Itching and burning during pregnancy: caring for the intimate area during pregnancy

Herpes in the intimate area in women or genital herpes in women is one of the most common clinical types of sexually transmitted herpes infection. Genital herpes in women is characterized by the appearance of characteristic rashes on the skin and mucous membranes in the urogenital and/or anal area, characterized by variability in the clinical picture and a tendency towards a persistent recurrent course.

The causative agent of genital herpes is the herpes simplex virus (HSV, Herpes Simplex virus).

Fact Infection with genital herpes in 76% of cases is caused by HSV-2 and in 24% by HSV-1.

In most patients, the causative agent of genital herpes is herpes simplex virus type 2 (HSV-2). There are cases of genital herpes caused by HSV type 1, which reflects the increased prevalence of oral-genital contact in various population groups. In some patients, the disease can be caused simultaneously by two types of herpes simplex virus (HSV-2 and HSV-1).

How is genital herpes transmitted?

Herpes in the intimate area in women is caused by the transmission of the HSV virus from an infected partner of a patient or a virus carrier during genital, oral-genital, or oral contact.

Fact Transmission of the genital herpes virus in women can occur in different ways, but the sexual route is the leading one.

Auto-infection is also possible (for example, with ophthalmic herpes, the virus is carried by hand from the conjunctiva of the eye to the genital area), infection through household items or personal hygiene, as well as transmission by blood transfusion (blood transfusion) and transplantation (organ transplantation).

In women infected with HSV-2, the virus is contained in saliva, nasal mucus, tears, blood, urine, vaginal secretions, menstrual blood, amniotic fluid, the contents of the herpetic vesicle, etc.

HSV enters the body through mucous membranes or damaged areas of the skin, where it multiplies. Further, regardless of the signs of the disease, the virus invades the sensory and autonomic nerve endings and then into the body of the neuron, into the ganglion, and continues replication there. Then it spreads to the skin along the peripheral sensory nerves, which explains the fact of the involvement of new surfaces located at a distance from the site of primary localization of the vesicles.

Herpes in the intimate area in women or genital herpes has some features compared to genital herpes in men:

• Women are more susceptible to the disease than men.
• Relapses of the disease occur more often in women than in men.
• In women, more often than in men, relapse is caused by hormonal changes.
• In women, subjective sensations (itching, burning, pain), as well as symptoms of general intoxication, are more common than in men.
• Women have a larger area of ​​lesions than men, which is due to the structure of the genital organs.
• Despite the fact that the frequency of relapses of genital herpes in women and men is the same, the manifestations of relapses are different. In women, relapse is characterized by severe clinical symptoms, usually one lesion and a shorter duration than in men.
• In women, genital herpes more often occurs in a latent form than in men.
• In women, recurrent genital herpes more often than in men leads to psychoasthenia and neuropsychiatric disorders.

Chronic herpetic infection is an immunodeficiency disease with lifelong persistence of the virus in the cells of the nerve ganglia with dysfunction of both the autonomic and central nervous system, characterized by periodic exacerbations with the appearance of clinical signs (“herpetic vesicles”), localized in places that are constant for each patient - “Locus minoris” . Herpetic blisters affect the mucous membranes of the female genital area, the urethra, the anus, the skin, and when the process generalizes, the liver, brain and other organs. Rashes in the form of small, tense blisters on an edematous, hyperemic base after an incubation period of 2–4 days are accompanied by a period of increase in local clinical symptoms (tingling, burning) in some cases - general symptoms (malaise, weakness, fever). The lesion, without the addition of a secondary infection, disappears on days 7-9 without a trace.

Genital herpes in women symptoms

Genital herpes in women is clinically manifested by signs typical of GI in another location. Symptoms of genital herpes include painful blisters (rarely sores) in the infected area. After the initial infection, the blisters may recur periodically. The frequency of their occurrence varies among different people, but the place of occurrence is the same each time and is called “Locus minoris.” This sign of genital herpes in women is a characteristic feature not only of this form, but also of herpes virus infection in general.

The most characteristic symptoms of genital herpes in women:

• Rashes on the mucous membranes and skin of the genital organs,
• Painful sensations
• Itching, burning,
• Difficulty urinating
• Mucopurulent discharge from the genitals,
• Enlarged inguinal lymph nodes.

