The genital area in 40-60% of the adult population by the age of 40 is infected with HSV (herpes simplex virus). Genital herpes is one of the most common infectious diseases of the genitourinary system. Moreover, in most people, genital herpes is asymptomatic, or there is an unrecognized herpes. It is these forms that are the cause of the widespread increase in the incidence.
One of the reasons for the epidemic that began in the early 70s. The twentieth century, and this is how the epidemiological situation associated with genital herpes is regarded, was the sexual revolution that swept over North America and the countries of Western Europe, and the widespread practice of oral sex.
Primary genital herpes
It manifests itself on the mucous membranes of the genital organs and adjacent areas of the skin of grouped vesicular elements that arise on an erythematous background. After 2-4 days, the vesicles open up, forming weeping erosion, less often - ulcers, epithelizing under the crust or without its formation. Subjectively, patients are concerned about itching, burning, soreness in the area of the lesion. In some patients, there is an increase in body temperature up to 38 ° C, painful enlargement of the inguinal lymph nodes.
Localization of the lesion on the genitals is determined by the "entrance gate" of the infection. In men, rashes are usually located in the area of the outer and inner sheets of the foreskin, the coronal sulcus. Less commonly, the head and body of the penis, the skin of the scrotum are affected. In women, herpes sores can appear on the labia majora and small labia, the mucous membrane of the vagina, cervix, and perineum.
Approximately 25-30% of those infected develop a relapsing form. Characterized by early opening of the vesicles with the formation of erosive surfaces, pronounced subjective symptoms (pain, itching, burning sensation in the focus). Recurrent herpes is characterized by a severe course: often recurrent forms of the disease occur in 50-75% of patients. Recurrent external genital herpes
Typical recurrent herpes on the skin and mucous membranes of the genitals, usually in the same place, subjectively: burning, itching is manifested by repeated blistering rashes.
Atypical forms of recurrent herpes, which greatly complicate the diagnosis .
In atypical forms , either one of the stages of development of the inflammatory process in the focus (erythema, blistering) prevails, or one of the components of inflammation (edema, hemorrhage, necrosis), or subjective symptoms (pruritus), which give the appropriate name to the atypical form (erythematous, bullous, hemorrhagic, necrotic, itchy, etc.).
Atypical forms of herpes of the external genitals are more common in women than in men.
The subclinical (oligosymptomatic) form is manifested by microsymptomatics: a short-term (less than a day) appearance of one or more microcracks, accompanied by slight itching. Sometimes there are no subjective sensations, which reduces the appeal of patients to medical institutions and complicates the diagnosis.
The subclinical form is detected mainly during virological examination of the sexual partners of patients with any sexually transmitted infection, or during examination of married couples with impaired fertility.
Clinical diagnosis in abortive course, atypical and subclinical forms of RHH is difficult and can only be made using virological research methods.
A feature of genital herpes is multifocality. The pathological process often involves the lower part of the urethra, the mucous membrane of the anus and rectum.
• the entrance to the vagina; • vagina; • the vaginal part of the cervix; • cervical canal; • urethra; • bladder; • anus; • ampulla of the rectum; • the mucous membrane of the uterine cavity; • body of the uterus; • the fallopian tubes; • ovaries; • prostate; • seminal vesicles;
1. Typical; 2. Atypical; o with macrosymptomatics; o with microsymptomatics; 3. Asymptomatic form;
It is very difficult to establish the real frequency of damage to the internal genital organs, both in women and in men, since in 25-40%, and according to some reports, in 60% of patients, the disease proceeds without subjective sensations. It can be assumed that this pathology occurs much more often than it is diagnosed.
With herpes of the internal genitals, there may be no complaints. Sometimes they notice periodically appearing not abundant mucous discharge from the urethra and from the vagina. In a laboratory study of smears of the separated canal of the cervix, vagina and urethra, an increased number of leukocytes is periodically noted (30-40 in the field of view of the urethral discharge, 200-250 and higher in the field of view when examining smears from the vagina), indicating the presence of an inflammatory process.
The asymptomatic form of genital herpes simplex of the internal genitals (asymptomatic virus isolation) is characterized by the absence in patients of any complaints about the genital area, objective clinical data confirming inflammation. In a laboratory study of the detachable urogenital tract, HSV is released, while there are no signs of inflammation (leukocytosis) in smears. In 25-30% of men with idiopathic (when the cause of infertility is not clear) infertility, HSV is secreted from the semen .
