Genital herpes - symptoms, relapses, how to treat?

Genital herpes virus – how long does the disease last?

The content of the article

Genital herpes in men and women is one of the most commonly diagnosed sexually transmitted diseases, caused by the herpes simplex virus type HSV-1 or HSV-2. For many people, the disease is completely asymptomatic. And this does not prevent the virus from being transmitted during sexual intercourse.

Possible symptoms of genital herpes are well known to doctors. There is slight pain, changes on the skin resemble blisters. They are visible in the genital area, in the perineum.

The first wave of symptoms can last 2-3 weeks, sometimes less. In some cases, herpes symptoms may recur, but they are usually less bothersome than the first time.

Antiviral medications relieve the discomfort felt. Patients with chronic symptoms need to take medications every day.

Treatment

If the papillae are in normal condition and do not bother a person, then they do not require medical intervention. Therapy is needed in case of development of inflammatory processes. The following can be used to treat papillitis:

• Conservative techniques;
• Operational methods.

But initially the cause of the disease must be eliminated. Without this, only temporary results can be achieved. If you undergo a course of medication or surgical treatment, but do not eliminate the root cause of the formation of the papillae, then after some time they will become inflamed again.

Conservative treatment

In this case, the doctor prescribes medications with anti-inflammatory, analgesic, antimicrobial and immunomodulatory effects. If the patient suffers from constipation, then the treatment regimen includes laxatives, and for diarrhea, medications to normalize stool. Colloidal solutions may also be prescribed to facilitate bowel movements.

Nutrition is of no small importance. The diet for papillitis should include light foods aimed at improving intestinal activity. Therefore, it is recommended to consume more vegetables, fruits, and dairy products. Sweets, fried, spicy and salty foods should be excluded from the diet. The consumption of alcoholic beverages is strictly prohibited. The patient must also stop smoking.

Operational methods

Surgical treatment consists of excision of the tumor. For this purpose the following is used:

• Radio wave technique - removal of papillae using the Surgitron device, the action of which is based on the generation of high-frequency radio waves into thermal energy. Heat, acting on cells, stimulates their evaporation;
• Ligation with latex rings - the essence of the technique is to throw a ring onto the pedicle of the hypertrophied papilla in order to compress the vessels that feed the neoplasm cells. After this, the papilla shrinks and as a result it disappears.

Genital herpes - what is it?

Genital herpes is a viral infection that affects the penis in men (penile herpes) and the vulva and vagina in women (vaginal herpes, herpes on the labia), as well as the area around the genitals. Sometimes herpes can also appear on the buttocks and anus.

This disease is caused by the herpes simplex virus. There are two types of herpes simplex virus: herpes simplex virus type 1 and herpes simplex virus type 2.

• Herpes simplex virus type 1 is usually responsible for cold sores on the lips. It is caused by half of the cases of genital herpes.
• Herpes simplex virus type 2 is responsible almost exclusively for the development of genital herpes. Sometimes an infection can result in cold sores on the lips.

Genital herpes - how can you get infected?

Genital herpes is transmitted mainly through contact with a person who is already a carrier of the virus. The mucous membrane lining the mouth, genitals and anus is very susceptible to infection. That is, the virus most often passes from one person to another during sexual intercourse (including oral).

The herpes simplex virus can also enter another person's body through wounds or cracks in the skin on other parts of the body: fingers, hands, knees, etc., as long as the contact touches an infected area of ​​skin. Re-infection with your own virus through accidental touch is unlikely.

Transmission of herpes from the mouth to the genitals during oral sex can occur when one of the partners develops symptoms of herpes on the lips.

Chlamydia, gonorrhea, trichomoniasis

The manifestations of these diseases are so similar that it is difficult to determine which one caused the infection. Moreover, STDs combine well with each other, blurring and confusing the symptoms.

Patients who have contracted such a “bouquet” often believe that they have cystitis or thrush. As a result, after drinking a huge amount of inappropriate drugs, the patient, tormented by pain and itching in the intimate area, goes to the doctor with an advanced, complex “sore.”

A dangerous feature of chlamydia and gonorrhea is the ability to cause complications in other organs - eyes, joints. Skin manifestations are also possible. Sometimes people are treated for conjunctivitis and arthritis for years until they accidentally get tested for STDs. Unfortunately, changes in organs at this time are often irreversible.

There is another category of patients who have given themselves a “bad” diagnosis due to pain and inflammation in the genital area. In fact, such “gonorrhea” turns out to be a banal thrush or allergy. But patients, mostly women, manage to drink a mountain of antibiotics during this time, causing harm to the body.

Such “false patients” need to remember that in the weaker sex the manifestations of gonorrhea are minimal, and pain, discharge and other unpleasant symptoms are caused by something else. But Trichomonas and chlamydia actually cause inflammation, burning, itching and discharge.

In men, the situation is the opposite - gonococcus immediately causes pain and suppuration, sometimes accompanied by eye damage, and other microorganisms often do not make themselves felt, and the infection proceeds latently. Therefore, you can understand these infections only by going to the clinic and getting tested.