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How does genital herpes manifest in women?

Genital herpes on the labia is the most common place where rash elements appear. In addition to the external genitalia, damage to the mucous membrane of the uterus, fallopian tubes, ovaries, urethra and bladder is possible. In some cases, in addition to herpes on the labia, women have lesions of the urethra, cervical canal (cervical canal), uterine body, fallopian tubes, ovaries, and rectal ampulla. The weaker the immune system, the higher their likelihood.

The fastest way to detect the manifestations of herpes of the labia.

Why does herpes appear on the labia, vaginal walls, and cervix in women?

Women are infected with HH 4-6 times more often than men with the same number of sexual partners. This is due to the presence of larger areas of the mucous membranes of the external genital organs.

What does genital herpes look like in women?

Genital herpes in women photo

Symptoms of genital herpes in women photo

Prevention

To prevent the disease from occurring after therapeutic treatment, it is necessary to adhere to preventive standards:

• use contraceptives;
• monitor the hygiene of the intimate area;
• undergo preventive examinations from a specialist;
• exclude the possibility of sexual intercourse if there are rashes on the genitals;
• maintain a healthy lifestyle, eat well;
• strengthen the immune system;
• during the season of exacerbation, you can use immunomodulatory suppositories.

Not a single type of treatment, even the most effective, can completely eliminate the virus from the body, and therefore it is important to carefully follow preventive measures, not to have sexual relations before the age of 18 and to avoid unprotected acts.

How often can genital herpes occur in women?

Relapses of the disease can occur with varying frequencies: from 1-4 times a year to every 2 weeks. Herpetic lesions in women, which appear no more than 4 times a year, are considered a favorable prognosis, especially if the rash is moderate and fixed in the same place. Recurrences of genital herpes in women, occurring more often than once every 3 months, monthly or every 2 weeks, indicate a significant defect in the patient’s immune system.

Women, compared to men, have additional risk factors that can provoke a change in immune status and a new relapse:

• Menstruation in some people provokes a recurrence of HH (menstrual herpes)
• Pregnancy, childbirth, lactation
• The use of hormonal drugs, especially oral contraceptives
• Abortion
• Placement of the intrauterine device

Fact Having genital herpes means experiencing discomfort and restrictions in your sexual life, leading to depression, neuropsychiatric disorders, and in some patients, suicide attempts.

Recurrent genital herpes in women is accompanied by the risk of:

• Infections of the sexual partner;
• Infection of other areas (eyes, fingers, mucous membranes);
• Long-term persistence of symptoms (up to several months) in persons with reduced immunity;
• The appearance of a large area lesion or several lesions;
• Development of herpetic urethritis, colpitis (damage to the vaginal mucosa), cervicitis (damage to the cervix);
• Involvement of the fallopian tubes and ovaries in the process;
• Attachment of a secondary bacterial infection;
• HIV infection,
• Malignancy (malignant degeneration) of the cervix due to co-infection with the human papillomavirus;
• Development of rectal fissure;
• Development of infertility.

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Features of treatment for pregnant women

The herpes virus poses the greatest danger to pregnant women; it can cause serious disruptions during pregnancy and provoke the appearance of abnormalities and deformities in the unborn child. Therefore, in the acute form, especially if it is a primary infection, you need to start treatment as quickly as possible. During pregnancy there are some nuances during therapy.

Acyclovir and its analogues are used only in exceptional cases due to possible harm to the pregnant woman and the fetus. The following drugs are used with caution:

• Panavir;
• Zovirax;
• Vivorax and others.

The acute phase immediately before childbirth is dangerous, including. As long as the fetus is inside the womb, infection is unlikely. Most newborns become infected during childbirth, passing through the birth canal or touching the mother's genitals. Therefore, if an exacerbation or relapse occurs at the expected time of delivery, a cesarean section is offered.

Diagnosis of genital herpes in women

How to understand that it is herpes? What does genital herpes look like in women?

Diagnosis of genital herpes in women is made by collecting anamnesis, clinical examination, additional examination methods and is aimed at determining the severity of the condition and indications/contraindications for treatment.

Herpes in intimate places has a symptomatic typical course - there is no doubt in the doctor’s mind.

If there are characteristic elements of the rash and typical morphology, the diagnosis is established on the basis of clinical data, laboratory confirmation is not required.

