Herpes: causes of the disease and methods of treatment

Herpes simplex virus is a widespread infection throughout the world. Many people are familiar with the unpleasant tingling sensation when a bubble pops up on the lip, which itches, hurts and interferes with life. Here's what you need to know about him.

Many people constantly face “cold lips”. Especially in the autumn-winter period. What virus causes this problem, what is its peculiarity and how to treat it, says the doctor.

Elizaveta Kazachkina, family doctor at GMS Clinic.

Introduction

According to the World Health Organization, up to 90% of the world's population is infected with the herpes simplex virus. It can remain in the body for a long time without showing itself at all. With a decrease in immune strength, the disease makes itself felt in the form of colds on the lips, rashes on the mucous membranes of the nasal cavity, eyeball and genitals. Content:

• Classification and clinic of herpes
• Causes
• Routes of transmission of the herpes virus
• Prevention and treatment of the disease
• Precautionary measures
• Should you see a doctor?

Herpes is a common and very unpleasant problem. It is impossible to completely remove it from the body, but you can take the right preventive measures and prevent the development of the disease.

If your herpes symptoms don't go away

To understand why the symptoms of the virus remain, you will need to undergo a series of tests so that a specialist can assess the state of the immune system.

What kind of doctor cares for such patients?

The role of immunity, in this case, is of paramount importance, and in its absence, consultation with an immunologist is necessary.

The doctor will conduct the necessary examination and determine the reason for the lack of effectiveness of the therapy.

After this, the immune system will be corrected.

Classification and clinic of herpes

Regardless of the type, the infection manifests itself with such unpleasant symptoms as itching, tingling and a burning sensation in the area where herpetic blisters and ulcers occur.

Currently, the following types of herpes are distinguished:

• Simple or 1st type.

The inactivated virus is concentrated in the nervous system; when conditions favorable to it arise (decreased immune defense), it manifests itself in the form of skin rashes. They are small bubbles filled with a clear liquid containing thousands of viral particles. During this period, the patient is very contagious to others.

Most often, rashes appear in the area of ​​the lips or nose, accompanied by itching and burning. After a few days, the bubbles open, exposing the erosive surface. The ulcer gradually becomes covered with a crust and disappears without a trace within 5-7 days.

• Genital or type 2.

Clinical manifestations are similar to the previous version. The main difference is the localization of the rashes. Bubbles appear in the genital area. Genital herpes affects both men and women with equal frequency, usually during puberty.

The first contact with infection can occur in three ways:

1. Latent – ​​without clinical manifestations.
2. In the form of rashes on the mucous membrane of the oral cavity and nasopharynx.
3. ARVI with low-grade fever, headache, weakness and malaise.

After this, the herpes virus penetrates the nervous system and can manifest itself the next time either 1 month or 10 years after the initial infection. The main factor in its activation is a decrease in immunity, which is why it is so important to carry out preventive measures.

Herpes “wakes up” when immunity decreases

Causes of recurrence of herpes on the lips: stress or emotional distress; various other diseases, in particular colds, flu, diabetes, HIV; poisoning or intoxication; drinking alcohol, caffeine and smoking; excessive ultraviolet radiation; hypothermia or overheating; onset of menstruation; overwork and exhaustion; poor nutrition/diet or stomach upset; other factors individual to each person.

After “awakening,” the virus travels back to the skin. As the virus moves through a nerve, it causes inflammation of the nerve tissue.

The development of herpes can be divided into several stages. At the first stage, the person feels unwell. At the site where the “fever” appears, there is pain, tingling, and the skin turns red. At the inflammation stage, a small painful blister filled with fluid forms. After some time, the bubble bursts and a colorless liquid containing billions of viral particles flows out of it. An ulcer appears in its place. At the final stage, the ulcer becomes covered with a crust.

Most often, herpes appears on the lips, but lesions can also appear on the face, in the ears or in the mouth.

Causes

There are many provoking factors leading to exacerbation of the disease. In addition to the weakening of immune forces, there are a number of other reasons:

• Emotional stress, physical fatigue, stressful situations.
• Long-term insolation.
• Surgical interventions.
• Taking immunosuppressive drugs.
• Hormonal imbalances.

