including non-steroidal ones, are effective. Reduce weight, mechanical factors – this is the only way to reduce the need for NSAIDs.

Consolidation of fractures. A very difficult question, probably better known to orthopedic traumatologists, but, nevertheless, the use of bisphosphonates and strontium renalate, at least, will definitely not hurt and may accelerate the consolidation of fractures.

Where are schools for the sick held in Moscow? Institute of Rheumatology RAS. You are welcome.

How to stimulate cartilage regeneration? Nothing needs to be stimulated – neither the immune system, nor regeneration, in any case, this is still speculation. I do not know of reliable studies, where would it all be.

Predisposition to rheumatic syndromes. I can’t say anything about this, neither in our institute, nor in foreign literature, I see this problem, although we are very actively working on it. I can’t understand what is being said. I don’t see it, we don’t have these patients, where this problem would have any real clinical significance.

What refers to rheumatic masks of endocrine pathology? There are a lot of endocrine problems – diabetic foot, this is a wide range of issues, in general, such a problem as rheumatic endocrinology or, on the contrary, it exists, and there are a lot of diseases. I do not think that this is some kind of pillar direction in rheumatology.

Ivashkin V.T. :

– I want to thank Evgeny Lvovich and note one small detail – for doctors who persistently want to enlighten the medical community in the relevant problematic areas, sooner or later a touch of slight irritation appears, what is the reason for this? This is determined by the fact that these people are the leaders of their direction, they are always forced to row against the stream of ignorance. Here is the fight against ignorance, the transformation of ignorant people into knowledgeable people – this is actually a very difficult problem. I think that the hardest job of all the jobs that exist on the globe is the transformation of an ignorant person into an educated, knowledgeable person. I can’t imagine a harder job, no matter what people say about it.

Abram Lvovich Syrkin , Professor:

– Dear colleagues, firstly, thank you for your kind words, and secondly, thank you for the good questions that I would like to answer. I will answer very briefly.

What does defective platelet thrombus mean, is it not a contrived topic, but is used in the literature? No, there may be different words, but the question itself is absolutely legitimate. Platelet thrombus, as the first phase of thrombus formation, when there is no irreversibility, which requires very serious measures. And these blood clots associated with platelet aggregation are the ones that usually lend themselves to spontaneous thrombolysis. So, I don’t know how it is with terminological subtleties, but in essence the question is absolutely legitimate, this is a favorable variant of thrombosis.

Do you have posterior myocardial infarction and bradycardia? Are beta blockers necessary? No, you don’t need beta-blockers, but I’ll tell you something else. If there is a posterior myocardial infarction and bradycardia, then this is with a high probability both a myocardial infarction of the right ventricle. And who said myocardial infarction of the right ventricle, he should be extremely careful with vasodilators and, in particular, with nitroglycerin. Here’s what to say about it. And beta-blockers, why give them for bradycardia, no matter what the heart attack is. But the fact that you emphasized the back is generally characteristic of a diaphragmatic infarction, but look for a right ventricular infarction, very often you will find it.

Can functional class 1-2 angina be classified as unstable angina? Strictly speaking, no, the appearance of functional angina pectoris of high and medium stress is most often just the beginning of coronary heart disease, but I think that you will not be mistaken if you nevertheless take note of such a patient and, perhaps, put him on the track maybe pay special attention to risk factors. And in general, dear colleagues, the first attack of angina pectoris, even sometimes very mild, like that professor who was walking down the street, has a myocardial infarction much more often than we used to think, because he often has a mild clinic.

I have never seen an isolated atrial myocardial infarction in my life and I strongly doubt that such a thing exists, where there are large ventricular infarctions, there, most likely, some kind of necrosis in the atria occurs, they are not an independent problem.

