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What Is Genital Herpes? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Herpes is an incurable, chronic infection, but it can be managed with medication and lifestyle modifications. Medications don’t wipe out the virus completely, but they can ease symptoms and lower the risk of transmission to another person.

Medication Options

Antiviral drugs are the primary way that genital herpes is treated. These medications can reduce the pain of genital sores during the initial outbreak, provide relief during later outbreaks, and make it less likely that you’ll infect any sexual partners with the virus. (8)

Three antiviral drugs are used for treating genital herpes:

“The three drugs are all basically the same medication. Their efficacy [effectiveness] is the same,” says Baill. The difference, she explains, is how often a person takes them.

According to the CDC, the recommendation for a first episode of genital herpes is to follow one of these dosing options:

  • Acyclovir 400 milligram (mg) orally three times a day for 7 to 10 days
  • Acyclovir 200 mg orally five times a day for 7 to 10 days
  • Valacyclovir 1 gram orally twice a day for 7 to 10 days
  • Famciclovir 250 mg orally three times a day for 7 to 10 days

The therapy can be extended if healing is not complete after 10 days.

Some people also take antiviral medication during recurring episodes of herpes symptoms, and some take a daily antiviral to reduce symptom outbreaks and lower the likelihood of giving the infection to a sexual partner.

Learn More About Treatment for Genital Herpes: Medication and More

Alternative and Complementary Therapies

Although it’s not known for certain what triggers herpes outbreaks, they are often associated with fatigue, stress, and illness. (5) Mind-body interventions that reduce stress, such as meditation and yoga, may therefore be helpful in reducing outbreaks.

Getting adequate sleep and following a nutritious diet are also important for maintaining a healthy immune system and helpful for managing life stresses.

Certain supplements and herbal remedies have been tried for preventing herpes outbreaks or easing the symptoms of an outbreak. To date, however, there’s insufficient data to conclude that any of them is safe and effective for this use. (9)

If you wish to try a complementary therapy for genital herpes, speak to your doctor first to make sure the product you want to try won’t interfere with any medications or other therapies you’re currently using.

Learn More About Alternative and Complementary Therapies for Genital Herpes

Prevention of Genital Herpes

You can give a partner genital herpes with any kind of skin-to-skin sexual contact. It can spread during vaginal, oral, and anal sex.

Practicing safe sex can reduce the risk of transmitting the virus. This includes being monogamous, or having only one sexual partner, and using condoms or dental dams during sexual encounters.

Herpes can spread from areas of the body not covered by condoms, though. The virus can live on your thighs and buttocks, for instance.

Nonetheless, even though condoms can’t work all the time, regular use of condoms can reduce the risk of transmission. For greatest protection, use condoms and dental dams consistently, not just during outbreaks.

Other steps to lower the risk that you will spread herpes to another person include the following:

  • Learn what it feels like for you when an outbreak is starting, and stop having sex as soon as you sense that feeling.
  • Avoid sex completely during active outbreaks. Condoms can’t completely cover infectious areas and cannot be counted on during such times.
  • Wait for all sores to scab over and heal before having sex again.
  • Avoid touching your herpes sores, because you can spread the germs around your body that way. If you touch a sore, wash your hands right away.
  • Don’t kiss anyone — especially pregnant women, babies, or children — or have sex when you have a cold sore.
  • Tell a prospective sex partner about having herpes before you have sex with them, even though it may be hard.
  • Ask your doctor about taking antiviral drugs to control herpes.

Genital herpes symptoms & treatments – Illnesses & conditions

Genital herpes is a sexually transmitted infection caused by a virus called herpes simplex virus (HSV).

There are two different types of the virus (type 1 and type 2), both of which can affect the genitals. One of the types is the same virus that causes cold sores around the mouth (type 1).

Genital herpes causes painful blisters and sores on and around the genitals. It can also sometimes cause problems if it’s caught for the first time either very early or very late in pregnancy.

How do I get genital herpes?

The herpes virus (HSV) is easily passed from person to person by close, direct contact including:

  • kissing
  • unprotected vaginal, anal or oral sex (without a condom)
  • sharing sex toys that aren’t washed or covered with a new condom each time they’re used
  • your genitals coming into contact with your partner’s genitals – this means you can get genital herpes from someone even if there is no penetration, orgasm or ejaculation

Sometimes you can catch herpes when your sexual partner has no visible sores or symptoms. This is because the virus can become active on the skin without causing any visible blisters or sores. This is sometimes called ‘asymptomatic shedding’.

Herpes can also be passed to a newborn baby during childbirth. This is less common if the first episode of herpes is diagnosed before or at the beginning of pregnancy, and if there are no visible ulcers at time of delivery. Sometimes medications are started towards the end of pregnancy to reduce this risk.

Symptoms of genital herpes

Many people with the herpes virus do not experience any symptoms when first infected.

If symptoms do occur they usually take between two and twelve days after contact to appear.

Sometimes symptoms may not be noticed until months, or sometimes years, after being in contact with the virus.

Once you have the herpes infection, the virus stays in your body. It can lie dormant for long periods, but can reactivate in the area that was originally infected. If the virus reactivates, the sores and blisters can reappear. This is known as a ‘recurrent episode’ of genital herpes.

This first episode of genital herpes may last from two to four weeks. Repeated episodes are not usually as severe, or long, as the first and you may never have a repeat episode.

Symptoms of the first infection can include spots or red bumps around the genital area. These can be very painful. In time, these swellings can break open and form sores or ulcers which gradually crust over, forming new skin as they heal. 

Other symptoms include:

  • pain inside the vagina, head of penis or back passage (rectum)
  • vaginal discharge
  • pain peeing or being unable to pee
  • fever
  • flu-like symptoms, backache, headache and a temperature
  • mild swelling of the lymph glands in the groin, armpits and neck

If you have a recurrent infection, your symptoms may include:

  • a tingling or burning sensation before blisters appear (this can signal the start of a recurrent infection)
  • painful red blisters, which soon burst to leave ulcers
  • pain inside the vagina, head of penis or back passage 

Testing for genital herpes

If you think you may have genital herpes you should make an appointment with your GP or local sexual health services.

If there are symptoms present such as blisters, sores and ulcers, your doctor or nurse may be able to make a diagnosis straight away.

If you have visible blisters, your doctor or nurse may take a swab for testing, to check if this is herpes and what type. This swab can also test for another STI which causes blisters called syphilis.

The genital herpes swab tests is very reliable, though if the ulcer is too dry then the result may be less likely to find a positive result.

Treating genital herpes

Although there is no known cure for herpes, the symptoms of genital herpes can be treated.

The symptoms of recurrent genital herpes will usually clear up without any treatment. There’s also medication to help speed up the healing process and reduce the severity of an episode, if needed.

If you start taking the medication as soon as an outbreak begins, you may shorten or even stop the episode.

Some people experience many recurrences of genital herpes. In these cases, a longer course of tablets should prevent any recurrent episodes.

Talk to your doctor or nurse at the sexual health service, or to your GP about possible treatment options that may suit you.

If you’re pregnant and find out you have a genital herpes infection, tell your midwife as soon as possible.

As there’s no screening test for herpes, partners are only advised to have a test of they also have symptoms.

Avoiding passing genital herpes to a partner

If you have herpes, you can follow some simple measures to avoid passing the virus on to your partner(s), and to continue to have a healthy and happy sex life. These include:

  • telling your partner if you have herpes
  • learning to recognise the warning signs (tingling, itching or inflammation) that an episode is starting
  • not have sex during an episode of herpes
  • avoiding direct contact with your sores or blisters and another person
  • avoiding kissing and oral sex when you or your partner has cold sores around the mouth

If you have frequent episodes of herpes then it is worth talking to your GP or sexual health clinic about longer term treatment which may also reduce the chance of you passing on the virus to your partner.

Preventing recurring episodes

Keep a record of when you have an episode of genital herpes. You may see a pattern developing, and be able to identify your trigger factors.

Many people find that episodes occur when they’re run-down, under stress, around the time of menstruation or when the skin gets irritated due to friction or tight clothing.

If you do see a pattern of trigger factors, try to adjust your lifestyle to avoid or reduce your exposure to them or speak to your healthcare professional for advice.

Reducing the risk of genital herpes

The best way to prevent all sexually transmitted infections is to practice safer sex. This means using a condom for vaginal, anal or oral sex.

The herpes virus can’t pass through a condom. However, if the virus is present and active on the skin in areas around the genitals not covered by the condom (as is often the case), infection may still occur. Therefore condoms are not 100% protective against the herpes virus.

If your partner has herpes, avoiding sex when they have visible sores reduces your risk of getting herpes.

Other STI’s

If you’ve been diagnosed with herpes it’s recommended that you are tested for all STI’s including:

This is even more important if you have recurrent episodes.

Herpes – Symptoms, Diagnosis, Treatment

Symptoms of herpes

Many people who get herpes never have symptoms. Sometimes the symptoms are mild and are mistaken for another skin condition. If you experience symptoms, they may include:

  • Painful sores in the genital area, anus, buttocks, or thighs.
  • Itching.
  • Painful urination.
  • Vaginal discharge.
  • Tender lumps in the groin.

During the first outbreak (called primary herpes), you may experience flu-like symptoms. These include body aches, fever, and headache. Many people who have a herpes infection will have outbreaks of sores and symptoms from time to time. Symptoms are usually less severe than the primary outbreak. The frequency of outbreaks also tends to decrease over time.

Stages of infection

Once you have been infected with the virus, you’ll go through different stages of infection.

Primary stage

This stage starts 2 to 8 days after you’re infected. Usually, the infection causes groups of small, painful blisters. The fluid in the blisters may be clear or cloudy. The area under the blisters will be red. The blisters break open and become open sores. You may not notice the blisters, or they may be painful. It may hurt to urinate during this stage.

While most people have a painful primary stage of infection, some don’t have any symptoms. They may not even know they’re infected.

Latent stage

During this stage, there are no blisters, sores, or other symptoms. The virus is traveling from your skin into the nerves near your spine.

Shedding stage

In the shedding stage, the virus starts multiplying in the nerve endings. If these nerve endings are in areas of the body that make or are in contact with body fluids, the virus can get into those body fluids. This could include salivasemen, or vaginal fluids. There are no symptoms during this stage, but the virus can be spread during this time. This means that herpes is very Recurrences

Many people have blisters and sores that come back after the first herpes attack goes away. This is called a recurrence. Usually, the symptoms aren’t as bad as they were during the first attack.

