Symptoms and treatment of genital herpes in men

How to treat genital herpes in men and women on the genitals

Genital herpes is one of the main diseases that are sexually transmitted. According to statistics, it is given second place; doctors call trichomoniasis the first STD. Genital herpes is caused by the herpes simplex viruses HSV-II, and sometimes HSV-I. The concept of simple virus was applied to such viruses for obvious symptoms - the appearance of blisters and ulcers on the skin.

However, over the past decades, scientists and immunologists have come to disappointing conclusions. Because of its “simplicity,” the disease has become widespread, and yet it causes not only specific rashes, but can also cause serious disruptions in the functioning of internal organs. The virus will not necessarily “manifest” in the form of skin lesions.

And the name “genital” is nominal: every fifth PCR test detects the HSV-II virus in a vesicular rash outside the genital area. This means that 20% of patients do not attach importance to the rash, are treated incorrectly, do not consult a doctor and spread the disease.

How is genital herpes transmitted?

The cause of the disease is two types of herpes simplex viruses, mainly HSV-2. The first type of virus was previously associated with diseases of the skin and oral cavity. HSV-2 causes genital herpes and meningoencephalitis. Now there are cases of illness caused by the first type of virus or a combination of them. Often the carrier does not have any symptoms of the disease and does not suspect that he is the source of the infection.

How can you become infected with this disease? The most common routes of transmission of genital herpes are sexual and contact. Most often, infection occurs through sexual contact with a carrier of the virus or with a sick person. You can become infected by kissing, as well as by sharing common household items (spoons, toys). The virus can also be transmitted through airborne droplets.

There are several risk groups of people susceptible to infection:

• persons with frequent changes of sexual partners;
• sexually active age from 20 to 40 years;
• people practicing non-standard sexual practices;
• persons suffering from other sexually transmitted diseases;
• Women are more likely to get sick;
• people with immunodeficiency conditions;
• patients who have undergone surgery, organ transplantation, or immunosuppressive therapy;
• women using intrauterine devices for contraception.

For many people with the herpes virus, herpes outbreaks may be triggered by the following:

• general diseases;
• fatigue;
• physical or emotional stress;
• loss of immunity, such as due to a cold, AIDS, or medications such as chemotherapy or steroids;
• trauma, including during sexual activity;
• menstruation.

The pathogen enters the child's body from the mother during childbirth. The risk of such transmission depends on the type of lesion in the patient. It is up to 75%. In addition, infection of the fetus is possible through the blood during the period of viremia (the release of viral particles into the blood) during an acute illness in the mother.

Children in most cases become infected with HSV-1 in the first years of life. By the age of 5, HSV-2 infection also increases. During the first six months of life, babies do not get sick, this is due to the presence of maternal antibodies. If the mother was not previously infected and did not pass on her protective antibodies to the child, then children at such an early age become very seriously ill.

What should the patient and his sexual partner know?

1. 1Asymptomatic infection does not mean that the sexual partner will not become infected. The maximum probability of transmission of the virus from an asymptomatic patient is in the first 12 months of infection.
2. 2Using condoms reduces, but does not completely eliminate, the risk of infection.
3. 3It is necessary to inform your partner about the presence of the disease.
4. 4Treatment should be started as soon as possible from the appearance of the first symptoms.
5. 5HSV-2 increases the likelihood of HIV transmission.

What happens after infection?

One of the characteristics that distinguishes viruses from the herpes virus family from other types of viruses is latency. HSV and other herpes viruses have the ability to create small but permanent colonies of viral particles inside the body. These colonies are often completely inactive (or dormant), but they remain in the body for life.

As soon as HSV gains a foothold in the body, it begins to create copies of itself and spread. This can lead to a clinical picture of the infection ranging from mild and unnoticed symptoms to severe illness. In response to this, the immune system mobilizes its forces and limits the spread of HSV. Regardless of the severity of symptoms, the virus remains in the body. To avoid the immune system, HSV “retreats” along the nerve fibers and hides in the nerve ganglia. In the case of genital herpes, the virus is located in the sacral plexus of ganglia, located at the base of the spine. In the ganglia, the virus remains inactive (latent) for an indefinite period of time.

The phenomenon of latency is similar to the sleep cycle. Basically, the virus remains dormant in a safe place, sometimes for a very long time. Unfortunately, various biological events can activate HSV, after which the virus spreads along nerve fibers back to the skin. This may cause the symptoms and signs of genital herpes to reappear.