Diagnostic value of radiopharmaceuticals. I suggest forgetting it. And two words I will say why we need them. In the acute period, although there are such papers, and PhDs are defended, and maybe even doctoral ones, no one needs them, in fact. We can only talk about individual centers where this is possible. Maybe this applies to those patients in whom you cannot detect myocardial infarction by other methods, but you desperately want to identify it. Difficult, long, expensive. But here they ask me about the danger for the staff, well, with the right behavior it is safe for the staff, and it is supposed to behave correctly, but I think that in the diagnosis of acute coronary events this should simply be forgotten and not used.

Scientific works have the right to exist. I am not suggesting that such dissertations be abandoned. But I consider the practical application to be zero, although, perhaps, someone will disagree with me. In general, please do not agree with authority.

American guidelines for reducing lipid spectrum stringency and how do I feel about it? You know, so far I have no attitude, I just want to note that there are recommendations that you check on your own experience and think – this is right, but this is unlikely. Let’s say beta-blockers for angina pectoris, for example, but the use, what doses of a statin should be kept or what lipid levels should be achieved, what should be considered the target, no doctor can tell from his own experience, these are only multicenter large studies. And the fact that American recommendations have now moved in this direction, which is very reasonable, we are starting to move away from these most severe rules regarding arterial hypertension. 140 and 90 and under the influence of everything that is happening around, our patients are already running to us with their eyes wide open: “Doctor, I have 140”. There you somehow rely more on your experience, and with these recommendations I would wait to see how it will settle down in subsequent revisions.

Thank you very much, doctors, it was a pleasure talking to you.

Ivashkin V.T. :

– Thank you very much, Abram Lvovich. I will answer questions. Angela Zueva, a 4th year student from Chelyabinsk, asks – how to say Helicobacter or Helicobacter? How to say – gut or intestines? Actually, I say – Helicobacter H, but if doctors say – Helicobacter …

Syrkin A.L. :

– No, that’s not correct.

Ivashkin V.T. :

– I think helicobacter after all. Now how to say – gut or intestines? I imagine that after all, the intestine, although it is divided into subsections – the duodenum, lean, ileum, thick, is divided into sections, from the point of view of the therapist, after all, this is the intestine. I will explain to you what is the harm of the unit? Look, there is colorectal cancer, but surgeons once took and subdivided into the right intestine, colon, descending colon, rectum. And so, if you look at international statistics, everywhere there is cancer of the ascending tract, of the cecum, of the transverse colon, of the descending colon, of the rectum. And it’s like the frequency of these cancers is very small, but when you sum up the cancer of the entire colon, there is a huge number, it is equal in volume to stomach cancer. And if you add up the incidence of stomach cancer and the incidence of colorectal cancer, of the entire colon, then it turns out that the highest frequency of malignant diseases is malignant diseases of the gastrointestinal tract. If you add pancreatic cancer, esophageal cancer, liver carcinoma, and so on, this is the most common cancer. Therefore, this division into the intestines … I say – irritable bowel syndrome, inflammatory bowel disease, Crohn’s disease, ulcerative colitis – these are still inflammatory bowel diseases. Who agrees with me, who does not agree. In all likelihood, time will come to a certain denominator.

A few questions about different proton pump inhibitors and different doses. All proton pump inhibitors are a highly effective molecule, and you can modify the doses, give more, give less, but, in principle, they are all highly effective drugs.

When can antiplatelet therapy be restarted in a patient at high CV risk after gastric bleeding? There can be no setting here. It is necessary to monitor the condition of the gastric and duodenal mucosa, and after restoration of integrity, that is, after you achieve the integrity of the gastric and duodenal mucosa, it is possible to resume antiplatelet therapy.

Should aspirin ulcers be eradicated? Aspirin ulcers are more likely to develop in patients with Helicobacter infection, so in such patients it is necessary to diagnose Helicobacter and be sure to do eradication. In this case, aspirin will no longer be such a highly ulcerogenic factor in individuals without Helicobacter pylori infection. It becomes less ulcerogenic.

What should I do if peptic ulcer worsens in a stented patient after 1-2 months on the background of dual antiplatelet therapy, stop aspirin, clopidogrel? In no case should anything be canceled, prescribe proton pump inhibitors, prescribe antacids, do it all right, be sure to have a high-protein diet, and continue to treat, because an ulcer is an ulcer, and stent rethrombosis is stent rethrombosis.

