Genital herpes is a sexually transmitted disease caused mainly by herpes simplex virus II (HSVII). It is second only to gonorrhea and non-gonococcal urethritis in Western countries, and is one of the common sexually transmitted diseases in China. 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 harmful and has no specific treatment.
[Etiology]
Genital herpes is caused by herpes simplex virus (HSV) infection. HSV-1 is transmitted through the inhalation tract, skin and mucous membranes in close contact, mainly causing infections of the mouth, throat, eyes and skin, and in a few cases (about 10%) also causing genital infections. HSV-2 is the main pathogen of genital herpes (90%) and is present in the exudate of skin and mucous membrane damage, semen, prostatic secretions, cervical and vaginal secretions. It is transmitted mainly through sexual intercourse and causes 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 some 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.
[Clinical manifestations]
On average, about 4-5 days after infection, there is a burning sensation in the affected area of the vulva, followed by the development of clusters of papules, which may be one or more clusters, followed by the formation of blisters. After a few days, it evolves into a pustule, which breaks down and forms a vesicle or shallow ulcer, which is painful and finally crusts over and heals itself. The lesions are mostly found on the foreskin, glans, coronal sulcus and penis in men, and occasionally on the urethra; in women, they are mostly found on the labia, clitoris, mons pubis and cervix, and also on the urethra. Primary genital herpes is often accompanied by systemic symptoms such as general malaise, low-grade fever, headache, and swollen local gonads. The disease is often recurrent, and recurrent genital herpes is less severe than primary, with less damage and often no systemic symptoms. Male homosexuals can develop anorectal HSV-2 infection, which is second only to gonococcal anorectitis in incidence. Clinical manifestations include anorectal pain, constipation, increased discharge and urgency, perianal herpetic ulcers, and sigmoidoscopy commonly shows mucosal congestion, bleeding and small ulcers in the lower rectum.
[Diagnosis]
The diagnosis is not difficult based on typical features such as clusters of blisters on the vulva, local burning sensation, history of recurrence, and short duration of disease. Laboratory diagnosis can be made for some atypical damages, and the commonly used laboratory diagnostic methods are
(1) Cytologic diagnosis: smear the cells at the base of the lesion with Ritkissa or Papanicolaou stain to look for large multinucleated giant cells and eosinophilic inclusions in the nucleus of multinucleated giant cells to help in the diagnosis.
(ii) Herpes virus cytology: smear of cells with fluorescently labeled monoclonal antibodies against HSV-1 and HSV-2, and fluorescence microscopy for apple-green fluorescent viral inclusions in multinucleated giant cells can be diagnostic.
③Herpes virus tissue culture: Human embryonic fibroblasts, human amniotic cells, and kidney cells are used for virus isolation and culture, and identification by immunofluorescence method can be confirmed, but the operation is complicated and expensive.
④Electron microscopy: It has a confirmatory value but is not easily popularized.
⑤Serological diagnosis of herpes virus: detection of HSV-specific antibodies is of little practical value in diagnosis.
[Treatment]
(i) Systemic treatment
Acyclovir is a highly broad-spectrum antiviral drug that inhibits viral DNA polymerase and prevents DNA synthesis. It is given orally at 200mg 5 times a day for 10 days. Or intravenous administration of 5mg/kg once every 8 hours for 5 days.
Acitretinide 0.2-2mg/kg, intravenous for 5 days.
Phalloidin inhibits the replication of HSV and is effective in recurrent herpes.
Polymyxin 2mg intramuscularly once every 2-3 days.
Intravenous or subcutaneous injection of a2 interferon, transfer factor intramuscular injection, levamisole and other internal administration also have certain efficacy.
(B) Local treatment can be used topically with compound zinc copper wet compresses, 5% acyclovir ointment, phthalamide ointment, 0.1% herpes net solution, 0.1% gentian violet solution, etc.