Genital herpes - symptoms

The first infection with the herpes simplex virus is often called the primary infection. Such an infection may (but does not necessarily) cause symptoms.

After the initial infection, the virus is not eliminated from the body, but lives in it in an inactive form. In some patients, the virus occasionally wakes up and moves to the surface of the skin. This, in turn, provokes a relapse of symptoms of genital herpes if the primary infection concerned the genitals, or a recurrence of herpes lips if the primary infection developed in the mouth area.

Most people have no symptoms after contracting the sexual herpes virus; 8 out of 10 people with genital herpes don't even know they have it. Sometimes only very mild symptoms may appear that are difficult to associate with genital herpes.

These symptoms may include a slight burning sensation or a slight redness that quickly disappears. In such people, the virus sleeps and never causes a wave of symptoms to recur. However, even people who develop the disease asymptomatically pose a threat to their sexual partners. In fact, this is how most cases of genital herpes infection occur.

Once again about the dangers of self-medication

Sexually transmitted infections are often disguised as ordinary ones, without arousing suspicion, and non-contagious pathologies can easily be confused with STDs. But people persistently try to diagnose themselves with symptoms on the Internet and treat themselves with what the pharmacist at the pharmacy advised.

No one takes into account that diseases are often similar to each other and have hidden, atypical manifestations. Schematically, all people involved in self-medication of diseases of the genital area can be divided into two categories:

• those who became infected
  , but decided that they did not have an STD, but something else;
• not infected,
  but who have given themselves a “terrible diagnosis” and are trying with all their might to get rid of it without the help of doctors.

All these patients are united by the desire to be treated for something that does not exist. What diseases are most often disguised and mislead home-grown “dermatovenereologists”.

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Klokov Andrey Nikolaevich

Urologist-andrologist, doctor of the highest category

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Genital herpes - first symptoms

At the very beginning, symptoms of genital herpes infection take the form of slightly elevated body temperature, general pain and malaise. Small groups of painful blisters appear around the genitals or anus. Herpthetic changes can be visible on the labia, on the clitoris, near the entrance to the vagina, on the thighs, around the anus.

The blisters take another 1-2 weeks to grow before bursting and turning into shallow, painful ulcers. The lymph nodes in the groin may become enlarged and palpable as lumps in the upper legs. Frequently, urination is associated with pain, especially in the case of women who experience vaginal discharge.

Women also experience blisters and sores on the cervix. Blisters and sores usually develop within 10 to 20 days and then gradually disappear without leaving a scar. Sometimes symptoms appear in just a few days.

The first symptoms of genital herpes appear months or even years after infection. Therefore, the first wave of symptoms may occur when a person has sexual intercourse with only one regular partner. There is a possibility that the infection occurred months or years earlier as a result of sexual contact with a previous partner or a partner who did not know that he carried the virus.

It is not entirely clear why some people have symptoms of infection and others do not, or why the first wave of symptoms occurs months or years after the actual infection. This may be due to the immune system's response to the virus.

Genital herpes - relapses

Some people experience recurrences of genital herpes symptoms. Scientists cannot explain why an inactive virus wakes up from time to time. Relapses are often milder and last shorter than the first wave. In case of relapses, symptoms usually occur within 7-10 days.

Most people do not complain of fever or malaise. Mild tingling or itching of the genitals for 12–24 hours may indicate a recurrence of symptoms of the disease. The intervals between individual relapses vary.

Over time, relapses of genital herpes appear less frequently. Relapse rates may vary among people already dealing with them. Some people experience them 6 or more times a year, while others experience them much less frequently.

As a rule, in the first 2 years after the first wave of symptoms, relapses occur 4 to 5 times. Some people do not relapse at all. Sometimes it is possible to identify factors that cause symptoms to recur. These could be: sunburn, physical illness, excessive alcohol consumption, stress.

Prevention of papillitis

To avoid inflammation of the anal papillae, it is recommended:

• Observe hygiene procedures: rinse the anus after each act of bowel movement;
• If gastrointestinal diseases are detected, undergo timely treatment;
• Move more to eliminate congestion in the pelvic area;
• Get rid of bad habits (smoking, drinking alcohol);
• Avoid “heavy” foods;
• In case of constipation, use laxatives.

What tests should be taken for genital herpes?

As a rule, no additional research is required. The pattern of lesions, their location and other symptoms are sufficiently characteristic to make a diagnosis of genital herpes. In case of doubt and for invasive infections, the gynecologist prescribes:

• Culture analysis
  . Isolation of the virus from a cell culture requires taking a smear from the lesions, but the absence of the virus in the culture (negative result) does not exclude infection;
• PCR method
  . Requires taking smears from lesions. The method is more sensitive than isolation in detecting infection, but a negative result does not rule out infection.
• Serological tests
  . They allow you to detect antibodies to the HSV virus (they appear after a few weeks) and differentiate the type of virus that caused the infection. If an antibody to HSV-2 is detected, genital herpes is detected and thus increases the risk of recurrence in that location. Antibodies to HSV-1 indicate infection with herpes labialis, and thus the risk of recurrence of lesions in the genital area is lower.