Stress, being sick, or being tired may start a recurrence. Being in the sun or having your menstrual period may also cause a recurrence. You may know a recurrence is about to happen if you feel itching, tingling, or pain in the places where you were first infected.

Herpes: Signs, Symptoms and Complications

Both herpes simplex viruses (HSV) can cause sores. HSV type 1, which is normally transmitted through kissing or sharing objects like toothbrushes, normally causes sores on the mouth or tongue (cold sores). Sores from HSV type 2 are usually on the genital area, as this type of herpes is sexually transmitted. That said, it’s possible no symptoms will occur with infection, or that sores may come and go.

Illustration by Verywell

Frequent Symptoms

There are some similarities between the symptoms of HSV 1 and HSV 2:

  • Severity: Cold sores and genital herpes tend to cause more noticeable and extensive symptoms during the first infection. Generally, recurrences are milder. 
  • Asymptomatic intervals: Cold sores and genital herpes are caused by viruses that enter through the skin and travel to the nerves, where they remain dormant (inactive) before recurring. These asymptomatic intervals can last for weeks, months, or even years.  
  • Warning signs of reactivation: Pain, tingling, or burning can occur prior to a recurrent episode of herpes. This is due to inflammation and irritation of the nerves in the infected area. These warning signs of another outbreak (often referred to as prodromal symptoms) mean that you are very contagious even if you do not have any visible sores. 

The vast majority of the time, HSV types 1 and 2 cause superficial symptoms of the skin in the specific areas mentioned. In exceptional circumstances, more severe symptoms can involve other parts of the body. 

The main way symptoms of the two types of herpes virus differ is where the sores occur.

Cold Sores (HSV 1)

Cold sores can appear on the outside of the mouth or lips, inside the mouth, or on the tongue. Symptoms of HSV 1 include:

  • Open, blistery or crusted sores
  • Pain with chewing, swallowing, or talking
  • Itchiness of the sores and the area around them

The symptoms may last for about three to 10 days, and recurrent sores generally affect the same area. 

Genital Herpes (HSV 2)

Typical symptoms of genital herpes include:

  • Internal and external blisters and sores that are small, fluid-filled, and often occur in clusters
  • Itching or burning feeling in the genital or anal area
  • Pain in the legs, buttocks, or genital area
  • Pain when urinating
  • Unexplained penile discharge
  • Unusual vaginal discharge

Symptoms disappear in 10 to 21 days. Recurrent attacks usually affect the same area but are less severe.

In men, the infection can involve the penis, anal opening, buttocks, and/or thighs. In women, the sores can occur in the vaginal area, cervix, urethra (the tube that carries urine), area around the buttocks, anal opening, and/or the thighs.

Women may be more susceptible to a genital herpes infection primarily because a woman’s genital area is more likely to be moistened with body fluids, which allows the virus to more easily enter the skin.

Women tend to have higher rates of complications during the first genital herpes outbreak.

Less Common Symptoms

In general, herpes simplex infections cause sporadic recurrences of sores, often with a preceding trigger, such as a cold or a fever—and sometimes without any trigger at all.

An infection may cause other, though less common, symptoms as well. These include:

  • Severe pain in the area of the sores: The sores can cause extreme pain, usually as the result of repeated abrasion. For example, HSV type 1 can occur on the tongue near the teeth, which can cause extra irritation. HSV type 2 can occur near an area where there is repeated rubbing from the fabric of clothes, or an area that is aggravated by walking or sitting, which can exacerbate symptoms. 
  • Enlarged and painful lymph glands: Glands in the neck, under the arms, or in the groin can become enlarged or painful when you have an active herpes infection. 
  • Flu-like symptoms: The infection may cause a fever and generalized flu-like symptoms such as muscles aches and fatigue. This can happen due to the body’s immune system response to HSV infection.

Symptoms in Other Areas of the Body

It is possible for HSV type 1 to occur in the genital area and HSV type 2 to occur on or in the mouth. Either case is usually a result of spread through oral sex.

You cannot always know which type of herpes virus you have by looking at it, as the sores caused by both viruses look the same. 

HSV 1 can also affect other areas of the body, such as the neck, arms, and torso. Symptoms include pain, itching, and blisters or sores. This is most often associated with wrestling and is described as herpes gladiatorum when it occurs in that setting. 

Complications

Most of the time, herpes only causes superficial sores. Herpes can result in serious complications that affect other parts of the body, but this is rare.

Generally, complications of herpes are most likely to occur in two situations: when a baby is born with herpes transmitted from the mother during delivery, and when a person’s immune system is not functioning properly (as with HIV infection). 

Disseminated Herpes

Disseminated herpes occurs when a herpes virus infection spreads from the initial area of infection. For example, HSV type 2 herpes sores can recur, affecting multiple areas of the vagina; HSV type 1 sores can recur, affecting multiple areas of the tongue.

Disseminated herpes can be more severe, as the herpes virus can spread to other parts of the body, including the brain.

Ocular Herpes

Herpes infection can affect the eyes. This is a rare complication of HSV type 2, most often identified in newborns who may be exposed to the virus during vaginal delivery. Ocular herpes can produce painful sores on the eyelid or the eye itself.

Symptoms of ocular herpes include the following:

  • Pain in and around the eye
  • Redness, rash, or sores on the eyelids, around the eyes, or on the forehead
  • Eye redness
  • Swelling and cloudiness of the cornea
  • Tearing
  • Blurred vision
  • Light sensitivity
  • Discharge

Hearing Loss

Herpes has been associated with the sudden hearing loss in children and adults, as well as with newborn hearing loss. This complication can occur if the herpes virus affects the nerves that control hearing. 

Encephalitis

Encephalitis is an infection of the brain. This is a serious infection that can cause developmental delays in children or cognitive (thinking) deficits in adults. 

When to See a Doctor

If you have a cold sore, you do not necessarily need to make an appointment with your doctor, because it will likely go away on its own within a few days. However, make an appointment for an evaluation if you have signs and symptoms of cold sores that are persistent and/or extremely painful, especially if they are associated with fevers, swelling, bleeding, or oozing. Though cold sores are generally not serious and rarely cause complications, you’ll want to get outbreaks under control.

If you have any signs of genital herpes, however, you should see a doctor within a few days, before the lesions go away.  

Sores on or near the genital area can herald a sexually transmitted disease, or they may be the result of some other type of irritation. Most sexually transmitted diseases are treatable, but it is difficult to know which one you may have—or if you have one at all—unless you are trained in diagnosing them. Many people do not communicate with sexual partners when it comes to STD status, so it’s best to get a definitive answer on what’s causing your symptoms.

If you have pain or bleeding with urination, pain with sexual activity, or if you notice that lesions in the genital area seem to be inflamed, you should call your doctor, even if you have already been diagnosed with and treated for herpes.

What does genital herpes look like?

Many people who have genital herpes don’t show symptoms, or the symptoms are so mild they don’t notice them — so they might not even know they have it. When herpes does cause symptoms, the most common one is sores and blisters that show up on the parts of your body where the infection lives. This is called an “outbreak.”

What does the beginning of genital herpes look like?

Right before an outbreak, you might feel tingling, itching, or burning around the area where the sores will happen. You might also notice some small discolored or white bumps starting to form. Genital herpes sores can appear on your vagina, vulva, cervix, penis, scrotum (balls), butt, anus, or upper thighs.

What does a genital herpes outbreak look like?

Genital herpes outbreaks usually look like a cluster of itchy or painful blisters filled with fluid. They may be different sizes and appear in different places. The blisters break or turn into sores that bleed or ooze a whitish fluid. As the outbreak comes to an end, the herpes sores will scab over and eventually go away. The sores can take a week or more to heal.

Symptoms of genital herpes look different at different stages of the outbreak — they usually start out mild but get worse as the outbreak goes on. You can also have flu-like symptoms during an outbreak, like a fever, chills, body aches, and swollen glands. Herpes outbreaks look different in different people, and your next outbreak might look different from your last one.

Your first genital herpes outbreak is usually the worst one. If you do have more outbreaks in the future, they’re usually shorter and less painful. Most people get fewer outbreaks over time, and some people stop having them altogether. There’s no way to know for sure if you’ll have another outbreak, or how often you’ll get them — it’s different for every person. Your nurse or doctor can give you herpes medicine to help prevent or treat outbreaks, and there are ointments that can make your sores heal faster and hurt less.

Herpes sores can look a lot like other skin problems, like acne, contact dermatitis, or ingrown hairs. So the only way to know for sure if you have herpes is to see a nurse or doctor, like the ones at your local Planned Parenthood health center.

What do I do if I have genital herpes?

Some people have a lot of fears and misconceptions about herpes, but it’s a common STD. It can be painful and uncomfortable during outbreaks, but it’s not deadly and it doesn’t cause serious health problems. So if you have genital herpes, try not to panic or feel too bad about it. Millions of people are living with herpes, so you’re not alone. And even though there’s no cure for herpes, there are plenty of ways to treat the symptoms and manage the infection. Your doctor will tell you about the best treatment options for your situation.

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6 Herpes Symptoms In Women

What’s the first image that comes to mind when you think of herpes?

For doctors, it’s a rose. (Yes, the beautiful flower.)

“The classic description of genital herpes is ‘dew drops on a rose petal,’” says Peter Leone, M.D., an adjunct professor of medicine at the UNC School of Medicine. “You get these little blisters on a red base that hurt—and if you have that, the probability that you have herpes is pretty high.”

The problem is that most people with genital herpes don’t have any symptoms. Herpes is a super-common STD, and according to the Centers for Disease Control and Prevention, more than one in every six people has it. They just probably don’t know it.

Genital herpes spreads through skin-to-skin contact and is caused by two types of viruses: herpes simplex virus type 1, or HSV-1, and herpes simplex virus type 2, or HSV-2. The kind you have matters because it determines how you’ll be treated.

Herpes isn’t curable, but don’t freak out: It’s totally possible to manage it with the help of antiviral medications or daily suppressive therapy, and yes, you can still have a normal sex life.

Most doctors don’t test for herpes unless a woman is showing symptoms, and since that’s probably not going to happen, it’s one reason why so many people never know they have it.

In the U.S., 87.4 percent (!) of infected 14 to 49 year olds with HSV-2 have never been diagnosed, according to the CDC.

But if you’re curious or worried, stand your ground. “Women have a right to be proactive about this—it’s very easy for clinicians to be dismissive about the concern around herpes,” Leone says. “Don’t take no for an answer if you want to know your status.”