It is difficult to answer the question of how often the virus can be activated. Previously, it was believed that all cases of HSV activation lead to the development of a clinical picture of the disease. Research then revealed that the virus can become active without causing noticeable symptoms or signs—no itching, no pain, no rash. This phenomenon is called "asymptomatic reactivation."

Asymptomatic reactivation refers to the following situations:

1. Some herpetic eruptions may appear in places that are difficult or impossible to see.
2. Some herpetic lesions can be mistaken for something else, such as an ingrown hair.
3. Some manifestations of herpes cannot be seen with the naked eye.

The fact is that when the herpes virus is activated and moves to the surface of the skin or mucous membranes, it is difficult for even a doctor to notice. In addition, even for a person with symptoms and signs of genital herpes, several days pass before the full clinical picture develops, during which he will not be aware of the reactivation of the virus.

Features of HIV-infected people

For patients with HIV infection, as a result of weakened immune defenses, genital herpes is dangerous. Their episodes of exacerbation are more severe and last longer.

Prescription of antiretroviral therapy leads to a weakening of symptoms and a decrease in the likelihood of repeated exacerbations. Immediately after this, as a result of the restructuring of the immune system, the symptoms of herpes infection may worsen. Suppressive therapy may be recommended for HIV-positive individuals with established HSV-2 infection.

Forms of the disease

There are two forms of genital herpes: primary and recurrent. Primary genital herpes is said to occur when clinical signs appear for the first time after infection, which can happen after a couple of weeks or in some cases months. Recurrent herpes is a periodic exacerbation of the disease with the slightest weakening of the immune system. Depending on the number of exacerbations of relapses of genital herpes throughout the year, 3 degrees of severity are distinguished:

• mild degree – the number of relapses is 3 or less per year;
• moderate – exacerbations occur 4–6 times a year;
• severe - relapses occur monthly.

During the course of the disease:

All factors that suppress immunity in genital herpes are also causes of exacerbation.

How to relieve symptoms at home?

1. 1It is necessary to avoid overheating and hypothermia, which can cause a greater irritating effect and cause increased symptoms.
2. 2You cannot use perfume or antibacterial soap or gels to treat the skin of the perineum and genitals.
3. 3It is allowed to take anti-inflammatory drugs (ibuprofen, analgin, paracetamol) to relieve pain. The presence of contraindications should be discussed with your doctor. The duration of treatment should not exceed 3-4 days, usually this is enough.

As a rule, with the normal course of genital herpes, hospitalization in a hospital is not required. After prescribing therapy, a date for re-appointment is agreed upon with the doctor in order to monitor the effectiveness.

The presence of severe fever and weakness, unbearable headaches, shortness of breath, and serious condition may be an indication for hospitalization and additional examination.

Symptoms of genital herpes

For primary infection with herpes, the incubation period is up to 8 days. Then the following symptoms appear (see photo):

• itching, redness and burning in the genital area;
• small blisters filled with cloudy liquid form on the skin or mucous membrane;
• burst blisters transform into small erosions or ulcers covered with a crust;
• itching and tingling sensation during urination;
• when the cervix is ​​affected, the mucous membrane becomes hyperemic, erosive, with purulent discharge;
• the lymph nodes in the groin are enlarged.

Sometimes there is general weakness and malaise. It may take up to 30 days for the symptoms of the disease to completely disappear. Effective treatment of genital herpes shortens this period.

With genital herpes in the fairer sex, the rash is localized:

• near the external opening of the urethra;
• in the vestibule of the vagina and on the labia;
• on the cervix;
• near the anus or in the buttocks area.

In men, during exacerbation of herpes, the rash is located on the skin or mucous membranes:

• scrotum;
• around the anus or on the thighs;
• on the head or foreskin of the penis.

With secondary infection, the disease manifests itself with similar symptoms. Once the virus enters the human body, it turns him into a carrier of the disease. In this case, periods of remission are replaced by exacerbations.

The reddened areas where the rash appears are itchy, and the inguinal lymph nodes are enlarged. The remaining symptoms of genital herpes are the same in men and women. Herpetic manifestations gradually fade away after 1-2 weeks, and the manifestations of primary herpes completely disappear after 3-5 weeks.

You can see what genital herpes looks like in the photo.