Herpetic infection of the genitourinary system in men

N

The uncontrolled widespread increase in the incidence of genital herpes (GG) puts the problem of herpesvirus infection (GI) on a par with the most pressing socially significant health problems. The incidence of HS in Western European countries exceeds 80 cases per 100 thousand population. Currently, according to B. Halioua et al. (1999), there are 86 million people in the world infected with herpes simplex virus type 2 (HSV-II), traditionally associated with HH, although it has been proven that HH can also be caused by HSV type 1.

Our analysis of official statistics data showed that the incidence of HS in Russia for 1993–1999. increased from 8.5 to 16.3 cases per 100 thousand population, and in Moscow - from 11.0 to 74.8. The bulk of patients in Russia turn to doctors on their own: 70-94% of registered patients. The share of active identification of patients with HH by first-level health care providers during all types of preventive examinations in Russia was 22.7-27.8%, in Moscow - 5.4-7.2%. At the same time, obstetricians and gynecologists identify 45.1–54.8%, dermatovenerologists – 39.8–43.8% of the total number of actively identified patients with HS, and urologists account for no more than 5–12%.

While close attention is paid to the study of herpes of the external genitalia and the adverse effects of GI on the reproductive function of women, information about HSV as an etiological factor in diseases of the genitourinary system (GUS) in men is very limited. It should be said that assessing the true role of HSV in the development of pathology of the MPS organs in men, taking into account the frequent mild or asymptomatic course of the infection, often turns out to be a very difficult task.

Herpes is called “many-faced” and “insidious”, meaning the variety of manifestations of the disease and accompanying symptoms due to the peculiarities of the pathogenesis of GI. The main links of pathogenesis

herpes infections are:

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

2. Damage to immunocompetent cells, which leads to secondary immunodeficiency, creating conditions for relapse of the disease.

3. HSV tropism for epithelial and nerve cells, causing polymorphism in the clinical manifestations of herpetic infection.

Infection of the genitals occurs through close physical contact with a patient or a virus carrier during genital, oro-genital, genitorectal and oral-anal contact. Only 10% of infected people develop clinical symptoms of primary HH.

The virus begins to multiply at the site of inoculation, where typical blistering rashes appear, and penetrates the bloodstream and lymphatic system. At the early stages of HI, viral particles also penetrate into the nerve endings of the skin or mucous membrane, move centripetally through the axoplasm, reach the peripheral, then segmental and regional sensory ganglia of the central nervous system, where they remain in a latent state in nerve cells for life.

Infection of sensory ganglia is one of the important stages in the pathogenesis of HI. With herpes, the genitals are the sensitive 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 a relapse determines the anatomical fixation of lesions during relapses.

HSV can affect any nerve formations, which will clinically manifest as various neurological symptoms depending on the properties of the nerve formations involved in the infectious process. When sympathetic nodes and peripheral nerves are affected, patients experience symptoms of ganglioneuritis; combined damage to the ganglia and segmental roots of the spinal cord causes clinical manifestations of ganglioradiculoneuritis. Irritation of parasympathetic fibers causes subjective sensations in patients in the form of a burning sensation. The peculiarity of the pain syndrome with recurrent herpes (HR) is that it can periodically occur regardless of skin manifestations, which greatly complicates its interpretation. Neurological symptoms, complicating the course of the disease and worsening the prognosis, occur in every 3rd patient suffering from recurrent genital herpes (RGH).

The literature describes cases of acute urinary retention, the cause of which was sacral myeloradiculitis (Elsberg syndrome), meningitis and radiculomyelopathy, the cause of which was HSV.

In 25% of patients with RGG, increased trauma, dryness and the formation of small painful bleeding cracks on the mucous membranes of the external genitalia due to mechanical irritation appear.

Clinical manifestations of GG in men

Herpes of the external genitalia

In most cases, primary infection of the genitals is asymptomatic, with the subsequent formation of latent carriage of HSV or a recurrent form of genital herpes. In clinically significant cases, primary genital herpes usually manifests itself after 1–10 days of the incubation period and differs from subsequent relapses by a more severe and prolonged (up to 3 weeks) course (Fig. 1).

The likelihood of developing a recurrent form of HH depends on the serological type of HSV: when the genitals are infected with HSV type 1, a relapse within a year occurs in 25% of people who had a primary episode of HH; in HH caused by HSV type 2, relapses occur in 89%.

Clinically, herpes of the external genitalia can occur in typical, atypical and subclinical (asymptomatic) forms.

In men, rashes are usually located in the area of ​​the outer and inner layers of the foreskin, coronary sulcus, and scaphoid fossa. Less commonly, the head and body of the penis and the skin of the scrotum are affected.