There are the most common herpes symptoms in women:

1. Pimples—and not on your face

Well, at least it’s not as obvious as a big zit on your forehead? These tiny blisters don’t always occur, but when they do, there’s a good chance you have genital herpes. Like any miserable pimple, they eventually crust over and scab, says Jennifer Berman, M.D., a co-host on The Doctors. “It’s not necessarily on the genital area—sometimes it’s in the crease of the underwear or closer to the buttock,” she says.

2. A tingling sensation

It’ll be all over the affected area: your genitals, butt, or thighs. Tingling is one of the first symptoms of herpes in women, so if you just feel weird down there, take note, says Leone.

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3.

Irritation or itching in your lady parts

“Sometimes women ignore this because they’ve been exercising or wearing yoga pants, and they just assume the itching or irritation is from wearing tight clothing,” Berman says. In reality, that sensation is often a symptom of genital herpes in women.

4. A flu-like feeling

Blah. About 70 percent of women feel like they have the flu, with a headache, muscle aches, fever, and swollen glands during their first herpes outbreak, according to the University of Maryland Medical Center. Of course, you might actually just have the flu (congrats?), which is why it’s always good to get checked out.

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5. A dull, aching pain in your pelvis

If you’re spotting between periods, grimacing during sex (never good), or noticing weird-for-you discharge, you might have cervicitis—a fancy way of saying your cervix is inflamed. It’s caused by a number of STDs, including herpes, and will go away when the underlying infection is treated, says Berman.

6. Painful pee

When pee splashes on a herpes ulcer or blister, it can burn, according to the Mayo Clinic. That’s just not pleasant, so get to a doctor and find out what’s wrong.

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Genital Herpes Simplex (Discharge Care)

  1. CareNotes
  2. Genital Herpes Simplex
  3. Discharge Care

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

Genital herpes is a sexually transmitted infection (STI) that is caused by the herpes simplex virus (HSV). It is spread through oral, vaginal, or anal sex. It may be spread even if you do not see blisters. It can also be spread to other areas of your body, including your eyes, by touching open blisters. If you are pregnant, it may be spread to your baby while he is still in your womb or during vaginal delivery. Unprotected sex or sex with multiple partners increases your risk for genital herpes.

DISCHARGE INSTRUCTIONS:

Call 911 for any of the following:

  • You have trouble breathing.
  • You have a seizure.
  • Your neck is stiff.
  • You have trouble thinking clearly.

Contact your healthcare provider if:

  • You have chills or a fever.
  • You have painful blisters on your penis, vagina, anus, or mouth.
  • Fluid or blood is coming out of your genitals.
  • You have trouble urinating.
  • You think you are pregnant and you are bleeding from your vagina.
  • You have trouble chewing or swallowing.
  • Your symptoms do not get better, or they get worse, even after treatment.
  • You have questions or concerns about your condition or care.

Medicines:

  • Antivirals may help decrease your symptoms.
  • Numbing cream or ointment may help decrease pain.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Manage your symptoms:

Do the following to be more comfortable when your infection is active:

  • Keep the blisters clean and dry. Wash them with soap and warm water, and pat dry gently.
  • Wear cotton underwear and loose clothing. This may help to keep the blisters dry and keep clothes from rubbing.
  • Apply ice on the area for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
  • Apply heat on the area for 20 to 30 minutes every 2 hours for as many days as directed. A warm bath may also help. Heat helps decrease pain and muscle spasms.

Prevent the spread of genital herpes:

  • Use condoms. Use a latex condom when you have oral, genital, and anal sex. Use a new condom each time. Use a polyurethane condom if you are allergic to latex.
  • Try not to touch your blisters. Wash your hands before and after you touch the area. Do not kiss anyone if you have blisters around your mouth. Do not breastfeed if you have blisters on your breast.
  • Tell your partners that you have genital herpes. Do not have sex until he or she knows that you have genital herpes. Ask your healthcare provider for ways to tell partners about your infection.
  • Tell your healthcare providers that you have genital herpes. If you are pregnant, your baby may need special monitoring. Inform your healthcare provider of your condition to avoid spreading the infection to your baby.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

© Copyright IBM Corporation 2021 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Genital Herpes Simplex (Discharge Care)

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Further information

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Medical Disclaimer

Herpes – KVD No. 2

What is herpes 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 redness of a small area of ​​the skin, itching, the appearance of one or more bubbles, then the bubbles open with the formation of painful ulcers that heal with the formation of crusts. The first case of the disease is more acute than repeated, and takes 2 to 4 weeks.HSV-1 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 is therefore often referred to as genital herpes. Herpetic infection is a chronic disease, once it enters the body, HSV remains in it, living in nerve endings, for life. Some people may not have exacerbations of the disease, others have exacerbations very often. The latent course of the disease is the reason for the easy spread of the infection.

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Ways of infection with herpes

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

Infection with genital herpes (HSV-2) occurs through direct sexual intercourse. Infection can occur both with an exacerbation of infection in a sexual partner, and with the carrier of the virus. However, the risk of infection is much higher if one partner has herpes sores 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.

Possible infection of the fetus virus 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 symptoms of herpes appear 2 to 20 days after infection.

Initially, there may be flu-like manifestations – a slight increase in temperature, chills, weakness, fatigue.

A typical sign of genital herpes is the appearance of small (2–5 mm) fluid-filled vesicles 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 ulcers, covered with crusts, heal.Other manifestations: pain in the groin or on the inner sides 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 the manifestations subside, the herpes virus leaves the lesion in the nerve cells of the sacral spine. During the next exacerbation, the virus travels along 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

In persons with a decrease in the body’s defenses, very frequent prolonged exacerbations occur, which cause both physical suffering and psycho-emotional discomfort.

The addition of a secondary (bacterial) infection is possible, 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 acute genital herpes are more at risk of contracting HIV. People with HIV who have acute genital herpes are more likely to infect their sex 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, the newborn during childbirth through an infected birth canal. Herpes infection of newborns is very dangerous and can lead to the death of the baby.If during childbirth a woman has herpetic eruptions in the genital area (birth canal) – this is an indication for a cesarean section. This dramatically reduces the risk of transmitting herpes to the newborn during labor. 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.

Diagnostics of herpes

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

Diagnostics includes a visual examination of the patient’s clinical manifestations, if exacerbation is typical. A study of scrapings from ulcers for HSV is carried out 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 number of antibodies are assessed. The ELISA method allows you to diagnose genital herpes without exacerbation.

Treatment of herpes infection

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

Once infected with HSV, it is no longer possible to recover completely. There are no drugs that finally cure herpes. Antiviral antibiotics suppress the multiplication (replication) of the virus, speed up the healing time of ulcers and help prevent their reappearance.

For greater effectiveness, antibiotics should be used as early as possible, at the very first signs of an exacerbation – increased sensitivity, itching and / or redness of the skin areas where rashes usually appear.

Prevention of herpes

The best way to prevent sexually transmitted infections is long-term sex with one healthy sexual partner. Male latex condoms, when used correctly and covered with herpes sores, can reduce the risk of transmission.

People with herpes should refrain from unprotected intercourse with uninfected partners when manifestations of herpes are present.

It is important to know that even if a person does not have manifestations of genital herpes, he can still infect sexual partners. Sex partners of infected people should be aware that they may become infected.

90,000 Genital herpes in women | Semenova T.B.

Moscow City Antiherpetic Center

AND The study of the attitude of doctors of the most widespread specialties in a number of developed countries to the problem of genital herpes, conducted in the mid-90s, showed that about half of them do not consider genital herpes a disease that deserves special attention.They do not instruct patients about their behavior with sexual partners, not considering it necessary to “frighten patients” with stories about the complications and potential danger of the disease. Meanwhile …

Epidemiology of genital herpes

Among viral diseases, infection caused by the herpes simplex virus (HSV) occupies one of the leading places, which is determined by the widespread spread of the virus, 90% infection of the human population by it, lifelong persistence of HSV in the body of the infected, significant polymorphism of the clinical manifestations of herpes infection (GI ), torpidity to existing methods of treatment.

There are two main antigenic groups of HSV: type I and II (HSV-I, HSV-II). At the same time, strains belonging to the same antigenic type may differ in immunogenicity, virulence, resistance to the effects of various chemical and physical factors, which ultimately determines the characteristics of the clinical manifestations of the disease.

Genital herpes (HH), being a special case of HSV infection, is one of the most common sexually transmitted diseases, and differs from other diseases of this group by lifelong carriage of the pathogen in the human body (latency), which determines a high percentage of recurrent forms of the disease.

HSV transmission is usually carried out through close contact with a patient or a virus carrier. The virus enters through the mucous membranes of the genitals, urethra, rectum or skin microcracks. In couples where one of the partners is infected, the likelihood of the second partner becoming infected within a year is 10%. In most cases, infection occurs when the infected partner has not had a clinically significant recurrence of HH. Asymptomatic and unrecognized forms of infection play an important role in the spread of HH.HSV can be excreted with sperm, cases of infection of women during artificial insemination are described. Speaking about the pathways of HSV transmission in HH, it is necessary to note the important epidemiological significance of orogenital contacts, which are associated with an increase in the frequency of HSV type I excretion from the genitourinary system.

Historically, the occurrence of HH has been associated with HSV-II, and it is by the frequency of detection of antibodies (AT) to this serotype of the virus in epidemiological studies that conclusions are drawn about the prevalence of genital infection in the population.

Antibodies to HSV-II are detected in all population groups. The frequency of their detection depends on the studied population and the socio-economic status of the surveyed, it increases with age, correlates with the number of sexual partners. So, among college students AT to HSV-II are detected in 4% of the surveyed, among university students – in 9%, among representatives of the middle strata of society – in 25%; among patients with dermatovenerologic clinics with heterosexual orientation – in 26%; among homosexuals and lesbians – 46%, among prostitutes – 70-80%.Antibodies to HSV-II are more often detected in representatives of the Negroid race than in whites. Women become infected more often than men, with the same number of sexual partners during their lifetime.

Seroepidemiological studies have shown a significant difference between the prevalence of seropositivity and the actual incidence of HH, which in Western Europe exceeds 80 cases per 100 thousand population, and in the United States is close to 200 cases per 100 thousand inhabitants. According to American researchers, about 30 million adults in the United States suffer from recurrent genital herpes, and about 500,000 new cases of the disease are recorded each year.It is believed that in developed countries, HH may suffer from 10–20% of the adult population.

Numerous studies on the general population have shown that the incidence of HH increases with age: single cases of HH are detected in the group of patients aged 0-14 years; the highest incidence of HH is recorded in the age group 20–29 years old; the second peak in incidence occurs at 35–40 years of age. The main risk factors for the development of HH are a large number of sexual partners throughout life, early onset of sexual activity, homosexuality in men, black race, female sex, and a history of sexually transmitted infections.