If you have positive IgM, you absolutely cannot plan a pregnancy. Because genital herpes is a sexually transmitted infection (STI), screening of all sexual partners is recommended

To detect the virus itself, highly accurate diagnostics using the PCR method is most often used, which is the “gold standard” for diagnosing HSV, because detects viral DNA. Electron microscopy can also be used. The material for isolating the virus most often is the contents of the vesicles, saliva, secretions of the nasopharyngeal mucosa, vaginal secretions, and blood. For serological diagnosis, reactions that detect antibodies, immunoglobulins, and Ig are used. Ig G is a class of antibodies that provide a person with long-term immunity to infections. Ig M is a class of antibodies that correspond to the severity of the process. If they are elevated, this is a relapse or primary infection. Their level increases by the 3-5th day of the disease.

If herpes occurs in the intimate area in women, what should you do?

Consult a doctor (infectious disease specialist, dermatologist-venereologist, gynecologist) for advice.
Self-medication is not acceptable!

How to treat genital herpes in women?

It must be emphasized that it is necessary to treat genital herpes in women only after consultation with a doctor.

It should also be noted that currently there are no drugs for herpes that can remove the virus from the human body and lead to a complete cure. Therefore, treatment is aimed at suppressing the virus in the body and, most importantly, restoring immunity.

Genital herpes in women is treated to:

• prevent complications
• prevent relapse of the disease,
• to prevent transmission of the virus and infection of children, loved ones, sexual partners, work colleagues, etc.,
• prevent a decrease in quality of life,
• prevent further weakening of immunity.

Drug treatment comes down to 3 stages:

• suppressing an outbreak or relapse of the disease with the help of antiviral (chemo) drugs, interferons;
• restoration of the body's defenses - immunity with the help of general strengthening agents, probiotics, vitamins, interferons;
• vaccination with the antiherpetic vaccine "Vitagerpavak".

How to treat genital herpes?

Effective antiviral chemotherapy drugs for herpes are drugs such as acyclovir, as well as its more effective second-generation derivatives: valacyclovir, Valtrex, famciclovir, penciclovir. These drugs have a comparable mechanism of action and clinical effectiveness, they help to quickly and effectively reduce the severity of symptoms, subjective sensations, and the duration of relapse, but they cannot cure the infection (completely remove the virus from the body).

Acyclovir and its analogues act only on the active herpes virus, but do not affect viruses that are in a latent state. A common disadvantage of acyclovir-containing drugs is the inability to prevent relapses of the disease and infection with a related type of virus and a negative effect on the immune system. Further suppression of the immune system leads to the emergence of resistant strains of the virus. Antiviral chemotherapy drugs are used occasionally in a short course (5-10 days) for primary herpes or for relapses of herpes.

For herpes, it is possible to use antiviral agents topically. This helps lead to a significant reduction in the time of appearance and regression of rashes due to the high bioavailability of active substances at the site of the lesion. Acyclovir (ointment, cream) and the new drug Penciclovir (1% cream Fenistil® Pencivir) have proven themselves well. The effectiveness of Fenistil® Pentsivir is 20–30% higher than acyclovir-based cream. Fenistil® Pencivir cream can be used in patients over 12 years of age. If there is resistance to acyclovir-containing drugs, antiviral drugs with a different mechanism of action (foscarnet, isoprinosine, panavir, aloferon, etc.) are used.

During pregnancy, for the purpose of treatment and prevention of recurrence of genital herpes and infection of the fetus, herpes medications in tablets (Acyclovir, tablets) are prescribed starting from the second trimester of pregnancy in consultation with a doctor.

The presence of side effects from the use of chemotherapy drugs contributed to the introduction of modern, effective and harmless drugs - interferon drugs - into the treatment of herpes. The ability of interferons to suppress the multiplication of a virus in the human body explains the need for their use (giaferon, viferon, genferon, etc.). The effectiveness of Giaferon is 30% higher than the effectiveness of other drugs in this group, because also contains hyaluronic acid, an independent immunomodulator. Their use as antiviral agents and immunomodulators, stopping relapses of the disease and correcting immunity, allows them to be effectively used in the treatment of pregnant women and nursing mothers, and to prevent intrauterine infection of the fetus.