In addition, there may be a combination of several negative factors leading to the activation of infection in the body. During illness, it is important to isolate yourself from others.

Diagnosis of the disease

Herpetic blisters look so characteristic that they cannot be confused with the morphological signs of other diseases - neither with an abscess, nor with specific ulcerations, nor with an allergic rash. In the vast majority of cases, the diagnosis is made on the basis of clinical manifestations.

A blood test for antibodies to the herpes simplex virus is an indirect method of identifying the pathogen in the body. It can be used if the body’s reactivity (the intensity of the response to external harmful agents) is low, and the infiltrate does not develop into characteristic blisters, which raises the question among clinicians: is it herpes?

Herpes simplex, which is manifested purely by a rash on the face, should be distinguished from herpes type 6, which is characterized not only by a rash, but also by a sharp increase in temperature.

Prevention and treatment of the disease

A herpetic infection can resolve on its own without treatment, but in this case the recovery period will be longer and range from 1 to 3 weeks. If you start taking medications on time, the disease will go away faster and easier. Treatment should begin when the first symptoms appear - burning and tingling, in places typical for the virus.

Also, do not forget about preventive measures. Try to plan your day correctly, get enough sleep, and avoid stressful situations. On sunny days, use protective creams, and in the cold season, moisturizing hygienic lipsticks.

The following groups of drugs are used to treat herpes:

• Antiviral agents in the form of ointments and tablets. The most commonly used are Acyclovir, Penciclovir, and Valaciclovir. When using them, the duration of the disease can be reduced to three days.
• Painkillers and antipyretics. They are used to relieve unpleasant symptoms: high fever, itching and burning. If such manifestations occur, you can take paracetamol or any NSAID (Nise, Nimesil, Ibuprofen).
• Folk remedies also help combat discomfort during illness. Gel with aloe vera extract, witch hazel and lemon balm have proven themselves to be effective in treating infections.

Principles of treatment of herpes simplex

WITH

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

Unfortunately, modern medicine does not have treatment methods that can eliminate HSV from the human body. Therefore, the goal of therapeutic measures is: a) suppression of HSV reproduction during an exacerbation, b) formation of an adequate immune response and its long-term preservation in order to block the reactivation of HSV in areas of persistence, c) prevention of the development or restoration of those disorders that are caused by HSV activation in the body.

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

1) use of antiviral chemotherapy

, the main place in which is given to acyclic nucleosides and, first of all, acyclovir;

2) complex treatment method

, including immunotherapy (specific and nonspecific) in combination with antiviral therapy.

Creation of acyclovir

(ACV) opened a new stage in the treatment of herpes. In many countries around the world, the industrial production of acyclovir-containing drugs (ACV drugs) has been established.

Antiviral chemotherapy

Etiopathogenetic therapy is based on the ability of chemotherapeutic drugs to selectively disrupt the process of interaction between HSV and cells, to be included in the development cycle of only HSV at the stages of viral DNA synthesis and assembly of viral particles, inhibiting their reproduction, which ultimately leads to a virusostatic effect. Chemotherapy takes a leading place in acute herpetic infection, which occurs with damage to the central nervous system and other systems and organs, as well as in herpes of newborns. Antiviral drugs are of great importance in the treatment of recurrent forms of herpes simplex with damage to the skin and mucous membranes.

Etiopathogenetic therapy

Acyclovir

- a synthetic acyclic analogue of deoxyguanosine, a natural component of DNA, and today remains the standard of antiherpetic treatment. Acyclovir penetrates predominantly into a cell infected with a virus, where, under the influence of a virus-specific thymidine kinase, it transforms into an active form as a result of phosphorylation with the formation of mono-, di- and triphosphate. Acyclovir has found its use in the treatment of all forms of herpes infection. Pronounced antiherpetic activity, low toxicity, and the presence of several dosage forms (ointment, tablets, cream, suspension, solution for intravenous administration) allow the drug to be widely and effectively used in medical practice.