Compulsory registration of YY was introduced in the Russian Federation in 1993. Over the period 1993 – 99, the incidence of hepatitis C in Russia increased from 8.5 cases to 16.3 per 100 thousand population. One gets the impression of relative well-being: the indicator is 5 times lower than the “European” one and 12 times lower than the “American” one. However, an analysis of the incidence of hepatitis C in Moscow alone shows that this indicator has grown over this period from 11.0 to 74.8 cases per 100 thousand population and has practically reached the level of European countries.

Pathogenesis of recurrent herpes

The pathogenesis of HH does not differ from the mechanism of development of any other form of herpes simplex, the causative agent of which is HSV type I or II. HSV-I strains are more often isolated when the skin of the face, upper extremities is affected, HSV-II strains – with genital localization of foci, although there is no direct connection between antigenic specificity and the localization of clinical manifestations of herpes.

The virus begins to multiply at the site of inoculation – the “gateway” of infection, where typical vesicular rashes appear, and penetrates the bloodstream and lymphatic system.In the early stages of herpes infection, viral particles are also introduced into the nerve endings of the skin or mucous membrane, move centripetally along the axoplasm, reach the peripheral, then segmental and regional sensitive ganglia of the central nervous system, where they remain in a latent state for life in nerve cells.

Infection of sensory ganglia is one of the important stages in the pathogenesis of GI. With herpes, the genitals are the ganglia of the lumbo-sacral spine, which serve as a reservoir of the virus for its sexual transmission.The spread of HSV in a centrifugal direction during relapse determines the anatomical fixation of lesions in relapses of herpes simplex.

Under certain conditions, HSV multiplies in the patient’s T- and B-lymphocytes, which leads to damage to immunocompetent cells and disruption of the genetic mechanisms that control immune responses at the level of cells and mediators.

In most cases, primary genital infection is asymptomatic. Recurrent genital herpes (RHH) develops in 30-50% of those infected.Exacerbations of RHH can be triggered by hypothermia or overheating (bath), physical or mental trauma, alcohol intake, hormonal cycles.

Recurrent forms of herpes have a negative effect on the patient’s immune system. Clinically, secondary immunodeficiency manifests itself in frequent colds, decreased performance, low-grade fever, lymphadenopathy, and psychoasthenia. Recurrent genital herpes, disrupting the normal sex life of patients, is often the cause of neuropsychiatric disorders, leading to family troubles.

Clinical manifestations of genital herpes in women

Description of various clinical forms of genital herpes is found in many works, but they, as a rule, are limited to the description of lesions of the skin and mucous membranes.

According to the existing international classification, primary and recurrent genital herpes are distinguished. The latter, in turn, is subdivided into typical and atypical clinical forms and asymptomatic virus shedding.

Actually, the term “genital herpes” arose at the beginning of the 20th century to designate a lesion on the skin and mucous membranes of the external genital organs. With the development of virological research methods, information about “atypical” forms of the disease began to appear. The diagnosis “atypical form of genital herpes” is made by gynecologists to indicate a chronic inflammatory process of the internal genitalia (colpitis, vulvovaginitis, endocervicitis, etc.) in the presence of a laboratory confirmed herpetic nature of the disease, in contrast to the “typical” picture of the disease, in which the mucous membrane these organs have lesions with vesicular-erosive elements.At the same time, herpetic lesions of the urethra, anal region and rectal ampulla fall out of the field of vision of doctors, although these organs are anatomically and functionally closely related to the genital area.

Given the variety of clinical manifestations of genital herpes with damage to the external and internal genitals, as well as the organs of the urinary system and the anal region, a certain difficulty in conducting a virological examination of patients and interpreting the results obtained, we propose a working classification and clinical and virological characteristics of the encountered forms of genital herpes (Table …1 and 2).

Without dwelling on a detailed description of the typical forms of herpes of the external genitals, we note the following.

Atypical forms of RHH, which greatly complicate the diagnosis, can be caused by: 1) a change in the development cycle of herpetic elements in the lesion focus; 2) unusual localization of the focus and anatomical features of the underlying tissues; 3) the predominance of subjective sensations in the focus.

In atypical forms of RHH, any one of the stages of the development of the inflammatory process in the focus (erythema, blistering), or one of the components of inflammation (edema, hemorrhage, necrosis), or subjective symptoms (pruritus) predominates, which give the appropriate name for atypical form of RHG (erythematous, bullous, hemorrhagic, necrotic, itching, etc.)etc.). According to the intensity of clinical manifestations, atypical forms can proceed violently, as manifest (bullous, ulcerative-necrotic), or as subclinical (microcracks). Atypical forms of herpes of the external genitals in women are much more common than in men.

The subclinical form of RHH is detected mainly during virological examination of the sexual partners of patients with any sexually transmitted disease, or during examination of married couples with impaired fertility.

In the epidemiological aspect, it is the asymptomatic forms of genital herpes that are most dangerous for the spread of herpes infection, when, against the background of minimal clinical manifestations of the disease, HSV with secretory discharge occurs, and the absence of pronounced symptoms allows patients to have an active sex life and infect sexual partners.

Herpetic infection of the pelvic organs

A feature of genital herpes of the female genital organs is multifocal .The pathological process often involves the lower part of the urethra, the mucous membrane of the anus and rectum. The involvement of these organs in the infectious process can occur a second time, following the onset of herpes of the external genitals, or it can proceed as an isolated lesion. We will dwell on the description of these clinical forms of GI in more detail, since they are little known.

According to the peculiarities of clinical manifestations, herpetic lesions of the pelvic organs should be divided into:

1.Herpes of the lower urogenital tract, anal region and rectal ampulla , which manifests itself in two clinical forms: focal, characterized by the appearance of vesicular-erosive elements typical for herpes simplex mucous membranes, and diffuse , in which the pathological process proceeds along type of nonspecific inflammation.

2. Herpes of the upper genital tract manifests itself as symptoms of nonspecific inflammation.Usually, patients complain of vaginal discharge, recurring pain in the small pelvis, perineum, in the area of ​​the projection of the uterus, ovaries. These patients are treated with antibacterial and antifungal drugs for a long time without effect. At the same time, a significant number of patients who have no discharge and subjective symptoms do not go to the doctor at all and for a long time remain a source of infection. It is very difficult to establish the real frequency of damage to the internal genital organs, since in 25–40%, and according to some data, in 60–80% of patients, the disease is asymptomatic.It can be assumed that this pathology occurs much more often than it is diagnosed.

For the subclinical form of herpes of internal genitalia, the absence of complaints in patients is typical, sometimes there are indications of recurrent, non-abundant mucous discharge from the vagina. On a gynecological examination, symptoms of inflammation are usually not detected. With dynamic laboratory examination of smears of the separated canal of the cervix, vagina and urethra, there is a periodic increase in the number of leukocytes (up to 200-250 and higher in the field of view), indicating the presence of an inflammatory process.

Asymptomatic form herpes of internal genitalia is characterized by the absence of any complaints about the genital area in patients, objective clinical data confirming inflammation. In a laboratory study of the detachable urogenital tract, HSV is released, while there are no signs of inflammation (leukocytosis) in smears.

Asymptomatic form of herpes of internal genitalia is detected in 20-40% of women suffering from RH of the buttocks and thighs .This important circumstance must be taken into account when planning pregnancy in women with this form of RH due to the existing likelihood of complications of HSV infection during pregnancy.

The complications of RHH include the involvement of the nervous system in the infectious process , which is due to the neurotropism of HSV. It should be noted that pain syndrome with RHG occupies a special place. Attention is drawn to the frequent lack of objective data during gynecological examination, indicating inflammation of the internal genital organs.At the same time, patients complain of recurrent pulling pains in the lower abdomen, in the area of ​​the ovarian projection, radiating to the lumbar region and rectum, pain in the perineum. In some cases, the pain syndrome can mimic the “acute abdomen” clinic. This phenomenon, as a rule, is associated with the specific herpetic neuralgia of the pelvic nerve plexus present in patients.

The variety of clinical manifestations of herpes simplex, the presence of atypical, subclinical and asymptomatic forms of the disease, the involvement of many body systems in the infectious process often complicate the diagnosis of this disease. In cases of doubtful diagnosis, in order to clarify the severity and prevalence of the infectious process, as well as to determine the tactics and scope of therapy, patients need to conduct a virological examination.

Laboratory diagnostics of herpes

Existing methods of laboratory diagnosis of herpes simplex are fundamentally divided into two groups: 1) isolation and identification of HSV or detection of the pathogen antigen from an infected material, for which cytological or immunofluorescence studies, enzyme immunoassay (ELISA), isolation on cell cultures are used; 2) detection of virus-specific antibodies in blood serum.

The frequency of HSV detection in materials from different parts of the urogenital tract in women varies. Most often, the virus can be isolated from the separated cervical canal (in 32–34% of cases), less often from the vagina (28%) and urethra (21%). The virus is rarely detected simultaneously in all samples obtained from a patient, therefore, to reduce diagnostic errors, it is necessary to examine the maximum number of samples from one patient (discharge of the cervical canal, vagina, urethra, urine).

The frequency of HSV shedding in women largely depends on the phase of the menstrual cycle. In more than 70% of patients with herpes simplex, HSV is secreted at the beginning of the luteal phase. At the same time, there is an increase in the clinical manifestations of HSV infection in the majority of patients. A significant variation in the detection of HSV antigen in women on different days of the menstrual cycle shows that a negative result of a single virological study cannot completely exclude the diagnosis of genital herpes.If HSV infection is suspected, it is necessary to repeat a virological study of the urinary tract discharge in patients once every 7 days (2-4 times a month).

The diagnostic value of serological methods for herpes simplex is different and depends on the form of infection (primary, recurrent), the state of reactivity of the patient’s body, the duration of the disease and a number of other factors.

In response to the introduction of HSV in the body, the production of specific class M immunoglobulins (IgM) begins, which are determined 4–6 days after infection and reach a maximum value on 15–20 days.From 10-14 days, the production of specific IgG begins, a little later – IgA. IgM and IgA remain in the human body for a short time (1–2 months), IgG – throughout life (seropositivity).

Detection of IgM and / or a fourfold increase in titers of specific immunoglobulins G (IgG) in paired blood sera obtained from the patient with an interval of 10-12 days has diagnostic value in primary GI.