Typical form of RGG

characterized by the classic dynamics of lesions (erythema - vesicles - erosive-ulcerative elements - formation of crusts) and local subjective sensations in the form of itching, burning, pain. The lesions are usually limited, less common and localized in the same area of ​​the skin or mucous membrane. Frequent exacerbations of RGG are often accompanied by a deterioration in the general condition of patients, symptoms of intoxication due to viremia appear (headache, chills, malaise, low-grade fever), and the inguinal lymph nodes may enlarge and become painful.

Atypical forms of RGG

, which significantly complicate the diagnosis, may be due to: 1) a change in the development cycle of herpetic elements in the lesion; 2) unusual localization of the lesion and anatomical features of the underlying tissues.

In atypical forms of RGG, one of the stages of development of the inflammatory process in the lesion (erythema, blistering) or one of the components of inflammation (edema, hemorrhage, necrosis) predominates. According to the intensity of clinical manifestations, atypical forms can occur rapidly with manifestation (bullous, ulcerative-necrotic) or subclinically (microcracks), see Fig. 2-4.

Subclinical form of RGG

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

Herpetic infection of the pelvic organs

A feature of GG is its multifocality. The pathological process often involves the lower part of the urethra, the mucous membrane of the anus and rectum, which can occur secondary to the occurrence of herpes of the external genitalia, or can occur as an isolated lesion.

According to the characteristics of clinical manifestations, it is advisable to divide herpetic lesions of the pelvic organs in men into:

• herpes of the lower part of the urogenital tract, anal area and rectal ampulla;

• herpes of the upper genital tract (Table 1).

Herpes of the lower part of the urogenital tract, anal area and ampulla of the rectum
manifests itself in two clinical forms:
focal
, characterized by the appearance of vesicular-erosive elements typical of herpes simplex mucous membranes, and
diffuse
, in which the pathological process proceeds as a nonspecific inflammation.

Herpes urethra

The generally accepted classification of urethritis distinguishes between viral urethritis caused by HSV and human papillomavirus (HPV). HSV is more often the cause of prolonged torpid urethritis and recurrent cystitis, as well as exacerbation of chronic prostatitis. The frequency of herpetic urethritis (HU) ranges from 0.3 to 2.9% of all registered non-gonococcal urethritis (Ilyin I.I., 1977; Nahmias A. et al., 1976), which allowed researchers in the 70s to classify HU as rare forms of urethritis. Work in recent years has shown that GU is detected in 42.4–46.6% of cases in men suffering from RGG (Baluyants E.R., 1991; Semenova T.B., 2000).

Subjectively, GU is manifested by pain in the form of burning, sensations of heat, hyperesthesia along the urethra at rest and during urination, and pain at the beginning of urination. The incubation period for the development of HU remains unclear, but is probably several months, less often weeks or days. During a clinical examination, hyperemia and swelling of the urethral sponges are determined, and scanty mucous discharge from the external opening of the urethra periodically appears. The course of HU is subacute or sluggish with periodic remissions and relapses. In the urethral discharge, epithelial cells and mucus usually predominate, and leukocytosis periodically appears. With a mixed infection, urethral discharge becomes more abundant and opaque. With a two-glass sample, the urine in the first portion is transparent, but contains inflammatory products in the form of floating threads and flakes.

The diagnosis of GU is made based on the isolation of HSV from material taken from urethral discharge in cell culture or detection of the HSV antigen by PCR.

The organs of the MPS in men are in a close anatomical and physiological relationship, which does not allow a mechanistic approach to assessing the results of laboratory research. Thus, detection of HSV in urine or urethral discharge allows us to suspect the possibility of involvement of the prostate gland in the infectious process, even if HSV is not detected in prostate juice, but there is clinical evidence of torpid prostatitis.

For dry urethroscopy

on the mucous membrane of the urethra there is usually a soft infiltrate (less often transitional) with fragments of red mucosa, with pronounced large folds and disappearing small ones. Herpetic lesions are represented by small single or merging erosions with polycyclic edges against the background of local vasodilation (focal form of GI), or severe focal hyperemia of the mucous membrane (diffuse form of GI). More often, the anterior and middle third of the urethra are involved in the process. Contraindications to urethroscopy are exacerbation of urethritis and the presence of herpetic eruptions in the glans, scaphoid fossa and inner layer of the foreskin of the penis. Urethroscopy is recommended when external manifestations of herpes have subsided, complaints from the urethra persist, the patient has chronic recurrent urethritis of unknown etiology, and other urogenital infections have been previously excluded.

Bladder herpes

The leading symptoms of herpetic cystitis are the appearance of pain at the end of urination, dysuric phenomena; hematuria is its characteristic manifestation. Patients have a urinary disorder: the frequency, nature of the stream, and the amount of urine change. Herpetic cystitis in men is usually secondary and develops as a complication during exacerbation of chronic herpetic urethritis or prostatitis. During cystoscopy, catarrhal inflammation and isolated erosions are observed.