It has been established that in 5–7% of patients suffering from recurrent herpes (HR)

, during treatment, resistance to acyclovir develops or it initially does not have a therapeutic effect. The mechanism of resistance is associated with a decrease in the activity or absence of viral thymidine kinase, damage to the substrate specificity of this enzyme and the appearance of mutations in the DNA polymerase gene.

valacyclovir, has been developed based on acyclovir.

, which is the L-valine ester of acyclovir. The advantage of valacyclovir in comparison with acyclovir is that its oral administration creates concentrations of acyclovir in the blood serum and other internal media that are equivalent to those achieved only with intravenous administration of acyclovir. This is what allows the patient to reduce the number of doses of the drug during a relapse to 2 times a day (as opposed to acyclovir, which is taken 5 times a day) and take valacyclovir once a day for suppressive therapy.

Famciclovir

is transformed in the body into an active antiviral compound - penciclovir, effective against HSV-1, HSV-2 and other herpes viruses. Penciclovir reaches HSV-infected cells, where it is converted to triphosphate by the action of viral thymidine kinase.

Acyclovir, val acyclovir and famciclovir are “first aid” drugs for any form of herpes. However, ACV drugs exert their indirect virusostatic effect by interacting with the thymidine kinase of herpes viruses, which to a certain extent limits the universality of their action on HSV strains with genetically altered viral thymidine kinase activity. Therefore, the list of specific antiherpetic drugs has been supplemented with foscarnet.

Foscarnet

is a competitive inhibitor of pyrophosphate and has a wide spectrum of antiviral activity, inhibiting the DNA polymerase of herpes viruses. However, it should be noted that this phosphorus-containing drug is more toxic than acyclovir, which may limit its use.

There are a number of drugs with different mechanisms of antiviral action that can be used for herpes: brivudine, ribamidil, metisazone. And yet they are significantly inferior to acyclovir in therapeutic effectiveness.

Immunotherapy for herpes simplex

Impaired immune response is the most important link in the pathogenesis of herpes simplex. As a rule, the disease occurs against the background of suppressed immune reactions: there is a decrease in the total number of T- and B-cells, a change in their functional activity, disturbances in the macrophage component of immunity, in the interferon system. Correction of violations of nonspecific and specific immunity is one of the directions in the complex therapy of herpes simplex.

Nonspecific immunotherapy

includes the use of:

1) immunoglobulin;

2) interferons and interferon inducers;

3) drugs that stimulate the T- and B-links of cellular immunity and phagocytosis.

Mechanism of action of immunoglobulins

For a long time, herpes was explained by a replacement effect against the background of the inherent failure of humoral immunity for this disease. In recent years, it has been found that immunoglobulin preparations also have immunomodulatory and antitoxic effects and activate opson-phagocytic reactions.

Normal human immunoglobulin is used to treat recurrent herpes. The drug contains a sufficient amount of specific antiherpetic antibodies to achieve a therapeutic effect, which is explained by the almost 100% carriage of HSV in the population.

To treat severe forms of herpetic infection (central nervous system lesions, neonatal herpes, primary herpes in pregnant women), human immunoglobulin with a high content of antiherpetic antibodies (Sandoglobulin) or domestic immunoglobulin for intravenous administration can be used.

Wide spectrum of antiviral activity, absence of interferon-resistant (IF)

virus strains predetermined the prospect of using interferon as a means of etiopathogenetic therapy of herpes simplex. Interferons are factors of natural immunity, produced by cells in response to the influence of viruses, bacteria, foreign antigens and cause activation of effector immune cells involved in the reactions of elimination of infectious agents from the body. According to modern concepts, interferons, along with antiviral activity, have antiproliferative and immunoregulatory effects. IF increases nonspecific cell resistance (stimulates phagocytosis, increases the activity of natural killer cells), and the level of interferon formation can be used to judge the general immunological reactivity of the body.