Recurrent herpes usually occurs against the background of high IgG values, indicating constant antigenic stimulation of the patient’s body.The appearance of IgM in such a patient indicates an exacerbation of the disease.

To establish HSV infection in diagnostically difficult cases, a comprehensive virological examination of patients is required, including antigen detection and analysis of serological parameters in dynamics. The diagnosis of HSV infections only on the basis of a serological study can lead to a diagnostic error, since low titers of antiherpetic IgG do not always prove the absence of active herpes infection.The detection of IgG titers above average is an indication for additional examination of the patient in order to confirm or exclude the diagnosis of HSV infection.

Treatment of genital herpes

Modern medicine does not have methods of treatment that would allow the elimination of HSV from the human body. Therefore, the goal of treatment is to suppress the reproduction of HSV during an exacerbation, the formation of an adequate immune response and its long-term preservation in order to block the reactivation of HSV in the foci of persistence.

Currently, there are two main directions in the treatment of herpes simplex:

1. Etiopathogenetic antiviral therapy, the main place in which is given to acyclovir (ACV) -containing drugs (zovirax, valtrex, acyclovir-acri, etc. ). Pronounced antiherpetic activity, low toxicity, the presence of several dosage forms (ointment, tablets, cream, suspension, solution for intravenous administration) make it possible to widely and effectively use them for stopping recurrence of herpes, prevention and treatment of complications of HSV infection.The clinical efficacy of ACV-containing drugs in acute and recurrent genital herpes is 70 – 80%.

With a low therapeutic efficacy of this group of drugs, antiherpetic drugs with a different mechanism of antiviral action (triapten, virus-mertz, hevizosh, alpizarin) are used.

2. The complex method of treatment includes immunotherapy (specific and nonspecific) in combination with antiviral therapy.

Correction of violations of nonspecific and specific links of immunity is one of the directions in the complex therapy of herpes simplex.

The main barrier to viral infections is the interferon system. Interferon (IFN) is the most important protective protein formed in response to the penetration of the virus into the cells of the body. The ability of IFN to suppress the reproduction of the virus, to have an immunomodulatory effect allows the use of interferon preparations and its inducers in the treatment of exacerbations of HH, as well as for the prevention of relapses.

Synthetic inducers of IFN have a pronounced effect in the treatment and prevention of herpes simplex, and among them is the domestic drug Poludan, which since the 70s.It is successfully used in the form of eye drops and subconjunctive injections for the treatment of ophthalmic herpes and other viral eye diseases.

To date, convincing clinical data have been obtained on the high efficacy of Poludan for the treatment of other forms of recurrent herpes. In case of herpetic lesions of the skin and mucous membranes of the external genitals, Poludan is used in the form of applications, for which 200-400 μg of the drug (1-2 bottles) is dissolved in 4-8 ml of water, moistened with a cotton swab and applied to the affected areas of the body for 5-7 minutes . ..The procedure is repeated 2-3 times a day for 2-4 days. For the treatment of herpetic vulvovaginitis and colpitis, Poludan is used in the form of irrigation: 400 μg (2 bottles) of Poludanum is diluted in 10 ml of water and the affected mucous membranes are irrigated. The procedure is repeated 2 times a day for 2-4 days.

In case of skin lesions with recurrent herpes of the thigh or buttocks, it is possible to inject the lesion with Poludan: 200-400 mcg of the drug is dissolved in 2-4 ml of distilled water and injected subcutaneously under the focus.The procedure is repeated daily; the course of treatment consists of 2–5 injections, which is determined by the rate of regression of the lesion. With parenteral administration of Poludan under the lesion, a more pronounced effect is observed than when using the drug in the form of lotions, which is due to its general immunostimulating effect.

The advantage will undoubtedly have IFN inducer drugs administered orally, which allows patients to independently carry out preventive courses of anti-relapse therapy recommended by a doctor.These drugs include Amiksin , the mechanism of action of which includes the induction of interferons of type a, b, g, immunocorrection and direct antiviral action. Amiksin has a mild immunomodulatory effect, stimulates bone marrow stem cells, enhances antibody production, and reduces the degree of immunosuppression.

Amiksin is included in the complex treatment of RHH according to the scheme: 250 mg once a day – 2 days, then 125 mg every other day for 3-4 weeks.According to the same scheme, Amiksin can be recommended to patients between courses of vaccine therapy to prolong the achieved effect.

The antiviral activity of the IFN inducer – Arbidol is due to its immunomodulatory and antioxidant properties. Arbidol can be included in the complex treatment of RHH (0.2 g x 2 times a day with meals every day for 10-14 days) and used between courses of vaccine therapy to prevent recurrence of herpes (0. 2 g once a day with meals daily for 2-3 weeks).

Taktivin, Timalin, Timogen, Mielopid and others can be used to stimulate T- and B-links of cellular immunity in patients with recurrent herpes.

Specific immunotherapy consists in the use of a domestic herpes vaccine (polyvalent, tissue, killed). The therapeutic effect of the vaccine is associated with the stimulation of specific reactions of antiviral immunity, the restoration of the functional activity of immunocompetent cells and specific desensitization of the body.

Taking into account the peculiarities of the pathogenesis of herpes simplex, the most appropriate for achieving a therapeutic effect is the use of drugs with a different mechanism of action. The combined use of chemotherapy drugs with a different mechanism of antiviral action prevents the emergence of resistant HSV strains. The use of interferons and their inducers in combination with the herpes vaccine and immunomodulators makes it possible to comprehensively solve the issues of herpes simplex therapy.

Conclusion

The list of diseases etiologically associated with HSV is constantly growing.According to the literature, in 3.6% of women suffering from colpitis and cervical leukoplakia refractory to therapy, HSV is one of the etiological factors of the disease. A new form of latent intrauterine HSV-II infection with localization of the pathological process in the glandular epithelium of the endometrium is described. It has been proven that HSV can be the cause of the development of endometritis and salpingo-oophoritis. The etiopathogenetic role of HSV in cervical cancer has been established. The foregoing emphasizes the growing etiological role of HSV in the structure of diseases of the pelvic organs in women.

Severe forms of neonatal herpes develop when a newborn is infected with herpes simplex virus during labor. In case of primary HH in the mother, from 30% to 80% of children are infected, with recurrent herpes – 3-5%. Infection of the fetus during delivery, if the mother had herpes sores at the end of pregnancy, occurs in 50% of women with RHH; however, 60–80% of infected children develop encephalitis.

Viremia in women during pregnancy can cause fetal death, stillbirth, premature birth.Herpesviruses cause up to 30% of spontaneous abortions in early pregnancy and over 50% of late miscarriages, ranked second after rubella in teratogenicity.

Summarizing the above, it should be noted that currently medicine has new knowledge about the pathogenesis of herpes simplex, about the ways of spreading HSV in the population; methods of diagnosing herpes that are available for practical health care have appeared, new antiviral drugs and complex methods of drug treatment of herpes have been developed, which make it possible to achieve a positive effect in 80–90% of cases of patients’ supervision.Insufficient literacy of the population remains objective problems, which leads to late visits of patients to a doctor, as well as the passivity of doctors and their underestimation of the importance of the herpes problem.

Literature:

1. Barinsky I.F., Shubladze A.K., Kasparov A.A., Grebenyuk V.N. Herpes. Etiology, diagnosis, treatment // M.– 1986.– 272 P.

2. Genital infection caused by the herpes simplex virus (overview information) // J.STDs. – 1994. – No. 3. – p. 5-8.

3. Marchenko L.A. Genital herpes infection in women (Clinic, diagnosis, treatment) // Abstract of the thesis. diss. d.m.s. – 1997. – M. – 32 S.

4. Semenova T.B. Herpes simplex. Clinic, diagnostics, treatment, prevention. // Autoref. diss. d.m.s. – 2000. – M. – 48 S.

5. Semenova T.B., Krasnikov D.G. The impact of herpes infection on the health of mother and child. // Pediatrician. – 1990. – No. 10. – p. 88-93.

6.Sukhikh G.T., Vanko L.V., Kulakov V.I. Immunity and genital herpes // N.-Novgorod – M. – 1997. – 221 p.

Amiksin (trade name)

(LENS-Pharm)

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Genital herpes

09/26/2018 from Grigorieva Vera Sergeevna (temporarily does not receive)
Obstetrician-gynecologist, pediatric gynecologist

Genital herpes is a viral lesion of the genitals, which is characterized by the appearance of a group of vesicles, and then erosions and ulcers.It is accompanied by a local burning sensation, swelling, hyperemia and intoxication. In rare cases, the skin of the genitals does not develop bubbles, but painful redness or swelling. In addition, with the localization of herpetic eruptions in the urethra, a person may be concerned about pain during urination. If a woman has herpetic vesicles in the vagina, then abundant discharge, painted in a whitish color, may appear. It is especially dangerous in pregnant women, because it increases the likelihood of spontaneous miscarriage, pathology of the newborn.Included in the group of sexually transmitted diseases. (STD) .

The causative agent of genital herpes is a type of herpes simplex virus (HSV) .

Genital herpes, with various forms of sexual intercourse, easily penetrates through damaged skin and mucosal epithelium. After infection with HSV, it migrates to nerve ganglia , remaining there for life.

The infection is characterized by a chronic course and manifests itself cyclically: periods of activity or relapses (2-21 days), when rashes appear in the form of bubbles, alternate with periods of remission, when clinical symptoms disappear.

Primary HSV infection usually occurs by airborne droplets in childhood (in children 6-7 years of age, the incidence rate is 50%). Secondary infection occurs, as a rule, as a result of sexual intercourse.

The human immune system reacts to the penetration of HSV by producing specific antibodies, and at a normal level of immune responses, clinical manifestations are not observed. Under the influence of a number of unfavorable factors that reduce the body’s immune reactivity, HSV is activated, which is manifested by rashes on the skin and mucous membranes, and neuralgic pains.Episodes of recurrence of genital herpes often occur against the background of chronic stress, lack of vitamins, hypothermia, overheating, hormonal imbalance, sexual intercourse, and colds.

According to the clinical course, primary genital herpes (the first episode of the disease) and relapsing (all subsequent episodes) are distinguished. The course of recurrent genital herpes can be arrhythmic, monotonous and subsiding.

The arrhythmic course of is characterized by an alternation of remissions from 2 weeks to 5 months.Moreover, the longer the periods of remission, the more intense and longer the recurrence of genital herpes, and vice versa.

With a monotonic course of , there are frequent episodes after varying periods of remission. Menstrual herpes, which is persistent and difficult to treat, belongs to this type.