Is it necessary to talk about the importance of treatment aimed at strengthening defenses and preventing relapse of genital herpes? In cases of moderate and severe forms of the disease (relapse once every 3 months or more often), to increase the effectiveness of treatment, treatment regimens, along with antiviral drugs, include immunocorrective drugs: immunomodulators, interferons, vitamins, restoratives, immunoglobulins and probiotics. It should be noted that immunotherapy leads to deep remission, i.e. to restore immunity, allows you to shorten the duration of treatment, reduce the toxic effect of chemotherapy drugs on the body, prevent the formation of resistance to them and lead to deep remission, i.e. to restore immunity.

To increase the effectiveness of treatment of herpes virus infection, a group of virologists and infectious disease specialists led by Doctor of Medical Sciences, Prof. V.A. Isakov* developed a step-by-step, comprehensive method for treating and preventing recurrence of the disease using the drugs described above:

• Stage 1 of treatment – ​​relief of the acute period of the disease (chemotherapy, interferons),
• Stage 2 – restorative therapy, immunocorrection,
• Stage 3 – specific immunoprophylaxis – vaccination with the antiherpetic vaccine Vitagerpavak,
• Stage 4 – clinical observation.

Chemotherapy drugs and interferons only suppress the virus in its active stage, but the vaccine treats, normalizing immune defense, and therefore belongs to the group of therapeutic vaccines.

It should be noted that special attention is paid to restoring the body’s immunological reactivity with the help of medication and anti-relapse treatment using general tonic agents, vitamins, interferons, probiotics, and immunoglabulins. Immunoprophylaxis at the final stage of treatment with the antiherpetic vaccine Vitagerpavak allows you to restore specific antiviral immunity, i.e. achieve suppression of the virus and normalization of immunity, leading to long-term (many years) remissions. This technique was called the “Russian method of treatment” in the West.

It is important to remember and consider that:

• Herpetic infections are a consequence of impaired immunity.
• In mild forms of the disease (exacerbation no more than once every 3 months), there is slight immunosuppression. Therefore, vaccination can be carried out immediately, without restorative treatment (7-10 days after healing of herpetic eruptions with an interval of 7-10 days, in the amount of 5 injections).
• In moderate and severe forms of the disease (recurrence once every 3 months or more often), it is necessary to eliminate severe immunosuppression by prescribing general tonic drugs, vitamins, immunomodulators, probiotics, and only then begin vaccination (10 days after healing of the rash with an interval of 10 days in the amount of 5 injections). It is necessary to carry out 4 courses of vaccination with an interval of 3 months under the cover of Giaferon (1 suppository 2 times a day rectally - 5 days).

The effectiveness of treatment is more than 86%, which is confirmed by the results of its use for 12 years and numerous studies of effectiveness conducted by leading scientists and clinicians of the Russian Federation in various fields.

The Vitagerpavak vaccine is used during the period of remission of the disease. The purpose of vaccination is to activate cellular immunity, i.e. its immunocorrection.

The use of the Vitagerpavac vaccine has a number of advantages over antiherpetic drugs, as evidenced by studies conducted in leading medical institutions in Russia.

Prof. N.S. Potekaev** and Associate Professor M.A. Samgin (Department of Skin and Venereal Diseases of the I.M. Sechenov First Moscow State Medical University) studied the effectiveness of the Vitagerpavak vaccine in 233 patients with recurrent herpes, including herpes on the lips . The treatment was the Vitagerpavac vaccine. It was shown that regular vaccination led to an increase in the period of remission to 1-3 years. Over time, 5 years after regular 4-year vaccination, 88 patients were examined: a positive effect was noted in 72% of patients with a recurrent form of herpes; complete cure - in 42 patients, significant improvement - in 24 patients.

In another study, the vaccine was studied in 3,000 patients with frequently recurrent forms of herpesvirus. Dynamic observation of patients over a period of 3 to 5 years showed that vaccine therapy led to a complete cessation of disease relapses in 1890 patients (63%), to a decrease in the frequency of relapses in 810 people. (27%). The lack of effect was detected in 240 (8%) patients (MD, professor, head of the department of skin and venereal diseases of the RUDN University, A.L. Tishchenko).