Yuri Aleksandrovich Karpov , Professor:

– Why does sartana have a more pronounced organoprotective effect? I did not say that sartana has a more pronounced organoprotective effect, I said that drugs that block the renin-angiotensin system have a very good evidence base, ACE inhibitor and sartana, namely, first of all, in cardioprotection and nephroprotection. They are quite good. And this is due to the fact that a decrease in the activity of the renin-angiotensin system, including at the organ level, these are the so-called local systems, have a very favorable effect on the course of the disease.

Daily low-dose aspirin time? Aspirin, in principle, is not tied to any terms, since it is long-acting, although it must be taken every day, it is usually taken in the morning. But statins are traditionally used in the evening.

What is the lower limit of normal blood pressure figures according to the new recommendations? This level is not indicated in European recommendations, we traditionally adhere to it, this is fixed in our recommendations, 115 to 75 millimeters of mercury.

Does KSAP matter or is the approach to blood pressure correction obsolete? No, KSAR is not outdated, sartans in combination with diuretics is one of the most effective ways to control blood pressure.

Leveling of adverse events that occur with monotherapy, tachycardia, calcium antagonists? It is a common belief that tachycardia should occur when using amlodipine. Nothing like this. Firstly, initially this drug, created as a long-acting, with a gradual effect in terms of releasing the drug, that is, there are no grounds for this. What’s more, we have conducted repeated studies, this is a huge research breakthrough, we specifically controlled the heart rate, as the blood pressure was controlled by the calcium antagonist inhibitor combination, we found a significant decrease in heart rate.

In general, inhibitors, for example, have a cough, there is such an undesirable event. It is believed that the use with calcium antagonists seems to reduce cough, there are such data. But it is known for sure that an ACE inhibitor corrects edema, which often accompanies the appointment of amlodipine.

What is the current role of calcium antagonists, remember the article in the New York Times in the late 90s, that this is a killer? In fact, it was not in the late 90s, but in the mid-90s, it was associated with short-acting drugs. Now we must absolutely state that calcium antagonists and especially amlodipine are the most important element, the most important drug in the treatment regimen for many patients, and not only those with arterial hypertension. A very important role in the treatment of coronary heart disease, especially in combination.

What is the niche of predizine in patients with diabetes mellitus and arterial hypertension? Predizine is one of the drugs trimetazidine, and in patients with poorly controlled coronary heart disease, I mean in terms of angina pectoris, the appointment of such a drug is quite possible if the possibilities of other drugs have been exhausted. At one time, there were works that the use of trimetazidine seems to have some additional benefits in patients with diabetes mellitus.

Should patients who work in hazardous working conditions be advised: elevated temperatures, noise, night shifts, refuse to work? This is lifestyle modification. If the patient is diagnosed with arterial hypertension, then along with other areas – smoking cessation, weight loss, sufficient physical activity – it is recommended to change working conditions, because a patient with hypertension should not work at night and should not work in harmful conditions.

I want to end with a question – how much has been said about the treatment of hypertension, but questions always remain. Thanks for your lecture.

Herpes – KVD №2

What is a herpetic infection?

Genital herpes is a sexually transmitted infection (STI). The disease is caused by the herpes simplex virus 1 or 2 (HSV – 1.2) type – Herpes Simplex Virus.

Herpes is manifested by the appearance of reddening of a small area of ​​the skin, itching, the appearance of one or more vesicles, then the vesicles open with the formation of painful sores that heal with the formation of crusts. The first case of diseases is more acute than repeated ones, and takes from 2 to 4 weeks. HSV-1 most often affects the skin of the face, lips, mouth, cornea of ​​the eye, and less often the genitals. HSV type 2 affects the genitals and anus, and therefore often this virus is called genital herpes. Herpetic infection is a chronic disease, once it enters the body, HSV remains in it, living in the nerve endings, for life. Some people may not have exacerbations of the disease, while others experience exacerbations very often. The latent course of the disease is the cause of the easy spread of infection.