A more favorable course has genital herpes of a subsiding type . It is characterized by a decrease in the intensity of relapses and an increase in the periods of remission.

Atypical forms of genital herpes are erased, in the form of chronic inflammation of the external and internal genital organs ( vulvovaginitis, colpitis, urethritis, cystitis , etc.).

This form is characterized by mild edema, areas of erythema, small-point blisters, persistent burning and itching.

The higher the herpes infection penetrates the genitourinary tract, the more serious the prognosis.

The consequences of the disease (especially if the recovery took place without medical supervision) are: dry skin and mucous membranes on the genitals ; the development of various bacterial infections; persistent neurosis, depression; aching pains that involve the lower abdomen, perineum; diseases of the genitourinary system (cystitis, urethritis).

Additional information can be obtained from Arnika Medical Center. Make an appointment by phone 8 (3952) 799-305 or by sending an application from our website.

Podolsk KVD | Official website of Podolsk dermatovenerologic dispensary

Full name Position Qualification category Certificate Education
Eltsova Natalya Vladimirovna Chief Physician

dermatovenerologist

Higher
Dermatovenereology
Dermatovenereology
12.04.2019 0550270015119
Higher, 1998 Nizhny Novgorod State Medical Academy

Khamitsaeva Irina Romanovna Head of department

Dermatovenereologist

Higher

Dermatovenereology

Dermatovenereology
02/29/2016 0177180393915
Higher, Moscow State University of Medicine and Dentistry, 2000
Borisova Tatiana Timofeevna Doctor of clinical laboratory diagnostics Higher

Clinical lab.diagnostics

Clinical laboratory diagnostics
06/27/2017 0550270007479
Higher, 1998 Moscow Medical Academy named after I.M. Sechenov

Bogatova Elena Yurievna Head of laboratory

Clinical laboratory diagnostics doctor

Higher
Clinical lab. diagnostics
Clinical laboratory diagnostics
06/16/2016 No. 0377180538858
Higher, 1985Khabarovsk State Medical Institute

Byzgina Evgeniya Sergeevna Dermatovenereologist b / c Dermatovenereology 07/31/2015

0177040027630

Higher, 2014 Izhevsk State Medical Academy
Dmitrieva Raisa Vladimirovna Dermatovenereologist Higher
Dermatovenereology
Dermatovenereology
08.12.2017 0550270009082
Higher, 1974 2nd Moscow State Medical Institute named after I.I. N.I. Pirogov
Kozlova Evgeniya Yurievna Dermatovenereologist Higher
Dermatovenereology
Dermatovenereology
16.02.2018 0550270010045
Higher, 1997 Moscow Medical Dental Institute
Kirillova Natalia Ivanovna Dermatovenereologist Higher
Dermatovenereology
Dermatovenereology
10.02.2017 0177040056222
Higher, 1983 2nd Moscow State Medical Institute named after I.I. N.I. Pirogov
Klimontova Tatiana Vladimirovna Doctor-laboratory assistant Higher
Clinical lab. diagnostics
Clinical laboratory diagnostics 12/16/2019
1178270024845
Higher, 1994 Kemerovo State University
Lyamina Elena Vladimirovna Dermatovenereologist, Candidate of Medical Sciences Higher
Dermatovenereology
Dermatovenereology
16.10.2020
0550270021262
Higher, 1996 Tver State Medical Academy
Samokhvalova Elena Viktorovna (parental leave) Dermatovenereologist b / c Dermatovenereology 09/01/2017
0550270008008
Higher, State Budgetary Educational Institution of Higher Professional Education “Russian National Research Medical University named after N.I. Pirogov “Ministry of Health of the Russian Federation 2015.
Sityukov Yuri Pavlovich Dermatovenereologist Higher
Dermatovenereology
Dermatovenereology
16.10.2020 0550270021267
Higher, 1st Moscow Medical Institute named after I.M. Sechenov, 1989
Staforova Ksenia Nikolaevna Dermatovenereologist b / c Dermatovenereology

08/31/2015

0550140010218

Higher, Moscow State University of Medicine and Dentistry. A.I. Evdokimova, 2013
Pogorelova Yulia Viktorovna Dermatovenereologist Second
Dermatovenereology
Dermatovenereology 24.04.2017 0136180594935 Higher, Voronezh State Medical Academy named after N.N. Burdenko “
Silakova Tatiana Aleksandrovna Dermatovenereologist b / c Dermatovenereology
03/27/2017
0146040012791
Higher, 2011 SBEE HPE “Kursk State Medical University” MH and SR RF
Zaitsev Maxim Eduardovich Dermatovenereologist b / c Dermatovenereology
31.08.2018
0277040002754
Higher, 2016
SBEE HPE First Moscow State Medical University THEM. Sechenov “MH RF
Udalova Irina Valerievna Dermatovenereologist Second
Dermatovenereology
Dermatovenereology
04/21/2018
0164040011685
Higher, GOU VPO Saratov State Medical University named after IN AND. Razumovsky
Filatenkova Victoria Petrovna Doctor-laboratory assistant Higher
Clinical laboratory diagnostics
Clinical laboratory diagnostics 15.03.2019 0177241849270 Higher, Siberian Order of the Red Banner of Labor Medical University, 1993

Urogenital herpes: symptoms and treatment

Urogenital herpes is a viral disease that is an extremely urgent problem for society, since almost 80% of the population is infected with it. These statistics are based on the results of modern diagnostics, which allows for a thorough examination of patients.

The causative agent of genital herpes is the herpes simplex virus of the first and / or second type (HSV1-2).

The disease is transmitted primarily through sexual contact.

Genital herpes can be caused by both HSV-1 (the causative agent of labial herpes) and HSV-2. The clinical manifestations of the disease are identical for both types of infections. At the same time, the symptomatology of a particular episode in a particular patient is determined by the presence of herpes in history (labial or genital), as well as by the primary focus of infection.

Causes of exacerbation

Exacerbations of genital herpes caused by HSV-2 occur more often than with HSV-1.
The virus lives in the nerve ganglia. There he is at rest, but under the influence of unfavorable factors, general and local immunity is suppressed, as a result of which the virus is activated and the disease relapses. The main reasons for this are:

  • stress;
  • neuroses;
  • depression;
  • chronic fatigue;
  • intense physical activity;
  • the presence of foci of chronic infection in the body;
  • Change of time zone or climate;
  • excessive insolation, hypothermia;
  • lack of vitamins and minerals;
  • alcohol abuse;
  • use of certain medicines.

HSV1-2 have the ability to create permanent colonies of viral particles inside the human body. When a relapse occurs, the pathogen moves along the nerve pathways to the skin and mucous membranes in the genital / perianal region, due to which the external symptoms of genital herpes appear there. They are characterized by painful rashes, accompanied by severe itching and paresthesias.

Symptoms

The classic manifestations of genital herpes include:

  • papular eruptions transforming into vesicles and then ulcers;
  • regional lymphadenitis;
  • Prodrome period before rash appears (with recurrent genital herpes).

A primary episode of genital herpes caused by herpes simplex virus I (HSV-1) or II (HSV-2) can manifest manifestly with clinical manifestations localized at the site of infection in the human body. Herpes in men is more often manifested by rashes localized in the urethra. It can also be accompanied by pain when urinating. In women, with vaginal localization of rashes, mucopurulent vaginal discharge, an increase and soreness of regional lymph nodes are possible.

General symptoms of intoxication occur more often with the first episode than with relapses. These include:

  • increase in body temperature;
  • headache;
  • nausea;
  • malaise;
  • myalgia;
  • Sleep disturbance.

The severity and duration of clinical manifestations is also more pronounced during the first episode.
Atypical forms of genital herpes are manifested by hyperemia and edema in the affected area in the absence of pathological rashes.Clinical manifestations may not occur. In this case, the infection remains unrecognized. In addition, systemic manifestations characteristic of many viral infections can also be detected. Further, the herpes simplex virus enters a latent phase, localizing in the peripheral sensitive nerve ganglia. At the same time, it can cause periodic exacerbations (lesions of the skin and mucous membranes) or the disease remains asymptomatic, which, nevertheless, does not mean the impossibility of its transmission.

Transmission of the virus

The risk of infection with the virus is greatest during exacerbations with lesions of the mucous membranes and / or skin, as well as during the feeding period. For this reason, modern medicine recommends abstinence during these periods. In addition, transmission of the virus can occur in the absence of rashes as a result of subclinical viral shedding. There is no exact data on the effectiveness of condom use for the prevention of herpes.

Despite the fact that the clinical manifestations of the disease are well recognized, it should not be forgotten that its manifestations can vary widely from one patient to another.In many people, lesions in the region of the urogenital tract can be mistaken for other genital dermatoses. Therefore, it is recommended to avoid making a diagnosis solely on the basis of the clinical picture, especially if atypical symptoms are detected.

Treatment and prevention

The nature of the primary episodes of genital herpes often determines the subsequent course of the infectious process. If left untreated, many patients can develop local or generalized complications.It is during the initial episode that therapy is most effective.

Patients who seek help within 5 days from the onset of clinical manifestations (or later, but in the presence of fresh elements of rashes), it is necessary to select antiviral therapy both to eliminate symptoms and to reduce the duration of relapse. At the same time, none of the drugs prevents the further development of the infectious process. Local drugs are less effective than systemic ones. This means that their use is not enough to successfully treat genital herpes.

Some patients have a relapse of more than 5 days. With prolonged exacerbations of genital herpes (with persisting general manifestations, the appearance of new rashes and the development of complications), the course of therapy should be extended.

The diagnosis is established not only on the basis of clinical manifestations, but also according to the results of laboratory tests, which are used to clarify the etiology of the disease, as well as in atypical forms of the disease and for the purpose of differential diagnosis.Therefore, a doctor, not a patient, should make a diagnosis, relying on information on the Internet, which is only superficial, cognitive and informational.

The specialist will tell the patient about the existence of a high risk of transmission of the virus (including periods of subclinical virus shedding) even with the use of condoms and the use of antiviral drugs. He will also point out the need to inform the sexual partner about the presence of genital herpes, report on preventive measures that reduce the risk of transmission of the virus.When confirming the diagnosis, it is necessary to examine the sexual partners and, if possible, establish the source of the infection, as well as develop treatment options.

Given the high prevalence of the virus, it is very important to provide women and men with detailed information about the dangers of illness during pregnancy. Since there is a risk of intrapartum transmission, the patient should inform the obstetrician about the presence of urogenital herpes . As a rule, the first-heard diagnosis causes a stress response that continues during exacerbations, but can be reduced with the use of antiviral drugs.