Transmission routes

1. 1You can become infected with genital herpes through direct contact (usually during sex) with an infected person. In theory, any close contact with the skin of a carrier can result in infection (direct contact and sexual transmission).
2. 2The source of infection can be either a man or a woman. The transmission of the virus does not require the presence of characteristic symptoms, which contributes to its widespread spread.
3. 3During pregnancy, the fetus may become infected with HSV-2. The greatest risk is observed in the first 20 weeks of pregnancy in women with primary herpes.
4. 4During an active infection (the presence of a rash, general weakness and other clinical manifestations), the patient is the most dangerous for a sexual partner. During this time, any form of sexual contact should be avoided. Even the use of condoms does not protect 100% from the transmission of the pathogen, since there is no guarantee that all lesions will be covered with latex.

Recurrent herpes

Recurrences of genital herpes are observed in 50-70% of women and men after the disappearance of the primary signs of the disease.

The frequency of relapses and the duration of remissions are very variable - from once every 2-3 years to monthly exacerbations. The frequency of relapses and the severity of the clinical picture can be criteria for the severity of the process. With a mild form of chronic herpetic infection, exacerbations occur no more than 1-3 times a year, with a moderate form - 4-6 times a year. Severe course is characterized by monthly exacerbation of the disease.

Atypical form

The atypical form of the pathological process is characterized by an erased abortive course, which affects not only the external genitalia, but also the internal genital organs. As a rule, this form of infection is characteristic of chronic recurrent herpes, but at the same time, it can also occur with primary lesions.

It's no secret that many chronic pathologies of the genital organs are diagnosed as diseases of unknown etiology. This is due to the inability to identify the cause of the disease, and therefore the prescribed treatment is very often ineffective. It is in such cases that good specialists suspect the development of an atypical form of herpesvirus infection.

Complications

Genital herpes itself does not cause serious illness. However, its complications, which are often observed in people with weak immune systems (especially those with HIV infection), can pose a serious threat to health and even life.

1. Herpetic eczema is a skin lesion that leads to the appearance of a rash similar to that of eczema;
2. Herpetic keratoconjunctivitis is a lesion of the cornea and mucous membrane of the conjunctiva of the eye. Manifested by photophobia, burning, lacrimation, redness of the eye. Small white spots appear on the surface of the cornea, causing itching and pain. Without treatment, vision loss is possible;
3. Herpetic encephalitis is an inflammation of the brain caused by the HSV type 2 virus. Without treatment, the complication leads to death. The virus infects nerve cells in the cerebral cortex, leading to focal and general brain symptoms. Complete cure is possible with adequate and timely therapy;
4. Intrauterine herpes is the transmission of infection from mother to child. Primary infection is dangerous, which leads to damage to the fetal nervous system;
5. Herpetic meningitis is an inflammation of the meninges caused by the HSV type 2 virus. A severe complication leading to a number of neurological symptoms, including convulsions, severe headaches, and disturbances in the circulation of cerebrospinal fluid.

In people with normal immune status, complications are rare. On average, the acute phase of infection during primary infection lasts several weeks. During this period, the infected person releases a large number of viral particles with biological fluids. Carriage lasts up to 1 year. In most cases, the immune system controls the infection and suppresses its activity. This occurs due to the production of antibodies directed against the virus. During the period of remission, the virus remains only in the nerve cells of the sensitive nerve plexuses.

In patients with immunodeficiency, the herpes simplex virus often causes complications. Infection is especially dangerous in patients with AIDS. Herpetic lesions in such patients are extensive and often occur in the form of severe meningoencephalitis with a fatal outcome.

general information

There are two types of viruses that cause herpetic rashes on the body - HSV-1 (herpes simplex virus type 1) and HSV-2 (type 2). Rashes in the genital area and private parts are most often caused by the herpes simplex virus type 2.

The appearance of a characteristic rash around the mouth is associated with HSV-1, which rarely causes the genital form of the disease.

Epidemiology:

1. 1The prevalence of HSV-1 among adults is 56-85%, HSV-2 - 13-40%.
2. 2The highest incidence is determined in the group of young (20-30 years old), sexually active men.

Genital herpes and pregnancy

Pregnant women with genital herpes should be careful to avoid passing the virus to their baby, but not be overly concerned about it.