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Ways of infection with herpes

Infection with HSV-1 occurs mainly in childhood and adolescence by airborne droplets or by contact (kissing, etc.). Sexual transmission is also possible through oral-genital contact.

Infection with genital herpes (HSV-2) occurs through direct sexual contact. Infection can occur both with an exacerbation of infection in a sexual partner, and with the carriage of the virus. However, the risk of infection is much higher if one partner has herpetic eruptions on the skin and mucous membranes and there is close contact with the skin and mucous membranes of the other sexual partner.

Exacerbations of genital herpes are provoked by hypothermia, physical and emotional stress, menstruation in women, sexual intercourse, concomitant diseases (flu, etc.) and ultraviolet radiation.

The virus can be transmitted to the fetus from an infected mother during pregnancy or childbirth.

Manifestations of herpes

Most of those infected do not have manifestations of the disease. The rest of the signs of herpes appear 2 to 20 days after infection.

Initially, there may be flu-like manifestations – slight fever, chills, weakness, fatigue.

A typical sign of genital herpes is the appearance of small (2-5 mm) fluid-filled blisters on the genitals, buttocks and anus. The rash is accompanied by itching and/or pain. Rashes can be located in the vagina, on the cervix, in the rectum. Within a few days, the blisters burst, turning into painful sores. After 1-2 weeks, the sores, covered with crusts, heal. Other manifestations: pain in the groin or on the inside of the thighs, painful urination, vaginal discharge in women or from the urethra in men.

Primary infection lasts about 3 weeks with severe manifestations.

When symptoms subside, the herpes virus leaves the lesion and enters the nerve cells of the sacral spine. During the next exacerbation, the virus goes through the nerves to the skin or mucous membranes, where it causes typical rashes.

After the initial episode of the disease, exacerbations occur several times (usually 4-5) during the year. In the future, the number of exacerbations decreases, the severity of manifestations decreases.

Complications of infection

Persons with a decrease in the body’s defenses experience very frequent prolonged exacerbations that cause both physical suffering and psycho-emotional discomfort.

It is possible to attach a secondary (bacterial) infection and then the deeper layers of the skin are involved in the inflammatory process, the exacerbation becomes protracted and requires changes in treatment.

Persons with genital herpes in the acute phase are more at risk of contracting HIV infection. HIV-infected people who have genital herpes in the acute stage are more likely to infect their sexual partners with the human immunodeficiency virus.

The effect of the disease on a pregnant woman and her child

Infection of the fetus occurs during pregnancy, a newborn during childbirth through an infected birth canal. Herpetic infection of newborns is very dangerous and can lead to the death of a child. If during childbirth a woman has herpetic eruptions in the genital area (birth canal) – this is an indication for a caesarean section. This dramatically reduces the risk of transmitting herpes to the newborn during childbirth. It is very important for a woman to avoid contracting genital herpes during pregnancy, since it is the initial episode of infection that is most dangerous for the fetus.

Diagnosis of herpes

The manifestations of genital herpes are varied, it is difficult to detect ulcers and distinguish them from ulcers caused by other diseases.

Diagnosis includes visual examination of the patient’s clinical signs if an exacerbation is typical. Scrapings from sores for HSV are being studied by PCR (polymerase chain reaction). It is very important to establish the microorganism that caused the clinical manifestations in order to prescribe the correct and timely treatment. Swabs and scrapings may cause minor discomfort. Additionally, a blood test is performed by ELISA to determine specific antibodies to HSV-2, the duration of the last exacerbation and the amount of antibodies are estimated. The ELISA method allows you to diagnose genital herpes without exacerbation.

Treatment of herpetic infection

Diagnosis and treatment of genital herpes, as well as other STIs, should be carried out in a specialized clinic – KVD, which has all the necessary tools for quick and accurate diagnosis.