Urogenital herpes has an unpredictable course and is accompanied by complications. Therefore, in no case should you self-medicate with the appearance of characteristic symptoms. It is important to seek professional medical help in specialized medical institutions so that it is the doctor who prescribes a competent laboratory examination and individually selects the treatment. In addition, the specialist will give valuable recommendations regarding the prevention of genital herpes, which will undoubtedly reduce the number of relapses and maintain a comfortable quality of life.

modern aspects of etiology, pathogenesis and clinic “Medvestnik

Etiology. Pathogenesis

There are two main antigenic groups of HSV: type I and II. At the same time, strains belonging to the same antigenic type may differ in immunogenicity, virulence, resistance to the effects of various chemical and physical factors, which ultimately determines the characteristics of the clinical manifestations of the disease. HSV-I strains are more often isolated when the skin of the face, upper extremities is affected, HSV-II strains – with genital localization of foci, although there is no direct connection between antigenic specificity and the localization of clinical manifestations of herpes.

The source of HSV infection is a sick person or a virus carrier. The virus is transmitted by airborne droplets, contact, transfusion and organ transplantation. During pregnancy, fetal infection can occur through the transplacental and transcervical (ascending) pathways.

It has been established that in 40% of cases, primary HSV infection occurs by airborne droplets in early childhood, while the source of infection is usually family members with active signs of GI.

The main links in the pathogenesis of GI are:

1. Infection of the sensory ganglia of the autonomic nervous system (ANS) and lifelong persistence of HSV in them.

2. Damage to immunocompetent cells leading to secondary immunodeficiency.

3. HSV tropism to epithelial and nerve cells, causing polymorphism of clinical manifestations of GI.

The virus begins to multiply at the site of inoculation – the entrance gate of infection (skin, red border of the lips, mucous membranes of the oral cavity, genitals, conjunctiva), where typical blister eruptions appear, and penetrates the bloodstream and lymphatic system.In the early stages of GI, viral particles are also introduced into the nerve endings of the skin or mucous membrane, move centripetally along the axoplasm, reach the peripheral, then segmental and regional sensitive ganglia of the central nervous system (CNS), where they remain latent for life in nerve cells.

Infection of sensory ganglia is one of the important stages in the pathogenesis of GI. With herpes of the face, these are sensitive ganglia of the trigeminal nerve, with HH – ganglia of the lumbosacral spine, which serve as a reservoir of the virus for its sexual transmission.The spread of HSV in a centrifugal direction during relapse determines the anatomical fixation of lesions in relapses of herpes simplex.

Recurrent infection occurs in 30-50% of the population infected with HSV. Recurrent herpes (RH) affects representatives of all age groups.

The progressive course of HSV infection is the appearance of more severe clinical symptoms with an increase in the duration of the disease, as well as the involvement of organs and systems in the infectious process.

Exacerbations of GI can be triggered by hypothermia, sun exposure, physical or mental trauma, alcohol intake, hormonal cycles.

The frequency and intensity of exacerbations in RH vary widely and depend on the virulence and pathogenicity of the pathogen, as well as the resistance of the human body. The disease often occurs as a local process, the rash is usually limited.

Herpes simplex can occur in local and widespread forms; the latter is less common and is characterized by the simultaneous appearance of several lesions in remote areas of the mucous membrane or by the involvement of tissues adjacent to the lesion in the pathological process.

The appearance of symptoms of intoxication caused by viremia (general weakness, malaise, subfebrile body temperature, an increase and soreness of peripheral lymph nodes) in patients during relapses, along with herpetic eruptions, indicate the dissemination of the infectious process, the inability of the immune system to localize the process.

Recurrent forms of herpes have a negative effect on the patient’s immune system. HSV, which develops in immunocompetent blood cells, leads to secondary immunodeficiency, which is clinically manifested in frequent colds, decreased performance, the appearance of low-grade body temperature, lymphadenopathy, psychoasthenia.Recurrent genital herpes (RHH), disrupting the normal sex life of patients, is often the cause of neuropsychiatric disorders, leading to family troubles.

Viremia in women during pregnancy can cause fetal death, stillbirth: herpes viruses cause up to 30% of spontaneous abortions in early pregnancy and over 50% of late miscarriages, ranked second after rubella virus in teratogenicity.

To date, evidence has been obtained that HSV is often an etiological factor in inflammatory diseases of the central nervous system (meningoecephalitis, ganglioneuritis), ear, throat and nose, lungs (chronic bronchitis), cardiovascular system (peri- and myocarditis, possibly, ischemic heart disease ), gastrointestinal tract, genitourinary system.Lesions of the skin and mucous membranes are the most common clinical manifestation of GI, and HSV genital lesions are one of the most common sexually transmitted diseases.

Clinic of genital herpes (HH)

According to the existing international classification, primary and recurrent HH are distinguished; the latter, in turn, is divided into typical and atypical clinical forms and asymptomatic viral shedding.

The term “genital herpes” suggests the presence of a lesion on the skin and mucous membranes of the external genital organs.With the development of virological research methods, information about asymptomatic and atypical forms of the disease began to appear. The diagnosis of “asymptomatic form of HH” is made on the basis of the results of virological examination when HSV is isolated from the detachable urogenital tract, while there are no symptoms of damage to the skin and visible mucous membranes of the genitals.

The diagnosis “atypical form of HH” is made by gynecologists to indicate a chronic inflammatory process of the internal genitals (colpitis, vulvovaginitis, endocervicitis, etc.).in the presence of a laboratory confirmed herpetic nature of the disease, in contrast to the “typical” picture of the disease, in which there are lesions with vesicular-erosive elements on the mucous membrane of these organs. At the same time, herpetic lesions of the urethra, anal region and rectal ampulla fall out of this group, although these organs are anatomically and functionally closely related to the genital area.

Infection of the genitals in adults usually occurs through sexual intercourse.The highest incidence of HH was registered in the age group 20-29 years old. People who have sex at an early age and have many sexual partners are at increased risk of developing HH.

Clinical manifestations of HH are more pronounced in seronegative individuals than in seropositive individuals, which indicates the influence of the immune response formed on HSV-I GI in childhood on the severity of clinical manifestations of herpes during infection of the genitals with HSV-II.

In most cases, the primary infection of the genitals is asymptomatic, subsequently turning into a latent carrier of the herpes virus or a recurrent form of HH.However, in cases of clinically pronounced onset, primary HH usually appears after a 1-10-day incubation period and differs from subsequent relapses in a more severe and prolonged course.

A typical clinical picture of primary HH is characterized by the appearance on the mucous membranes of the genital organs and adjacent areas of the skin of grouped vesicular elements arising on an erythematous background. After 2-4 days, the vesicles open up, forming weeping erosion, less often – ulcers, epithelializing under the crust or without its formation.Subjectively, patients are concerned about itching, burning, soreness in the area of ​​the lesion. Some have an increase in body temperature up to 38 ° C, painful enlargement of the inguinal lymph nodes. The duration of the acute period with primary HH can reach 3-5 weeks.

RGH is one of the most common infectious diseases of the genitourinary system. The disease is difficult to treat, is characterized by a chronic course, impaired sexual function of the patient, which often leads to the development of neurasthenia.In women, herpetic eruptions can appear on the labia majora and small labia, the mucous membrane of the vagina, cervix, in the perineum and anal region, and the skin of the buttocks and thighs is often affected. The disease is accompanied by the appearance and development of symptoms of intoxication (low-grade fever, general weakness and malaise), an increase and soreness of the inguinal lymph nodes (usually on one side).

Early opening of vesicles with the formation of erosive surfaces, pronounced subjective symptoms (pain, itching, burning in the focus) is characteristic of RHG.RHG is characterized by a severe course; often recurrent forms of the disease occur in 50-75% of patients.

A typical form of RH of the external genitals is characterized by pronounced symptoms of the disease, the classic development of the lesion focus (erythema, formation of vesicles, the development of erosive and ulcerative elements, epithelialization) and subjective sensations, manifested by repeated vesicular rashes. The lesions are usually limited, less common and localized in the same area of ​​the skin or mucous membrane.Frequent exacerbations of RHH are often accompanied by a violation of the general condition of patients. For 12-48 hours local and general prodromal phenomena may appear: itching, burning sensation, soreness in places of future rashes, regional lymphadenitis, symptoms of intoxication caused by viremia.

The presence of vesicular or erosive rashes on the skin and mucous membrane of the genitals, pronounced subjective symptoms (itching, burning) allow doctors to visually diagnose RHH, prescribe treatment in a timely manner and inform the patient about the infectious nature of the disease and the danger of infection of the sexual partner.

It should be noted that under the influence of the therapy, a typically flowing RHH can significantly change and acquire an abortive course. In this case, the elements in the lesion bypass separate stages of development. In these cases, the lesion focus can be represented by a papular element, microerosis, edematous spot on an erythematous background. Help in making a diagnosis when treating a patient with an abortive RHH can be provided by a correctly collected anamnesis, which indicates the presence of rashes typical for herpes in the patient in the past.

Atypical forms of RHH, which greatly complicate the diagnosis, are due to a number of factors:

1) changes in the development cycle of herpetic elements in the lesion focus;

2) unusual localization of the focus and anatomical features of the underlying tissues;

3) the predominance of subjective sensations in the focus

In atypical forms of RHH, any one of the stages of development of the inflammatory process in the focus (erythema, blistering), or one of the components of inflammation (edema, hemorrhage, necrosis), or subjective symptoms prevails (itching), which give the appropriate name to the atypical form of RHH (erythematous, bullous, hemorrhagic, necrotic, itching).According to the intensity of clinical manifestations, atypical forms can proceed violently as manifest (bullous, ulcerative-necrotic) or as subclinical (microcracks). And if in atypical forms of RHH, manifested by the formation of vesicles and erosions, into which bubbles and ulcers can be transformed with the addition of, for example, a necrotic component, one can suspect HH, then in clinical forms that are not accompanied by a violation of the skin and mucous membrane or the lesion has an unusual form, the diagnosis is made with great difficulty.

Atypical forms of herpes of the external genitalia are more common in women than in men.

In the edematous form of RHH, the lesion focus on the mucous membrane of the vulva is represented by hyperemia and diffuse edema.

The “itchy” form of RHH is characterized by periodic local appearance of pronounced itching and (or) burning in the external genital area with slight hyperemia of the vulvar mucosa in the focus.

HSV infection also belongs to atypical forms of RHH, manifested by single deep recurrent fissures of the mucous membrane and underlying tissues of the labia minora and majora, accompanied by sharp pain.

