Genital herpes (GH) is a common sexually transmitted disease caused by herpes simplex virus (HSV) invading the skin and mucous membranes of the genital area, which is easily recurring and mainly transmitted sexually. The disease has a high incidence and can infect newborns through the placenta and birth canal, leading to miscarriage and neonatal death, and is also associated with the occurrence of cervical cancer, which is more dangerous and has received much attention.
I. Etiology
HSV-2 is the main pathogen of genital herpes (90%) and is present in the exudate of skin and mucous membrane damage, prostate secretion, cervical and vaginal secretions, and is transmitted mainly through sexual intercourse, causing primary genital herpes. After the primary genital herpes has subsided, the residual virus is latent in the sacral ganglion along the nerve axis via the peripheral nerves for a long time, and the latent virus can be activated and recur when the body’s resistance is lowered or by certain stimulating factors such as fever, cold, infection, menstruation, gastrointestinal disorders, trauma, etc. Humans are the only host of herpes virus, and the virus cannot survive outside the human body, and can be inactivated by ultraviolet light, ether and general disinfectants.
Second, the transmission route
The source of infection of genital herpes is the patient and subclinical asymptomatic virus carrier, especially in the patient’s genital skin or mucous membrane herpes contains herpes simplex virus, can be transmitted to the spouse or other sexual partners through sexual contact, but also in homosexuals infect each other. Sometimes people who have herpes in or around the mouth can infect each other with genital herpes through oral-genital intercourse. Therefore, different ways of sexual intercourse can also transmit genital herpes disease.
III. Clinical manifestations
(a) Primary infection 80% to 90% of those with primary infection are recessive, and can be divided into primary and non-primary infections.
1. Primary infection: Patients have no previous history of herpes simplex and no HSV antibodies in the serum. The clinical manifestations are most severe after HSV infection. Patients develop the disease after sexual contact with someone who has active herpes simplex damage. The incubation period is 2 to 10 days, with an average of about 6 days. In men, it occurs in the glans, coronal sulcus, urethral orifice and penile body skin; in homosexuals, it can occur in the anus and rectum; in women, it occurs in the vulva, cervix, perianal area and buttocks. Typical manifestations are blisters, pustules, ulcers, and urethritis, but can also manifest as atypical damage such as fissures or cracks in the genital area, nonspecific erythema, hard nodules, and tiny linear ulcers. The symptoms last at least 1~2 weeks, and after a period of time the damage area crusts and heals.
2.Non-primary infection There is a history of HSV infection and anti-HSV antibody in the serum. The symptoms are milder than those of primary infection.
(B) Recurrent infection About 60% of patients with primary genital herpes have a recurrence within 1 to 4 months. The triggers for recurrence are mostly fatigue, menstrual flow, and too frequent sexual intercourse. Each recurrence tends to have blisters in the same area, but they are lighter than the initial ones and usually subside in about 10 days.
(iii) Subclinical HSV infection, i.e. asymptomatic genital herpes, is generally considered to be asymptomatic in more than 50% of genital HSV-1 infections and 70% to 80% of genital HSV-2 infections. Patients have atypical manifestations of genital herpes such as fissures and tiny linear ulcers, which are easy to ignore. Patients with subclinical genital herpes are the main source of genital herpes infection.
(iv) HSV latent infection HSV has the property of forming a latent infection state by sensory ganglia, and HSV infects the skin mucosa of the genital area and often lurks in the sacral nerve root area. Immunosuppression or immunodeficiency and HIV infection can lead to frequent HSV reactivation. Latent infection is the root cause of genital herpes recurrence, and elimination of HSV latent infection is the key to prevention and control of genital herpes.
(E) HSV infection in pregnant women and newborns Infection in the early 3 months of pregnancy can lead to fetal abnormalities or stillbirth. During delivery, when the fetus passes through the birth canal it can be infected. Neonatal herpes often develops 4-6 days after birth, with mild manifestations of oral, cutaneous, and ocular herpes, and severe hematogenous infection of the central nervous system and systemic viscera.
IV. Diagnosis
1. History The patient has a history of non-marital sexual contact, multiple sexual partners and unsafe sexual contact.
The diagnosis is not difficult when the typical damage is clusters of corn blisters, erosions, ulcers, and self-induced burning pain in the genital area, and enlarged lymph nodes in the near guard. However, there are quite a lot of atypical clinical manifestations, and some clues can sometimes be found by careful history taking and careful observation. As for asymptomatic subclinical infections, they can only be confirmed by specific laboratory tests. However, there is a lack of practical tests in clinical practice.