Herpes of the anal area and rectum

Herpetic lesions of the anal area and rectal ampulla occur in both heterosexual men and homosexuals. The anal area can be affected primarily or secondarily (if the infection spreads in a patient with GI of the external genitalia). The lesion is usually a recurrent crack, which is often a reason for diagnostic errors. Such patients with an erroneous diagnosis of “anal fissure” end up with surgeons.

When the sphincter and mucous membrane of the rectal ampulla are damaged (herpetic proctitis)

patients are bothered by itching, burning sensation and pain in the affected area, small erosions occur in the form of superficial cracks with a fixed localization, bleeding during defecation. The appearance of rashes may be accompanied by sharp bursting pain in the sigmoid region, flatulence and tenesmus, which are symptoms of irritation of the pelvic nerve plexus. Rectoscopy reveals catarrhal inflammation and sometimes erosion. A diagnosis of herpetic proctitis can only be made based on the results of a virological examination of the patient.

Herpes of the upper genital tract

manifested by symptoms of nonspecific inflammation.

Typical

The clinical picture of herpetic lesions of the organs of the upper genitourinary tract is manifested by symptoms of nonspecific inflammation. It is very difficult to establish the real incidence of damage to the internal genital organs in men, since in 40–60% of cases the disease occurs without subjective sensations.

In subclinical form

herpes of the internal genitalia, the patient has no complaints; Clinical examination does not reveal symptoms of inflammation. A dynamic laboratory study of smears of urethral discharge in the prostate secretion periodically reveals an increased number of leukocytes (up to 30–40 or more in the field of view), indicating the presence of an inflammatory process.

Asymptomatic form

Herpes of the internal genitalia (asymptomatic viral shedding) is characterized by the absence of any complaints and objective clinical symptoms of inflammation in patients. During a laboratory examination of the discharge of the urogenital tract, HSV is isolated, while in smears there are no signs of inflammation (leukocytosis).

Prostate herpes

In the modern etiopathogenetic classification of prostatitis, viral prostatitis is regarded as infectious canalicular complications of viral urethritis. According to the classification of Mears (1992) this type of prostatitis is classified as a doubtful or unproven type, according to Blumensaat (1961) - to a specific type, according to O.L. Tiktinsky and V.V. Mikhailechenko (1999) – to infectious.

In the development of viral prostatitis, the urethrogenic route of transmission is most often observed, and the descending (urogenic) route is rare - when viruses penetrate from infected urine during cystitis through the excretory ducts of the prostate gland (PG).

According to various authors, prostatitis is caused or maintained by HSV in 2.9–21.8% of cases (Weidner et al., 1981). Most often, chronic prostatitis with herpetic urethritis and RGG manifests itself in a catarrhal form, while the course of the disease is characterized by a frequent and persistently recurrent nature (O.B. Kapralov, 1988; Bennett et al., 1993).

In clinical practice, the diagnosis of chronic herpetic prostatitis is rarely made by urologists. The reason, apparently, is that virological diagnostic methods are not included in the standard examination of patients with chronic prostatitis. The doctor’s stereotype of thinking comes into play, and patients are traditionally screened for non-viral STDs. Meanwhile, with erased abacterial prostatitis, it can be assumed that the pathogenic agent is a virus.

In the clinical course of prostatitis, functional changes are noted - reproductive changes, pain (with irradiation to the external genitalia, perineum, lower back) and dysuric syndromes. In most cases, exacerbation of chronic prostatitis is preceded by the appearance of herpetic eruptions in the genital area. The appearance of vesicular-erosive elements may coincide with the appearance of complaints from the pancreas. Often in patients with RGG, prostatitis occurs subclinically: in these patients, the diagnosis of prostatitis is made based on the appearance of leukocytosis in the prostate secretion and a decrease in the number of lecithin grains.

It must be remembered that herpetic prostatitis can exist as an isolated form of GI. In this case, there are no symptoms of RGG and HSV is not detected in the urethral discharge. The etiological diagnosis is based on the detection of HSV in the secretion of the pancreas, while there is no pathogenic flora in the secretion and in the third portion of urine.

Ultrasound examination of the prostate gland in the area of ​​the paraurethral zones of the prostate reveals hyperechoic fibrous foci measuring 3–9 mm. In patients with herpetic prostatitis, compared with abacterial prostatitis of unknown etiology, there is a greater severity of fibrous sections in the peripheral zones. Along with this, there is an expansion of the seminal vesicles, indicating a violation of their drainage into the posterior urethra, which suggests damage to the prostatic uterus.

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.