It is known that herpes of the genitals, in 70-80% of cases, occurs in the form of a microbial association, in combination with chlamydia , urea-, mycoplasma , strepto-, staphylococci, fungal flora. A combined lesion of the genitals with HSV, gonococcus, treponema pale, viral diseases transmitted during sexual intercourse is not excluded, which indicates the need for a thorough examination of patients to exclude STIs, HIV infection .
A pronounced therapeutic effect in more than 90% of patients during treatment is achieved due to: • Decades of experience in the treatment of recurrent herpes; • An integrated approach to therapy; • Individual selection of antiviral treatment (drugs and regimens) and immunomodulators; • Experience in anti-relapse therapy;
The result of treatment depends to a large extent on the experience and skill of the doctor, as well as on the patience and careful implementation of the doctor's recommendations by the patient. The methods of treatment we use can significantly reduce the duration of treatment without losing the quality and effectiveness of therapy.
IT IS POSSIBLE, because the arsenal of antiviral and immune drugs existing today can solve many problems that arise in people suffering from recurrent forms (genitals, face, buttocks, and other more rare localizations). The correct methodological approach to examination and therapy will allow:
1. quickly stop acute manifestations of the disease; 2. to carry out effective immunocorrection; 3. reduce the frequency and intensity of clinical manifestations of the following relapses; 4. significantly increase the duration of relapse periods and achieve many months of clinical remission;
IT IS NECESSARY, because timely treatment is the prevention of the development of possible complications of herpes infection:
1. pain syndrome that develops when the nervous system is involved in the infectious process; 2. the spread of infection, when almost all organ systems can be involved in the infectious process; 3. pathology of pregnancy, fetus and newborn;
Your guarantees are our positive 18 years of experience working with patients suffering from severe complicated forms. We know almost everything about modern medicines (imported and domestic) and existing methods of treatment. We identify and eliminate the causes that led to the development of the disease.
Our employees (dermatovenerologists, obstetricians-gynecologists, urologists-andrologists) are the authors of methodological recommendations, textbooks and a course of lectures for Russian doctors; take part in international trials on herpes problems.
Laboratory diagnostic methods are fundamentally divided into two groups:
1. isolation and identification of the herpes virus (on cell culture) or detection of the herpes simplex virus antigen from the infected material (in the reaction of immunofluorescence, polymerase chain reaction "PCR" , etc.); 2. detection of herpes specific antibodies (IgM, IgG) in blood serum.
• To reduce the likelihood of a false-negative diagnosis, especially in genital herpes and asymptomatic forms of the virus, it is necessary to examine the maximum number of samples from one patient (vaginal discharge, cervical canal, urethra, prostate juice, semen, urine), because the herpes virus is rarely detected simultaneously in all environments. • If a herpetic infection is suspected, it is necessary to carry out a multiple virological study of the detachable genitourinary system in patients, because a negative result of a single virological study cannot completely exclude the diagnosis. • The frequency of virus shedding in women depends to a large extent on the phase of the menstrual cycle. More than 70% of patients with herpes shed the virus at the beginning of the menstrual cycle. • Detection of specific IgM immunoglobulins in the absence of IgG or with a 4-fold increase in specific IgG titers in paired blood sera obtained from a patient with an interval of 10-12 days indicates primary infection. • The detection of specific IgM immunoglobulins against the background of IgG in the absence of a significant increase in IgG titers in paired sera indicates an exacerbation of chronic herpes infection. • Detection of IgG titers above average is an indication for additional examination of the patient and detection of herpes virus isolation in the media.
Genital herpes, being a special case of herpes infection, belongs to the most common sexually transmitted diseases, and differs from other diseases of this group in the lifelong carriage of the pathogen in the human body, which determines a high percentage of the formation of recurrent forms of the disease.
Transmission is usually carried out through close contact with a sick person or a virus carrier. The virus penetrates through the mucous membranes of the genitals, urethra, rectum or skin microcracks. In couples where one of the partners is infected, the likelihood of the second partner becoming infected within a year is 10%. In most cases, infection occurs when the infected partner has not had a clinically significant recurrence of genital herpes. Asymptomatic and unrecognized forms of infection play an important role in the spread of the virus. The virus can be secreted with sperm, cases of infection of women during artificial insemination are described. Speaking about the ways of transmission of the virus, it is necessary to note the important epidemiological significance of oral-genital contacts, which are associated with an increase in the frequency of isolation of type 1 herpes from the organs of the genitourinary system.