In a study conducted by Prof. Barinsky I.F. et al., **** at the Federal State Budgetary Institution “Research Institute of Virology named after. DI. Ivanovsky" of the Ministry of Health of Russia, Moscow, it was shown that in patients with frequently recurrent herpes, including herpes on the lips, 6 months after vaccine therapy (Vitagerpavak) a significant improvement (increase in the inter-relapse period by 3 times) was noted in 19 (31.1%) patients, improvement (increase in remission by 1.5–2 times) - in 35 patients (57.3%) and only in 7 (11.6%) patients the therapeutic effect was weak or absent. As a result of vaccination, the majority of patients (38 people) stopped treatment due to improvement. In 52% (20 patients) of them, clinical symptoms of recurrent herpes were completely absent.

Prof. Barinsky I.F. et al.,*** also conducted a comparative study of the effectiveness of the vaccine alone and in combination with the immunostimulant Giaferon in patients with frequently recurrent herpes, including herpes on the lips. The means of treating herpes were: the polyvaccine Vitagerpavak and the immunostimulant Giaferon. Patients of group 1 (28 people) were prescribed the Vitagerpavac polyvaccine in combination with an immunostimulant. Patients of group 2 (25 people) received only the vaccine. Efficacy was assessed by reducing the duration and intensity of clinical manifestations of genital herpes during relapse and increasing the duration of the interval between relapses. When using the vaccine in combination with Giaferon, a positive result was noted in more than 96% of cases, when using one vaccine - in 84% of cases. The conducted studies demonstrated the advantage of the combined method of vaccine therapy and the immunostimulant “Giaferon”. The proposed combined treatment regimen made it possible to prevent relapses of herpes, including herpes on the lips.

Dynamics of clinical parameters in patients with recurrent HH during vaccine therapy

Of interest are the results of a study using the Vitagerpavac vaccine conducted by Prof. A.A. Kasparova et al. (Research Institute of Eye Diseases of the Russian Academy of Medical Sciences), with the participation of patients with ophthalmoherpes caused by the herpes simplex virus. Of 114 patients with ophthalmoherpes with frequently recurrent forms, relapses of the disease completely stopped in 71 patients (63%), their frequency became significantly less frequent in 32 (27%) and did not change in only 11 people. (10 %). Analysis of the results revealed a 5-fold reduction in the frequency of relapses and a 3.2-fold reduction in the duration of relapses per 1 patient suffering from herpetic keratitis, keratoiridocyclitis and iridocyclitis. When studying the blood of patients with herpes using PCR and MFA methods, it was revealed that the use of an inactivated vaccine was accompanied by the elimination of viremia.

In the above-mentioned studies, it was also shown that vaccination was accompanied by a 3-4 times increase in specific reactions of T-cell immunity, against the background of a constant level of B-cell immunity reactions. The study of T-cell immunity reactions showed an increase in the specific T-killer activity of lymphocytes and the activity of NK cells. Vaccination contributed to the cessation of viremia both after the end of vaccination and in long-term follow-up (after 6 months). Vaccination using Vitagerpavak led to a pronounced immunocorrective effect, reducing immune disorders from degrees 3 and 2 to 1. After 6 months after vaccination, immune disorders corresponded to the 1st degree.

The above results of long-term studies of the Vitagerpavak vaccine indicate the reliable effectiveness of the vaccine in preventing relapses of herpes infections against the background of activation of cellular immunity reactions and specific desensitization.

If you are faced with the question “how to get rid of genital herpes”, and other methods have proven to be ineffective, then you should definitely pay attention to this method of preventing relapses of the disease.

How to treat genital herpes using the Vitagerpavac vaccine?

The basic vaccination regimen using the Vitagerpavac vaccine: 0.2 ml of the vaccine is injected intradermally into the flexor surface of the forearm. The vaccination cycle consists of 5 injections, which are carried out at intervals of 7-10 days. For a lasting preventive effect, repeated courses of vaccination are necessary. In case of herpetic rashes, the intervals between injections should be increased to 14 days. After 6 months, revaccination is carried out (5 injections). In severe forms of the disease, revaccination is carried out after three months, 4 courses over 1.5 - 2 years.

Where can I get vaccinated?

Vaccine for the prevention of chronic herpes virus infection.
1 package – full course of treatment.
Vaccination course: 5 injections, given at intervals of 7-10 days. Store at a temperature of 2-8 ºС. The drug can be transported at a temperature of 9-18 ºС, but not more than 3 days.