Diagnosis of herpes

The diagnosis of recurrent genital herpes with typical clinical manifestations of the disease does not present any difficulties and can be made visually when examining the patient. Significant difficulties arise with atypical forms of HH or with herpetic lesions of the OMT. A carefully collected anamnesis is important in these cases. Complaints of itching, burning, scanty mucous discharge from the urethra, sanguineous discharge from the rectum, indications of pain, the recurrent nature of the OMT disease, as well as the resistance of the disease to previous antibiotic therapy. In addition, patients often note a tendency to colds, fear of drafts, periodic general weakness, malaise, low-grade fever, and depression. Patients with HH often experience pain, which patients do not always associate with exacerbations of herpes. Recurrent herpes, regardless of the location of manifestation of the pathological process, is characterized by a wave-like course, when painful states are replaced by periods of well-being, even without specific therapy.

The diagnosis of HSV infection is complicated by the fact that HSV is often in association with other microorganisms: chlamydia, strepto- and staphylococci, fungal flora, etc. A mixed infection of HSV with gonococcus, treponema pallidum, HIV cannot be ruled out, which indicates the need for careful patient examinations.

Existing methods for laboratory diagnosis of herpes simplex are fundamentally divided into two groups:

1) isolation and identification of HSV in cell culture or detection of the pathogen antigen from infected material through cytological, immunofluorescent studies, enzyme-linked immunosorbent assay (ELISA), PCR;

2) detection of virus-specific antibodies in blood serum.

The frequency of HSV isolation from different biological environments varies. When examining more than 200 patients with an established diagnosis of RH, suffering from chronic diseases of the urinary tract, HSV was isolated from urethral discharge in 22% of cases, prostate juice - 23%, sperm - 15%, urine - 26%. HSV may not be detected in everyone, but in 1–2 out of 3–4 biological materials obtained from the patient. Therefore, to reduce the likelihood of a false negative diagnosis, it is necessary to examine the maximum number of samples from one patient. A negative result of a single virological test cannot completely exclude the diagnosis of genital herpes. If an HSV infection is suspected, it is necessary to conduct a repeated virological examination of the discharge of the genitourinary system (once every 7 days, 2–4 times a month), and in some cases, use several examination methods.

The detection of IgM and/or a fourfold increase in the titers of specific immunoglobulins G (IgG) in paired blood sera obtained from the patient with an interval of 10–12 days is of diagnostic importance in primary HI. Recurrent herpes usually occurs against the background of high IgG levels, indicating constant antigenic stimulation of the patient's body. The appearance of IgM in a patient suffering from RGG indicates an exacerbation of the disease.

Treatment of genital herpes

General principles of treatment of herpes simplex

Modern medicine does not have treatment methods that can eliminate HSV from the 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 areas of persistence.

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

1. Antiviral therapy

, the main place in which is given to acyclovir (ACV) drugs, which are used to stop relapses of herpes, prevent and treat complications of HSV infection.

2. Complex treatment method

, which aims to increase inter-relapse periods, includes immunotherapy (specific and non-specific) in combination with antiviral treatment.

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

Synthetic interferon inducers (IFN) have a pronounced immunomodulatory effect in the treatment and prevention of complications of herpes simplex. Among them is the domestic drug Poludan

.

To date, convincing clinical data have been obtained on the high effectiveness of Poludan for the treatment of various clinical forms of recurrent herpes. Poludan has a general immunostimulating effect, which makes it possible to use it in secondary immunodeficiency conditions caused not only by herpesvirus infections. In these cases, poludanum is injected subcutaneously into the forearm: 200 mcg (1 bottle) is dissolved ex tempore in 1 ml of distilled water, administered daily, for a course of 10 injections.

One of the advantages of the IFN inducer tilorone
(Amiksin)
is the oral route of administration, which allows patients to independently carry out preventive courses of anti-relapse therapy recommended by their doctor. The mechanism of action of Amiksin includes: induction of interferons of types a, b, g, immunocorrection and direct antiviral effect. Amiksin has a mild immunomodulatory effect, stimulates bone marrow stem cells, enhances antibody formation, and reduces the degree of immunosuppression.

Amiksin is included in the complex treatment of RGG according to the following regimen: 250 mg once a day for 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.

Antiviral activity of the IFN inducer – Arbidol

due to its immunomodulatory and antioxidant properties. Arbidol can be included in the complex treatment of RH (0.2 g 2 times a day with meals for 10–14 days) and used between courses of vaccine therapy to prevent relapses of herpes (0.2 g 1 time a day with meals for 2–3 weeks).

To stimulate the T- and B-links of cellular immunity in patients with recurrent herpes, Taktivin, Timalin, Timogen, Myelopid and other immunomodulators can be used.

Specific immunotherapy consists of the use of domestic herpetic vaccine

(polyvalent, tissue, killed). The therapeutic effect of the vaccine is associated with the stimulation of specific reactions of antiviral immunity, 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 way to achieve a therapeutic effect is the combined use of drugs with different mechanisms of antiviral action, which prevents the emergence of resistant strains of HSV. The use of interferons and their inducers in combination with a herpetic vaccine and immunomodulators allows for a comprehensive solution to the treatment of herpes simplex.

Local treatment of GI organs of MPS in men

Achieving a therapeutic effect in the treatment of herpetic lesions of the MPS organs in men is impossible without local treatment

.