1. A mother can infect her baby during childbirth, often fatally. But if a woman becomes infected with genital herpes before becoming pregnant, or if she is infected early in pregnancy, the chance that her baby will be infected is very low—less than 1%. Women with genital herpes are carefully monitored for herpes symptoms before giving birth. If there are signs that a herpes outbreak is occurring during labor, a caesarean section is necessary.
2. The risk of infection of the child is high (30% to 50%) when a woman becomes infected late in pregnancy. This is because the mother's immune system has not produced protective antibodies against the virus. Women with a recurrent herpes infection have antibodies against the virus, which help protect the baby. If you are pregnant and you think you may have been recently infected, tell your doctor.

Women who are not infected with genital herpes should be careful about sex during the third trimester of pregnancy. Unless you know your partner does not have the herpes virus, you should avoid sex altogether during the third trimester. If your partner has herpes labialis, avoid sex during this time.

Some doctors believe that all pregnant women should be tested for herpes, especially if their sexual partner is infected. Check with your doctor if you or your partner need to be tested. Only a doctor can judge the advisability of taking antiviral and other drugs for herpes during pregnancy. The decision is made in each case individually.

During pregnancy, HSV-2 may be one of the causes of recurrent miscarriage and the development of fetal deformity. Perinatal losses due to neonatal herpes are 50-70%, with 70% of infected children born to mothers with asymptomatic genital herpes. Ignoring the fact of the possible presence of HSV-2, especially in premature birth, and fetal weight retention syndrome contributes to the fact that newborns do not receive timely antiviral therapy, and therefore they develop meningoencephalitis, damage to parenchymal organs, lungs (pneumonitis), etc.

Congenital genital herpes is observed in 1 child per 30 thousand alive, but the mortality rate in this group is 70%; the surviving children suffer severe neurological consequences. The virus is 4 times more common in premature babies than in those born at term. As a consequence of late intrauterine infection, the following anomalies occur in children: microcephaly, chorioretinitis, retinal dysplasia, microphthalmia, lens opacification, heart defects, hepatosplenomegaly, viral pneumonia. In the United States, between 400 and 1,000 babies are born each year with neonatal herpes.

In most cases, infection of the fetus occurs immediately before birth, through the ascending route after rupture of the membranes (critical period 4-6 hours) or during childbirth when passing through an infected birth canal. Infection of the fetus before 20 weeks of gestation leads to spontaneous abortion or fetal anomalies in 34%, in periods from 20 to 32 weeks - to premature birth or antenatal death of the fetus in 30-40% of cases, after 32 weeks - to the birth of a sick child. Typically, the entry points for infection are the skin, eyes, oral mucosa, and respiratory tract. Once infection has occurred, the virus can spread through contact or hematogenous routes.

When to see a doctor?

It is important to consult a doctor if the rash appears for the first time. The maximum effect is achieved by a course of treatment started within the first 24 hours from the onset of the first signs of infection, so do not delay your visit.

Subsequent exacerbations of the disease in healthy men rarely require visiting a doctor. It is necessary to discuss with him in advance options for preventing recurrent attacks. In case of relapse, it is important to abstain from any form of sex for the entire period of exacerbation.

Patients with HIV infection are at increased risk of complicated herpes infection. When the first signs of a rash appear, such men should immediately seek medical help.

Diagnostics

The diagnosis is made by a doctor based on the patient’s complaints and examination, during which a characteristic rash and enlarged lymph nodes can be detected. If an external examination does not reveal a rash, the doctor takes material for laboratory tests.

In addition, you need to know how to detect genital herpes using laboratory methods. Can:

1. Determine the disease using the PCR method during the period of relapse (the most effective), which determines not only the presence of the virus in the body, but also its type. Subject to sterility and temperature conditions, material taken from the site of the rash allows you to obtain results within 5 hours;
2. Identify antibodies to the virus by conducting blood tests;
3. Identify the virus by examining material taken from the location of the rash;
4. Conduct an enzyme-linked immunosorbent assay, which determines the presence of antibodies and evaluates the patient's immunity.

Since there are diseases similar to genital herpes in their manifestations (ulcers and erosions on the genitals), self-medication should not be done.

Herpes or so-called stomatitis on the genitals resembles:

1. Chancroid, sexually transmitted but rare in Europe and Asia;
2. Erosion resulting from trauma;
3. Syphilis.

Since the presence of antibodies alone cannot serve as a basis for the diagnosis of “genital herpes” (in women, the presence of antibodies to type 2 herpes is more likely, and antibodies are formed by 6-12 weeks after infection), it is additionally necessary to isolate the virus or use the PCR method.