To increase the effectiveness of treatment and prevent relapses of genital herpes in people with weakened immune systems, along with drug treatment, it is necessary to pay attention to strengthening the body's defenses. Particular attention should also be paid to the prevention of factors that contribute to decreased immunity and exacerbation of herpes infection.

Briefly about the Vitagerpavac vaccine:

Compound:

— The drug is a lyophilisate for preparing a solution for intradermal administration — Contains specific inactivated antigens of herpes simplex virus types I and II grown on a continuous cell line VERO, acceptable by WHO as a substrate for the production of vaccines

Indications:

• Patients with CGI are subject to vaccination.
• Preparing women with a history of recurrent chronic herpetic infection for pregnancy.
• HIV-infected patients in stages 1-2 of the disease.

Contraindications to the use of the vaccine:

• Active stage of herpes
• Acute infectious and non-infectious diseases
• Chronic diseases in the stage of exacerbation or decompensation
• Malignant neoplasms
• Pregnancy
• Presence of active AIDS symptoms

Antiviral agents

Antiviral drugs differ in composition and active ingredients, so a competent specialist must choose a drug for the treatment of genital herpes.

1. Famciclovir (Famvir) is a very powerful drug that can cope with those strains of the virus that cannot be treated with acyclovir. But these drugs are toxic and have many side effects, so they should be taken exactly as recommended by your doctor. When treating genital herpes, the standard daily dose is three tablets (250 mg each). It is recommended to take the drug for a week. If treatment is started late, a single dose of 6 tablets is allowed or this dose can be divided into two doses.
2. Acyclovir for herpes (analogues of Zovirax, Vivorax). Antiviral drugs that are highly effective against the herpes simplex virus. The active ingredient is acyclovir. The regimen of use and dosage of medications is determined by the attending physician depending on the severity of the symptoms, the general picture of the disease and the patient’s condition. When treating genital herpes, it is recommended to start taking acyclovir-based tablets after the first alarming signs appear and continue therapy for 5-7 days. Usually up to 5 tablets per day are prescribed (daily dose 800-1000 mg); in immunodeficiency states, the doctor may double the dose.
3. Valacyclovir (Valtrex). This is a modern drug based on an acyclovir derivative. The active ingredient, valaciclovir, has the highest activity against the herpes virus and is much better absorbed by the body. The drugs should be taken twice a day, 500 mg at a time. To achieve a lasting therapeutic effect, 5 days of treatment are sufficient.

To treat lesions, the doctor will prescribe antiviral drugs in the form of an ointment or gel. Their use allows you to relieve painful symptoms, eliminate inflammation, swelling and itching. The following medications are used in the treatment of genital herpes:

1. Levomekol. This is an excellent remedy for mild forms of genital disease. Eliminates burning sensation and soothes itching within 40 minutes. Ingredients: levomethicin, methyluracil, macrogol, polyethylene oxide. Directions for use: Apply a thin layer to rashes 3 times a day. Has a greasy texture. For women, apply by soaking a gauze pad with ointment. Place on the labia or in areas of rashes. Wear underwear on top. Contraindications: sensitivity to components. The period of pregnancy and lactation in women. Children's age up to 1 year.
2. Herpferon (ointment). A combination drug that includes interferon, the antiviral component acyclovir and the anesthetic lidocaine, which effectively eliminates pain. The use of ointment can reduce unpleasant symptoms in the acute phase of genital herpes. For mild forms of infection, the drug can be prescribed as monotherapy and used for 5-6 days.
3. Panavir. This remedy helps cure inflammation of the genitals at the very beginning of the disease. Promotes the production of interferon by the body. Ingredients: Nightshade extract, water, glycerol, lanthanum nitrate, ethanol, sodium hydroxide, macrogol. Directions for use: use on lips or intimate area. Apply a thin layer to the area affected by herpes. A day from 3 to 5 times. Contraindications: the drug is easily tolerated and therefore has virtually no contraindications. Not recommended for people with hypersensitivity to the components included in the ointment. Allergic reactions may occur.

In addition, Zovirax and Acyclovir ointments show good effectiveness in the treatment of genital herpes. They should be used 4 to 6 times a day, treating rashes every 4 hours.