Commercial series of human leukocyte interferon (HLI) produced by the domestic industry are species-specific and are quickly eliminated from the body (with intravenous administration after 4–6 hours, with intramuscular administration - after 20 hours). The high cost and complexity of industrial production of CLI to a certain extent limit its use. In practical healthcare, CLI is currently used in several dosage forms: 1) nasal drops; 2) PLI for injection - a mixture of interferons-a produced by leukocytes of clinically healthy donors, administered intramuscularly, subcutaneously, intravenously; the activity of 1 dose of the drug is 100,000 IU, 500,000 IU, 1000,000 IU; 3) leukinferon (for injection) – a natural complex preparation containing interferon-a and cytokines (1 dose – 10,000 IU); 4) interlock (for injection), 1.0 ml – 50,000 IU; 5) CLI in rectal suppositories (1 suppository contains 40,000 IU of antiviral activity).

The idea of ​​interferon therapy found its development in the creation of genetically engineered interferons and in the use of endogenous interferon inducers.

For the treatment of various forms of recurrent herpes, domestic rectal suppositories Viferon, which contain recombinant a2-interferon, are used. A combined drug, kipferon, has been created (consists of immunoglobulins and recombinant a2-interferon) in the form of suppositories for rectal and vaginal administration.

With the help of interferon preparations (natural or genetically engineered), replacement therapy is carried out, as a result of which the production of the patient’s own endogenous IF can be blocked. This must be taken into account when prescribing long-term (more than 2 weeks) courses of IF therapy, especially genetically engineered forms (Reaferon, Viferon). In cases of long-term administration of IF to patients, they should be discontinued gradually, reducing the dose to 3, then 2 times a week, followed by complete discontinuation of the drug.

The ability to induce the production of endogenous IF

has a large group of natural and synthetic compounds: levamisole, dibazole, vitamin B12, pyrogenal, prodigiosan, which are the drugs of choice for the treatment of herpes.

A synthetic interferon inducer, the domestic drug Poludan (poly A:U), which has been used since the 1970s, has a pronounced therapeutic and prophylactic effect in recurrent herpes. and is still widely used in the form of eye drops and subconjunctival injections for the treatment of ophthalmoherpes and other viral eye diseases. Convincing clinical data have been obtained on the high effectiveness of poludan for the treatment of recurrent herpes affecting the skin and mucous membranes. If smooth skin is affected by recurrent herpes of the buttocks and thighs, the lesion is injected with poludan (200–400 mcg per lesion). Poludan has a general immunostimulating effect, which makes it possible to use it in secondary immunodeficiency conditions caused not only by herpesvirus infections.

IF inductors used per os

, which allows patients to independently carry out preventive and anti-relapse treatment courses recommended by the doctor.

Amiksin, alpizarin, flocazide, arbidol, being inducers of IF, stimulate the production of endogenous IF in the patient's body. This explains the positive therapeutic effect of the listed drugs in many viral diseases (recurrent herpes, influenza, adenovirus infection), which makes it possible to recommend them in the complex treatment of herpesvirus infections, especially in patients suffering from frequent colds and acute respiratory viral infections.

To stimulate the T- and B-links of cellular immunity in patients with recurrent herpes, the drugs taktivin, thymalin, thymogen, myelopid, etc. are successfully used. Treatment must be carried out under the control of an immunogram.

Specific immunotherapy

consists of using a 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.

Comprehensive treatment of herpes simplex

Considering the peculiarities of the pathogenesis of herpes simplex, the most appropriate way to achieve a therapeutic effect is to use drugs with different mechanisms of action. Thus, the use of chemotherapy drugs with different mechanisms of antiviral action prevents the emergence of resistant strains of HSV; the use of interferons and their inducers in combination with a herpetic vaccine and immunomodulators makes it possible to comprehensively address the issues of herpes simplex therapy.

Treatment regimens for recurrent herpes can be different, which is determined by the clinical manifestations of HSV infection, the patient’s immune status and the doctor’s choice.