Treatment regimen for genital herpes

For diagnosed genital herpes, five therapeutic treatment methods are used:

1. Pathogenetic therapy. Immunomodulators, including agents that increase and decrease the immune status and its individual components in the form of native substances (natural, crude biological products), individual fractions and synthetic stimulants of immunogenesis.
2. Etiotropic therapy. Antiviral drugs that suppress the replication of the herpes virus.
3. Symptomatic therapy. Medicines that relieve pain, itching and fever.
4. Specific prevention is vaccination.
5. Physiotherapy is sometimes used.

The medical arsenal of drugs that can directly affect the virus has a limited range of drugs. Direct-acting antiviral therapy is based on medications from the group of synthetic analogues of acyclic purine nucleosides. The base drug of this group of drugs is acyclovir.

Several treatment regimens for patients with typical genital herpes:

1. Treatment regimen for recurrent genital herpes. Used during the period when warning signs of recurrent disease appear. The choice of therapy, their combination and preparative forms (ointments, solutions, tablets) depend on how often relapses of herpes occur, as well as on the recommendations of the attending physician. The universal regimen includes a combination of treatment of herpes with acyclovir (and analogues) with the use of immunostimulants, vitamins and other restoratives. At the very beginning of the appearance of precursors of the disease (itching in the area of ​​​​the future lesion), interferon preparations are indicated. They are most effective in the early stages of pathogenesis. At the height of the disease, the use of interferon or its stimulants does not make sense.
2. Preventive treatment regimen for genital herpes. Treatment is prescribed in the remission stage if there is a suspicion of rapid activation of the virus. This treatment option is used for frequent (more than 6 times a year) relapses in order to prevent their development. Drugs that stimulate the general immune status of the body are indicated. Optional: Cycloferon, Ribotan, Gradex, Vegetan, Immunofan and other medications, the dosage and frequency of use is determined by the doctor. Vitamins of group B (B1, B6) are also shown, improving the overall resistance of the body. Interferon stimulators are used limitedly during this period due to their almost complete uselessness at this stage. It makes no sense to use antiviral drugs (acyclovir and others) - the virus is in an inactive phase, inaccessible to drugs. It is advisable to begin treatment with acyclovir, Zovirax and other drugs of this group only after detecting an active herpes virus in the blood.
3. Treatment regimen for genital herpes at initial contact. Optional: Acyclovir, Valacyclovir, Farmciclovir and other medications in a clinical dosage, which is determined based on individual sensitivity (drug tolerance, patient weight, doctor’s recommendations) orally up to five times a day for ten days or until symptoms disappear. The effect increases if treatment is started in the early stages of the disease.

The above regimens include means of etiotropic, pathogenetic and symptomatic therapy (to eliminate the symptoms of herpes - pain, itching, fever). The herpes vaccine is prescribed by the attending physician, based on therapeutic feasibility. Treatment of atypical forms of genital herpes is carried out taking into account the symptoms of pathogenesis and the results of laboratory tests.

Diet

When doing treatment at home, you must follow a diet. This will help prevent the herpes from getting worse. The principle of the diet is a high content of lysine, a small amount of arginine.

1. Allowed foods include low-fat dairy products, beef, chicken, various fish and seafood.
2. For dessert you can eat ice cream or drink coffee with cream.
3. Blackberries, black currants, peaches, apples, bananas help cleanse the body.
4. Additionally, your daily diet should include garlic and brewer's yeast (you can use pharmaceutical preparations in the form of capsules).
5. You can eat a little green onion salad dressed with olive oil three times a day. The dish is rich in retinol and ascorbic acid, which helps strengthen the body.

Alcohol should be avoided completely. Minimize consumption of sugar, sweets and nuts.

Prevention

In order to prevent genital herpes, experts recommend constantly taking measures to strengthen the immune system, as well as directing your efforts to preventing possible infection.

usually occurs sexually) from a sick person to a healthy person. Manifested by the following symptom complex: rash (vesicles) on the genitals – purulent pustules – purulent ulcers – scabs. The duration of the disease is 30 days. Discharge, problems with urination, and enlarged or inflamed lymph nodes in the groin are also observed.

Currently, many developed countries are actively developing preventive herpetic vaccines that protect against infection, and therefore we can hope that in a few years humanity will be able to receive an effective vaccine against herpes.