Herpes is one of the most common viral infections in humans. Infection with herpes simplex virus (HSV) is 90%; 20% of the world’s population has clinical signs of infection. Genital herpes is a sexually transmitted chronic recurrent viral disease.
Etiology and pathogenesis. The causative agent of the disease is the herpes simplex virus serotypes HSV-1 and HSV-2 (more often – HSV-2). The herpes virus is quite large, DNA-containing, unstable in the environment and quickly dies when dried, heated, disinfectant solutions.
Infection occurs through sexual contact from infected partners who are not always aware of their infection. Recently, the oral-genital route of infection is of great epidemiological importance. Contagiousness for women reaches 90%. Domestic transmission of infection (through toilet articles, underwear) is unlikely, although it is not excluded. Herpes infection can be transmitted from the sick mother to the fetus by transplacental and intranatal infection.
The virus enters the body through the damaged mucous membranes of the genitals, urethra, rectum and skin. Bubble eruptions appear at the site of implantation. HSV, getting into the bloodstream and lymphatic system, can settle in the internal organs, nervous system. The virus can also penetrate the nerve endings of the skin and mucous membranes in the ganglia of the peripheral and central nervous system, where it persists for life.
Periodically migrating between the ganglia (with genital herpes, these are the ganglia of the lumbar and sacral parts of the sympathetic chain) and the surface of the skin, the virus causes clinical signs of disease recurrence. The manifestation of herpes infections contribute to reduced immunoreactivity, hypothermia or overheating, chronic diseases, menstruation, surgery, physical or mental trauma, alcohol intake. HSV, having neurodermotropism, affects the skin and mucous membranes (face, genitals), the central nervous system (meningitis, encephalitis) and the peripheral nervous system (ganglioliths), eyes (keratitis, conjunctivitis).
Classification. The first episode of the disease and recurrence of genital herpes is clinically distinguished, as well as the typical course of the infection (with herpetic eruptions), atypical (without eruptions), and virus-related symptoms.
Clinical symptoms. The incubation period is 3-9 days. The first episode of the disease occurs more rapidly than subsequent relapses. After a short prodromal period with local pruritus and hyperesthesia, the clinical picture unfolds. A typical course of genital herpes is accompanied by extragenital symptoms (viremia, intoxication) and genital signs (local manifestations of the disease). Extragenital symptoms include headache, fever, chills, myalgia, nausea, malaise. Usually these symptoms disappear with the appearance of blistering eruptions on the perineum, the skin of the external genital organs, the vagina, the cervix (genital signs). Vesicles (2-3 mm in size) are surrounded by a section of hyperemic edematous mucous membrane. After 2-3 days of existence, they open up with the formation of ulcers covered with greyish yellow purulent (due to secondary infection) by bloom. Patients complain of pain, itching, burning in the place of injury, heaviness in the abdomen, dysuria. With pronounced manifestations of the disease marked subfebrile temperature, headache, an increase in peripheral lymph nodes. The acute period of a herpes infection lasts 8–10 days, after which the visible manifestations of the disease disappear.
Currently, the incidence of atypical forms of genital herpes has reached 40-75%. These forms of the disease are erased, without herpetic eruptions, and are accompanied by a lesion not only of the skin and mucous membranes, but also of the internal genital organs. There are complaints of itching, burning sensation in the area of damage, leucorrhoea, non-antibiotic therapy, recurrent erosion and cervical leukoplakia, habitual miscarriage, infertility. Herpes of the upper genital tract is characterized by symptoms of non-specific inflammation. Patients are concerned with recurrent pain in the lower abdomen; conventional therapy does not give the desired effect.
In all forms of the disease, the nervous system suffers, which is manifested in neuropsychiatric disorders – drowsiness, irritability, poor sleep, depressed mood, decreased performance.
The recurrence rate depends on the immunobiological resistance of the macroorganism and ranges from 1 to 2–3 years to 1 time every month.
Diagnosis of genital herpes is based on anamnesis, complaints, the results of an objective study. Recognizing typical forms of the disease usually presents no difficulties, as the vesicular rash has characteristic signs. However, it is necessary to distinguish ulcers after opening herpetic vesicles from syphilitic ulcers – dense, painless, with smooth edges. Diagnosing atypical forms of genital herpes is extremely difficult.
Apply highly sensitive and specific laboratory diagnostic methods; the cultivation of the virus in the chicken embryo cell culture (gold standard) or the detection of viral antigen by ELISA; immunofluorescence method using PCR. The material for the study is a discharge from the herpetic vesicles, vagina, cervical canal, urethra. A simple determination of antibodies in the serum to the virus is not an exact diagnostic criterion, since it reflects only the infection of HSV, including not only genital. A diagnosis made only on the basis of serological reactions may be erroneous.