The subclinical (oligosymptomatic) form of RHH is manifested by microsymptomatics: a short-term (less than a day) appearance of one or more microcracks, accompanied by slight itching. Sometimes there are no subjective sensations, which reduces the appeal of patients to medical institutions and complicates the diagnosis. The subclinical form is usually detected by virological examination of the sexual partners of patients with any sexually transmitted disease, or by examination of married couples with impaired fertility.

Clinical diagnosis in abortive course, atypical and subclinical forms of RHH is difficult and can only be made using virological research methods.

In the epidemiological aspect, it is these clinical forms of genital herpes that are most dangerous for the spread of GI, when, against the background of minimal clinical manifestations of the disease, HSV is released into the environment, and the absence of pronounced symptoms allows patients to have an active sex life and infect sexual partners.

A feature of the female genital GG is multifocal. The pathological process often involves the lower part of the urethra, the mucous membrane of the anus and rectum. The involvement of these organs in the infectious process can occur a second time after the onset of herpes of the external genitals, or it can proceed as an isolated lesion.

Herpetic infection of the pelvic organs.

According to the peculiarities of clinical manifestations, herpetic lesions of the pelvic organs should be divided into:

1) herpes of the lower part of the urogenital tract, anal region and rectal ampulla;

2) herpes of the upper genital tract.

Herpes of the anal region and ampulla of the rectum, the lower part of the urogenital tract (damage to the mucous membranes of the entrance to the vagina, vagina, vaginal part of the cervix, cervical canal, urethra, bladder) manifests itself in two clinical forms: focal, characterized by the appearance of typical for simple herpes of the mucous membranes of vesicular-erosive elements, and diffuse, in which the pathological process proceeds as a nonspecific inflammation.

Herpes of the urethra and bladder. Herpetic urethritis is subjectively manifested by pain and cuts at the beginning of urination, dysuric phenomena. On examination, there is hyperemia of the external opening of the urethra, the presence of scanty mucous discharge; with ureteroscopy in the anterior part of the urethra, it is sometimes possible to detect small superficial erosions, catarrhal inflammation. The leading symptoms of herpetic cystitis are cystalgia, the appearance of pain at the end of urination, and dysuric phenomena.

Herpes of the anal area and rectum. The lesion in the anal region is usually a recurrent fissure, which is often the reason for diagnostic errors. Such patients with an erroneous diagnosis of “anal fissure” go to surgeons. Itchy form of herpes of the anus and herpetic lesions of hemorrhoids are also difficult to diagnose.

Lesion of the anal region can occur primarily as an independent disease or secondarily as a result of leakage of the vaginal discharge and maceration of the mucous membrane of the anus if the patient has herpetic colpitis, accompanied by abundant exudation.

In case of damage to the sphincter and mucous membrane of the rectal ampulla (herpetic proctitis), patients are disturbed by itching, burning sensation and soreness in the lesion, small erosions occur in the form of superficial cracks with a fixed localization, bleeding during bowel movements. With rectoscopy, catarrhal inflammation, sometimes erosion, is determined.

It can be especially difficult to diagnose herpetic proctitis. We observed patients with RH of the anal region, in whom the onset of the disease was associated with the periodic appearance of scanty mucous, sometimes bloody discharge from the rectum, which coincided in time with sharp bursting pains in the sigma region and flatulence, accompanied by severe itching in the anal region.Later, these patients began to develop bleeding fissures in the anal area. Based on the data of retro- and colonoscopy (in some cases with biopsy) and the results of virological examination, these patients were diagnosed with herpetic proctitis, RG of the anal region.

Herpes of the upper genital tract (damage to the uterus, fallopian tubes). A typical clinical picture of herpetic lesions of the organs of the upper urogenital tract is manifested by symptoms of nonspecific inflammation.Usually, patients complain of vaginal discharge, recurrent pain in the small pelvis, the area of ​​the projection of the uterus, ovaries. These patients are treated for a long time without effect by gynecologists with antibacterial and antifungal drugs. At the same time, a significant number of women who have no discharge and subjective symptoms do not go to the doctor at all and for a long time remain a source of infection.

Such diagnoses as “HSV-endometritis”, “HSV-salpingo-oophoritis” are practically not made by doctors.At the same time, the ascending forms of herpetic lesions of the internal genital organs in women are confirmed by the detection of HSV in the endometrium, fallopian tubes and sacro-uterine ligaments. It is very difficult to establish the real frequency of damage to the internal genital organs, tk. in 25-40%, and according to some data, up to 60% of women, the disease is asymptomatic. It can be assumed that this pathology occurs much more often than it is diagnosed.

For the subclinical form of herpes of internal genitalia, the patient usually has no complaints, sometimes there are indications of recurrent, abundant mucous discharge from the vagina.During a gynecological examination, symptoms of inflammation are not detected. In a dynamic laboratory study of smears of the separated canal of the cervix, vagina and urethra, an increased number of leukocytes (up to 200-250 and higher in the field of view) is periodically revealed, indicating the presence of an inflammatory process. In a virological study of smears by the method of immunofluorescence, the HSV antigen is determined in leukocytes.

Asymptomatic form of herpes of internal genitalia is characterized by the absence of any complaints about the genital area in patients, objective clinical data confirming inflammation.In a laboratory study of the detachable urogenital tract, HSV is released, while there are no signs of inflammation (leukocytosis) in smears. Asymptomatic form of herpes of internal genitalia is detected in 20-40% of women suffering from RH of the buttocks and thighs. This important circumstance must be taken into account when planning pregnancy in women with this form of RH due to the existing likelihood of complications of HSV infection during pregnancy.

Complications of genital herpes.

Every fourth patient suffering from RHH develops complicated forms of the disease. Complications can be local and systemic. Local complications of HH include a complex of symptoms, consisting of increased trauma, dryness and the formation of painful bleeding cracks on the mucous membranes of the external genital organs, arising from mechanical irritation. These symptoms appear several years after the onset of the disease and make it difficult for patients to have sex. The most commonly affected area of ​​the posterior commissure and the mucous membrane of the entrance to the vagina.

Involvement of the nervous system in the infectious process occurs in every third patient suffering from HH, which is due to the neurotropism of HSV and the fact that it is the ganglia of the ANS that are the depot of HSV in the human body. It should be noted that pain syndrome in RHH occupies a special place. Attention is drawn to the frequent lack of objective data during gynecological examination, indicating inflammation of the internal genital organs. At the same time, patients complain of recurrent pulling pains in the lower abdomen, in the area of ​​the ovarian projection, radiating to the lumbar region and rectum, pain in the perineum.In some cases, the pain syndrome can mimic the “acute abdomen” clinic. Long-term pain syndrome causes a decrease in sexual potency and libido in patients.

This phenomenon, as a rule, is associated with the specific herpetic neuralgia of the pelvic nerve plexus in patients.

Features of pain syndrome in RHH are determined by the properties of nerve formations involved in the infectious process. Irritation of parasympathetic fibers causes subjective sensations in patients in the form of a burning sensation, which is a pathognomonic symptom with relapses of HH.With herpes of the thighs and buttocks, there is often an increase in the superficial pain sensitivity of the skin (hyperesthesia), which is subjectively perceived by the patient as tingling, a feeling of “creeping”. Clinical manifestations of ganglioradiculitis are manifested by pulling pains along the back of the thigh, which is due to the involvement of the sciatic nerve in the pathological process.

synlab: Genital herpes

Herpes is a common sexually transmitted disease (STI) which can affect anyone who is sexually active.Most people with the virus have no symptoms. It is important to know that even in the absence of signs of the disease, it can be transmitted to sexual partners.
Genital herpes is an STI caused by two types of viruses. The viruses are called herpes simplex virus type 1 and herpes simplex virus type 2.
You can get herpes during oral, vaginal, or anal sex with someone with the condition.
The fluid in the herpes blisters carries the virus, so contact with such fluid can cause infection.You can also get herpes from an infected sex partner who has no visible lesions or does not know that he or she is infected, because the virus can pass through the skin and contribute to the infection of your partner.
Symptoms of herpes in both men and women can occur in the genital area, which is covered with a latex condom. However, lesions can occur in areas that are not covered by a condom, so condoms cannot completely protect you from getting herpes.
If you are pregnant and carry genital herpes you need to tell your doctor. In some cases, genital herpes can lead to miscarriage. It can also increase the likelihood of premature birth. Herpes infection can be passed from you to your unborn child and contribute to a potentially fatal infection (herpes simplex of the newborn). It is important that you avoid getting herpes during pregnancy.
If you are pregnant and have genital herpes, you may be offered to take herpes medications until the end of your pregnancy to reduce the risk of having any symptoms and passing the disease on to your baby.At the time of delivery, your doctor should carefully examine you for symptoms. If you have symptoms of herpes at the time of delivery, a caesarean section is usually done.
Clinical manifestations: Genital herpes lesions usually appear as one or more vesicles on or around the genitals, rectum, or mouth. The blisters burst and leave painful sores that may take several weeks to heal. If you touch erosions or fluid from a wound (bladder), you can transfer herpes to another part of your body, such as your eyes.To avoid spreading herpes to another part of your body, do not touch erosions or liquid. These symptoms are sometimes referred to as a “flare-up”. When someone first has an outbreak, they may also have flu-like symptoms such as fever, body aches, or swelling of the tonsils.
Recurrences of outbreaks of genital herpes are frequent, especially during the first year after infection. Recurrences of outbreaks are generally shorter and less severe than the first outbreak.Although the infection may remain in your body throughout your life, the number of outbreaks tends to decrease over the years.
If you notice any of these symptoms or if your partner has an STI or STI symptoms such as unusual sores, foul-smelling discharge, burning sensation when urinating, or, in women only, bleeding between menstrual periods, you should be evaluated by a doctor.
Often, your healthcare provider can diagnose genital herpes simply by looking at your symptoms.Doctors may also take a sample from the erosion or ulcers and analyze it. Talk honestly and openly with your healthcare provider and ask him if you need to be tested for herpes or other STIs.
The herpes virus once entered the body remains there for life. However, there are medications that can prevent or shorten outbreaks. Some of these herpes medicines can be taken daily, making it less likely that you will pass the infection to your sex partner.It’s important to take your medication every time you have another cold sore outbreak.
Some people who get genital herpes are worried about how it will affect their overall health, sex life and relationships. It is best for you to talk to your doctor about this.
If you are a carrier of herpes, you should talk to your sex partner and let him or her know about it and the risks involved. Using condoms can help reduce this risk, but it will not completely eliminate the risk.