V. Treatment
Antiviral drugs are effective in most patients with symptomatic genital herpes and are currently the mainstream treatment. Systemic administration of antiviral drugs can partially control the signs and symptoms of herpes attacks. However, these drugs do not eradicate the latent virus and do not reduce the risk of recurrence, frequency and severity after discontinuation of the drugs. In addition to this, psychotherapy and Chinese medicine treatment should be combined.
(i) Antiviral treatment Acyclovir, valacyclovir, and famciclovir for genital herpes can reduce symptoms, shorten the course of the disease, and reduce detoxification.
1, primary infection Acyclovir 200mg, 5 times/d, for 7~10d; or Acyclovir 400mg, 3 times/d, for 7~10d; or Valacyclovir 1g, 2 times/d, for 7~10d, or Famciclovir 250mg, 3 times/d, for 7~10d. If the healing of the ulcer is not completed after 10 consecutive days of treatment, the course of treatment can be extended.
2. Recurrent infection It is best to start treatment within 24h of the appearance of prodromal symptoms or damage. Acyclovir 200mg, 5 times/d for 5d; or Acyclovir 400mg, 3 times/d for 5d; or Valacyclovir 300mg, 2 times/d for 5d; or Famciclovir 125~250mg, 3 times/d for 5d.
3, frequent relapses (more than 6 relapses in 1 year) patients To reduce the number of relapses, suppressive therapy is available. Acyclovir 400mg, orally, 2 times/d; or valacyclovir 300mg, orally, 1 time/d; or famciclovir 125~250mg, orally, 2 times/d. All the above drugs need to be taken for a long time, usually for 4 months to 1 year.
4, heavy infection Refers to those with severe symptoms of primary infection or extensive skin lesions. Acyclovir 5mg~10mg/kg body weight each time, intravenous drip, 1 time/8h, with 5~7d or until the clinical symptoms subside.
5, for genital herpes occurring in immunodeficient people can be treated according to the above protocol, and if necessary, the course of treatment can be extended appropriately.
6, herpes during pregnancy Need to weigh the advantages and disadvantages of mother and child to choose the appropriate antiviral drugs and programs. It is currently advocated that pregnant women with initial genital herpes can be treated with oral acyclovir; those with serious complications that can be life-threatening should be treated with intravenous acyclovir; for pregnant women with frequent recurrence or recent infection of genital herpes, at full term, they can be treated with acyclovir to reduce the appearance of active damage and thus reduce the rate of cesarean delivery; for pregnant women with previous history of recurrent genital herpes but no recurrence at near full term For pregnant women with a previous history of recurrent genital herpes but no signs of recurrence in the last full term, acyclovir treatment may be withheld.
7. Neonatal herpes Acyclovir 30-60mg/(kg.d), intravenous, for 10-21 days.
(B) Local treatment Keep the affected area clean and dry. The lesion can be applied topically with 3% acyclovir cream, 1% penciclovir cream and phthalamide cream. If there is secondary bacterial infection, antibiotics should be added.
(C) Chinese medicine treatment Patients with recurrent genital herpes often have exertion and psychological anxiety. Therefore, along with active antiviral treatment, some Chinese herbal medicines can be given to strengthen the spleen and dampness, clear heat and detoxify and nourish the liver and kidney, nourish yin and clear heat, such as Ginseng and Baijiao San and Zhi Bai Dihuang Wan, which are effective for some patients.
(IV) Psychotherapy As the disease is prone to recurrence and recurrent attacks often bring troubles and anxiety to patients, patients should be given patient and careful psychotherapy to encourage them to enhance their confidence in overcoming the disease and actively cooperate with the treatment.
Six, disease protection
(a) Avoid unclean sexual intercourse and improper sexual relations. Patients with active genital sores are absolutely prohibited from having sexual relations with anyone.
(B) forbidden to have intercourse during the treatment period, if necessary, the spouse should also be examined.
(c) Care for local damage should be taken to keep it clean and dry to prevent secondary infection.
(iv) After recovery or with recurrence, attention should be paid to the prevention of colds, cold, exertion and other triggering factors to reduce recurrence.
(E) After recovery or with signs of relapse, friends need to arrange their work and rest rationally, regulate their diet, and avoid infection transmission between sexual objects.