If there are rashes on the skin and mucous membranes during RHG, patients are prescribed local antiviral drugs for external use: Zovirax (cream), Acyclovir-acri (ointment), Gevisosh (ointment), Viru-merz (gel), Epigen (aerosol), etc. P.

Local immunostimulating therapy is important in the treatment of HS. For this purpose, you can use Poludan

. Poludan for RGG is used in the form of applications to the lesion, for which 200 mcg of the drug (1 bottle) is dissolved in 4 ml of water, moistened with a cotton swab and applied to the lesion for 5–7 minutes. The procedure is repeated 2-3 times a day for 2-4 days.

In the treatment of herpetic urethritis, Poludan is used as instillation into the urethra (400 mcg diluted in 10 ml of water). The procedure is repeated once a day, every day for 5–7 days. You can use cycloferon liniment (according to the same scheme).

For herpetic proctitis, a pronounced therapeutic effect is observed when patients are prescribed Poludan solution in the form of microenemas (400 mcg diluted in 10 ml of water, 10 microenemas per course of treatment).

Along with local medicinal treatment, patients with chronic herpetic diseases undergo OMT traditional local manipulations: bougienage of the urethra, massage of the prostate, followed by total instillation of Poludan solution or cycloferon liniment. To achieve a more pronounced anti-inflammatory, absorbable and analgesic effect in such patients, it is advisable to include low-frequency laser therapy in the course of treatment. In this case, it is advisable to combine the intracavitary introduction of a fiber light guide into the urethra or rectum into the area of ​​projection of the pancreas with laser reflexology.

Complex treatment of men suffering from herpes MPS, including general antiviral and immunostimulating therapy in combination with local treatment, leads to regression of clinical signs of chronic urethritis and prostatitis (reduction or resolution of pain and dysuria syndromes), normalization of laboratory parameters, persistent positive dynamics of the course of RGG in 85 –90% of cases.

Conclusion

Among viral diseases, herpes infection occupies one of the leading places, which is determined by the widespread distribution of HSV, 90% of its infection of the human population, the lifelong persistence of the virus in the body, the polymorphism of the clinical manifestations of herpes, and its resistance to existing treatment methods.

Currently, the pathogenic effect of HSV on the development of chronic genitourinary diseases in women, the course of pregnancy and childbirth, and the health of the fetus and newborn is not in doubt.
The role of HSV in the development of pathological processes in the male body is clearly underestimated. At the same time, according to domestic and foreign researchers, in men suffering from chronic inflammatory diseases of the pelvic organs, it is possible to detect HSV in the discharge of the genitourinary system in 50–60% of cases. It has been proven that HSV is an agent that disrupts spermatogenesis and has the ability to infect sperm. This is of particular importance for men of reproductive age and opens up new aspects in the interpretation and solution of the problem of infertile marriages. Literature:
1. Barinsky I.F., Shubladze A.K., Kasparov A.A., Grebenyuk V.N. Herpes. Etiology, diagnosis, treatment // M. – 1986. – 272 pp.

2. Borisenko K.K. // Genital herpes. In the book. Unknown epidemic: genital herpes. Pharmagraphics. – 1997. – p. 75–83.

3. Bragina E.E. // Patterns of disturbances in human spermatogenesis in some genetic and infectious diseases. – Author's abstract. diss. ... doctor of biological sciences – M. – 2001. – 54 S.

4. Genital infection caused by the herpes simplex virus (review information).// J. STDs. – 1994. – є 3. – p. 5–8.

5. Semenova T.B. Simple herpes. Clinic, diagnosis, treatment, prevention. // Author's abstract. diss. ... MD – 2000. – M. – 48 S.

Tiloron –

Amiksin (trade name)

(LENS–Pharm)

Treatment of genital herpes with ointment - how effective is it?

A number of medications are used to treat and relieve symptoms of genital herpes.

Over-the-counter painkillers such as paracetamol and ibuprofen can help relieve pain. If there is pain when urinating, it is recommended to take a warm bath.

Anesthetic ointment for genital herpes with iceocaine relieves itching or pain. You can lubricate the skin with ointment 5 minutes before urinating to relieve pain. Some patients may be allergic to the pain-relieving ointment, and using such a drug may worsen symptoms. Instead of anesthetic ointment, you can rub Vaseline into the skin before urinating.

Causes

Factors that provoke the development of inflammatory processes include:

• Diarrhea and food poisoning - harmful substances released during bowel movements negatively affect the papillae;
• An inactive lifestyle - this contributes to the appearance of stagnant processes in the pelvis;
• Constipation, in which the papillae are injured during bowel movements;
• Abuse of enemas - with frequent procedures, the mucous membrane of the anal canal is damaged;
• Drinking alcoholic beverages;
• Allergy to personal hygiene products, underwear material;
• Proctological diseases: critpitis, proctitis.