Treatment of recurrent herpes

The most pronounced therapeutic effect is achieved with an integrated approach to therapy

, which includes several stages:

1) antiviral therapy in combination with immunocorrection and interferon therapy, taking into account the data of an immunological examination and the study of interferon status;

2) anti-relapse treatment with a herpes vaccine in combination with immunomodulators and symptomatic use of antiviral drugs;

3) the use of adaptogens, repeated courses of vaccine therapy (re-vaccination), symptomatic use of antiviral drugs.

The duration of observation and the intensity of therapy for patients depend on the severity of herpetic infection, which is determined by the frequency of relapses, the presence or absence of a prodromal period, intoxication, pain, and the involvement of various systems and organs in the infectious process (Table 1).

The effectiveness of the therapy is assessed by reducing the duration and frequency of relapses, as well as the intensity of general symptoms of the disease.

The main remedy for stopping relapses

herpes simplex are ACV drugs (acyclovir, val acyclovir and famciclovir). There are two fundamentally different approaches to prescribing antiherpetic chemotherapy drugs:

a) episodic treatment - taking ACV drugs at the time of relapse, in therapeutic doses, observing the frequency and duration of drug administration.

b) suppressive therapy - long-term, long-term, constant use of ACV drugs without relapse in lower doses.

For episodic treatment during a relapse, patients are recommended to include the drug IF or an oral interferon inducer in the course of treatment in order to strengthen antiviral immunity and prevent possible complications of a viral infection (for example, Viferon and Arbidol).

Treatment of mild forms of RG

is often limited to prescribing ACV-drug in ointment and tablet forms and one or two courses of amixin or alpizarin, multivitamins during a relapse. Considering that the majority of patients with RG have impaired interferon status, it is advisable for them to prescribe an IF inducer or viferon, kipferon during a relapse.

If there is no effect from several repeated courses of nonspecific immunotherapy, vaccine therapy is indicated for patients with a mild form of herpes. The methods of choice are: repeated courses of immunoglobulin (2-3 per year), long-term (up to 1.5 months) administration of amixin or alpizarin in combination with antioxidants, course administration of dibazole with eleutherococcus, multivitamins, prodigiosan, etc.

In the course of treatment of patients suffering from moderate and severe forms

RG, it is necessary to include a herpes vaccine. It is advisable to combine vaccine therapy with immunomodulators (poludanum, myelopid), which increase its immunogenicity. In this case, the antiherpetic vaccine is prescribed after a course of immunomodulator.

Treatment of patients with frequent relapses

(moderate “b” and severe forms) begin with nonspecific immunotherapy, including immunoglobulin, stimulators of T- and B-cell immunity (under the control of an immunogram). Against the background of immunotherapy, patients note an improvement in general well-being, increased performance and a decrease in the frequency and severity of relapses. At the end of nonspecific immunotherapy, patients are prescribed a herpetic vaccine.

Patients with continuously recurring forms of herpes

Vaccination is indicated against the background of a 3-4 month course of suppressive therapy with ACV drugs.

Every 6–8 months, patients suffering from RH need to undergo revaccination. In the intervals between revaccinations, patients in these groups (according to indications) can be prescribed maintenance courses of nonspecific immunotherapy.

Features of local treatment for RG

The problem of local treatment of RH of the skin and mucous membranes was solved with the advent of acyclovir in the form of cream and ointment. With timely use of the drug (at the first signs of relapse or when prodromal local phenomena appear), the relapse is stopped in 1–2 days. Patients with intolerance to ACV or with low effectiveness are prescribed creams, ointments, gels, lotions, and sprays with other antiherpetic drugs.

External administration of antiviral drugs for herpes of the skin and mucous membranes is necessary to reduce clinical manifestations in the lesion, accelerate epithelization and reduce the duration of virus isolation from the lesion.

Without local treatment for herpetic lesions of the genitourinary system in men

It is almost impossible to achieve a significant therapeutic effect. To treat herpetic urethritis, you can use the liniment of cycloferon or poludan, which is injected into the urethra in the form of instillations. For herpetic proctitis, a pronounced therapeutic effect is observed when patients are prescribed Poludan solution in the form of microenemas, as well as with rectal administration of Kipferon suppositories.