Drugs for genital herpes

Antiviral drugs, such as acyclovir, do not remove the virus from the body. Their goal is to inhibit (suppress) the process of its reproduction. These types of medications are most effective during the first episode of symptoms. They reduce symptoms and their duration - provided that therapy is started within 5 days of the onset of the first symptoms.

Treatment for genital herpes usually lasts 5 days, but it can be extended if the blisters are still present.

Antiviral medications for herpes may not be needed while treating relapses. This is because the symptoms are then much milder than the first time and last only a few days. However, in a situation where the symptoms during relapses are very annoying, therapy with antiviral drugs is necessary.

To shorten the duration of the disease and relieve symptoms, you should start taking the drug as soon as possible. Early treatment offers a better chance of herpes healing faster and reducing the symptoms of the infection more effectively.

If relapses occur frequently, you may need to take an antiviral drug daily. In people using this form of treatment, relapses are either completely inhibited or their frequency is significantly reduced.

When is antiviral treatment required for anal herpes?

Herpes goes away on its own in most people, even without antiviral medications.

But their purpose is still necessary to:

• get rid of symptoms faster
• reduce the risk of complications

Antiviral drugs must be used if herpes appears in the anus in women during pregnancy, children, people with immunodeficiencies, as well as in the case of complicated forms of the disease.

Most doctors do not question whether a person needs these drugs, but always prescribe them if manifest herpes is diagnosed.

These medications do not harm the body and have virtually no contraindications.

At the same time, they help get rid of the virus faster and reduce the risk of infecting a partner.

These drugs are inexpensive.

Therefore, even if herpes is not severe and does not threaten health, there is no reason to refuse treatment and passively wait for recovery.

Antiviral drugs may be prescribed for treatment:

• situational
• suppressive

The differences are that in the first case the person has symptoms, in the second there are none.

The goals of situational therapy are obvious: they are to quickly overcome an exacerbation and reduce unpleasant symptoms.

It is prescribed as early as possible.

Ideally, a person should have valacyclovir in his home medicine cabinet so that he can start taking it during the prodromal period.

That is, when there are no rashes in the anus yet, but itching, burning and tingling have already appeared.

If treatment is started late, when erosions and crusts have formed, then it will not be very effective.

The goals of using suppressive antiviral treatment in a patient who does not have herpes symptoms are:

• preventing infection of regular sexual partners
• reduction in the frequency and severity of exacerbations

Suppressive treatment is prescribed for frequent, severe exacerbations or immunodeficiency (for example, with HIV or chronic use of immunosuppressants).

Genital herpes - treatment at home

A cold compress may provide relief. Ice cubes wrapped in a towel are placed on the affected areas for 5-10 minutes. Do not apply ice directly to the skin.

It is important to take in plenty of fluids. This will make the urine more dilute, making it easier and less painful to pass through.

Avoid scented soaps, bath lotions, and other similar products that irritate your skin.

Do not share a towel or sponge - this will minimize the risk of infection.

Sexual abstinence is indicated until the blisters and ulcers disappear and until a subsequent visit to the doctor.

Genital herpes and sexual intercourse

If partners are carriers of the same virus, there is no possibility of re-infection.

It should be remembered that the disease does not have to be accompanied by any symptoms. But the herpes simplex virus is highly contagious when there are blisters. Sexual intercourse in this state is associated with a high risk of transmitting the virus to a partner. Therefore, it is recommended to avoid sexual activity from the moment the first symptoms appear until they disappear completely.

Using a condom does not provide complete protection against infection, as it only protects a covered area of ​​the body.

If you have no symptoms of genital herpes, you are less likely to pass the virus on to your partner. However, sometimes it happens that the virus is present on the surface of the skin of the genital organs. Therefore, there is a certain risk of contracting the virus through sexual intercourse, even in the absence of any symptoms.

Using a condom during every sexual intercourse can further protect yourself from infection. However, it should be remembered that a condom does not guarantee complete protection against transmission of the virus to a partner. People who take antiviral drugs for a long time are also less likely to contract the virus.

Diagnostics

If papillitis is suspected, the proctologist performs:

• Visual inspection;
• Palpation;
• Anamnesis collection.

If the nodules are located inside the anus, the patient will have to strain to get them out.

To obtain information about the condition of the rectum, the patient is referred to:

• Anoscopy - an anoscope is used for examination, which allows you to examine a section of the rectum 10-12 cm long from the anus and diagnose various proctological pathologies: polyps, bleeding, etc.
• Sigmoidoscopy - allows you not only to examine the rectum at a distance of up to 25 cm, but also to take samples for histology and to excise detected tumors.

Mandatory diagnostic measures include laboratory tests: stool, blood and smear analysis, flora culture, etc.

The need for differential diagnosis is due to the fact that the symptoms of papillitis are similar to some other proctological diseases. Therefore, in order to accurately establish a diagnosis, it is important to exclude the development of other pathologies. Hypertrophied papillae develop a stalk, so they resemble a polyp in many ways. Sometimes you need to make sure that these are not sentinel tubercles formed by fissures in the anus.