Along with medicinal local treatment, men with chronic herpetic diseases of the pelvic organs undergo traditional local manipulations: bougienage of the urethra, massage of the prostate, followed by total instillation of Poludanum solution or Cycloferon liniment. To achieve a more pronounced anti-inflammatory, absorbable and analgesic effect, such patients should include low-frequency laser therapy in the course of treatment.

Local treatment of urethritis and proctitis in women

carried out in the same way as for men. For the treatment of herpetic cervicitis and colpitis, Kipferon suppositories (vaginally) and Cycloferon liniment are used.

However, even with such an integrated approach to the treatment of GC, there are cases with low therapeutic efficacy

, manifested:

1) torpidity to the therapy, when despite the ongoing antiviral and immunocorrective treatment (including vaccine therapy), the frequency and intensity of relapses of herpes in patients remains the same;

2) persistence of symptoms of persistent impairment of general well-being (weakness, malaise, psychoasthenia) and decreased ability to work against the background of a pronounced improvement in the clinical course of RG achieved as a result of treatment (reduction in the frequency and duration of relapses).

Virological examination of patients with low therapeutic efficacy often reveals an association of two herpes viruses: HSV and CMV

, which requires correction in the therapy.

Conclusion

Modern international standards for the management of patients with herpesvirus infections determine the following requirements for doctors:

1. The minimum standard for monitoring a patient is to establish an accurate diagnosis. To do this, it is necessary to examine the patient, take a smear from the site of skin or mucous membrane lesions and conduct a virological examination.

2. The patient should receive reasoned advice on a healthy lifestyle and recommendations on antiviral therapy. The doctor must be aware that the patient needs complete information about the disease.

3. As with other STDs, for genital herpes it is necessary to obtain biological materials for the diagnosis of other genital infections, and this should be discussed jointly between the doctor and the patient.

4. The doctor’s responsibility is:

• diagnosing a patient with clinical symptoms of herpes;
• familiarizing the patient, based on the diagnosis, with the prognosis of the disease, the risk of transmission of infection and the possibilities of antiherpetic treatment;
• involving the patient in deciding on the choice of method (episodic or preventive) and treatment program for recurrent forms of genital herpes.

Precautionary measures

In order for the disease to pass in a mild form and its complications to appear, the following recommendations should be followed:

• Rule #1. Avoid touching your face with your hands, especially in the area of ​​blisters. Otherwise, you risk spreading the infection to a larger area of ​​skin.
• Rule #2. During illness, be especially careful about your personal hygiene.
• Rule #3. Isolate yourself and try to avoid close contact with people, especially the elderly and children.

How is herpes on the genitals in men treated?

Treatment of genital herpes, or, as it is more correctly called, genital herpes, is a difficult task. The fact is that at the moment there are no drugs that can completely remove the virus from the body. And therefore, relapses of the disease are possible even after complete therapy.

Herpes on the head of the penis requires complex treatment. Such treatment includes the prescription of antiviral drugs in the form of injections, tablets, suppositories, and topically in the form of creams. To correct the state of antiviral immunity, interferon inducers, immunomodulators, and herpes vaccine are prescribed. Classic methods of administering antiherpetic drugs externally, orally, intravenously, as well as an innovative method of electrophoresis of abnormal nucleosides and interferon into an organ affected by herpes are used. This gives maximum effect in case of protracted herpetic infection of the male and female reproductive systems, especially the prostate, bladder and fallopian tubes. The option of “just anointing it with something” is not suitable for the treatment of viral lesions of the genitals. This will certainly lead to the formation of a chronic process with frequent exacerbations, when sexual life becomes impossible in principle.

For the initial episode and rare relapses, the disease is usually treated within 7–14 days. If a chronic herpetic infection has developed with exacerbations more than 6 times a year, then the patient needs longer therapy up to 3-6 weeks, and sometimes taking medications for 6-12 months.

Our clinic has developed complex treatment regimens that not only stop this relapse, but also create the prerequisites for a long, relapse-free course of genital herpes without exacerbations, complications or a decrease in a man’s quality of life.