1. What is herpes simplex virus? What is the typing?
Herpes simplex virus (HSV for short) is an NDA virus with a diameter of about 120-150 microns, consisting of three concentric structures in the order of envelope, body and capsid. Humans are the only natural hosts of herpes simplex virus, with up to 80-90% of the population infected and 10% asymptomatic. Herpes simplex virus is particularly sensitive to ether and lipid solvents. It can survive for months at low temperatures and can be destroyed in 30 minutes at 50°C in humid heat and 90°C in dry conditions.
Herpes simplex virus can be divided into two types, HSV-Ⅰ and HSV-Ⅱ, depending on antigenicity. HSV-Ⅰ is mainly transmitted through close contact with the whistle, skin and mucous membranes, infecting skin mucous membranes and organs above the waist, such as causing inflammation and herpes in the mucous membranes of the mouth and lips, nasal vestibule, conjunctiva, and pharynx. Herpes occurring around the mouth and orifice is 99% caused by HSV-Ⅰ infection. HSV-Ⅱ mainly exists in the cervix, vagina, vulvar skin of women and penis and urethra of men, and is the culprit of genital inflammation and herpes. According to statistics, there is also a crossover between the infection sites of these 2 types of viruses. 90% of the pathogens of genital herpes are type II herpes viruses, and only 10% are HSV-Ⅰ.
2. Is genital herpes an STD?
Genital herpes is mainly caused by herpes simplex virus HSV-II will cause. The disease is clearly defined as one of the sexually transmitted diseases, both domestically and abroad. In foreign countries, the incidence of genital herpes is the third most common STD after gonorrhea and syphilis, and the first among STDs caused by viruses. In China, genital herpes is also showing an increasing trend year by year.
3. How is the herpes simplex virus transmitted?
Herpes simplex virus is mainly transmitted through direct close contact and sexual contact, HSV is found in the herpes fluid, oral and nasal secretions and feces of infected persons, among which herpes II virus is mainly found in the cervix, vagina, vulva skin of women and penis and urethra of men.
4.Does herpes simplex virus infection in pregnant women affect the fetus?
The fetus may be infected through the placenta during pregnancy and through the birth canal during delivery. Occult infection is common, with only 10-20% of first-time infections showing symptoms. Initial HSV infection in pregnant women is more likely to affect the fetus or newborn than recurrent pregnancies, mainly because recurrent pregnancies already have antibodies to the virus in their bodies. Intrauterine herpes infection in the fetus can lead to miscarriage, preterm delivery, stillbirth and birth defects. Pregnant women infected with the virus deliver newborns through the birth canal, causing neonatal herpes, leading to neonatal encephalitis with a high mortality rate (70-80%) and survivors mostly suffering from central nervous system sequelae.
5.What is the incubation period of herpes simplex?
HSV invades mucous membranes or broken skin, and after an incubation period of about 1 to 26 days (average 5 to 7 days), it produces erythema, papules and blistering damage at the invasion site. The incubation period for individual patients can also be months.
6. Why is genital herpes prone to recurrence?
Herpes simplex infection produces neutralizing and complement binding antibodies in the body after 1-3 weeks, and the residual virus may be transferred to the peripheral nerves along the nerve axis into the trigeminal ganglion (herpes virus type I) or sacral ganglion (herpes virus type II), where it remains latent for a long time and enters a quiescent state. When some triggering factors such as anxiety, trauma, cold, trauma, infection, drug allergy, high fever, menstruation, pregnancy, etc. disrupt the body’s physiological balance, specific transcriptase required for virus proliferation appears in the nerve cells, activating the virus and causing recurrence. humoral antibodies do not stop herpes virus recurrence, and weakened cellular immunity has a significant impact on recurrence. the recurrence rate of genital herpes in HSV-1 infection is much higher than that in The recurrence rate of genital herpes with HSV-1 infection is much lower than that of genital herpes with HSV-2 infection.
7. What are the manifestations of HSV infection?
HSV-I is mainly transmitted through close contact with the whistle, skin and mucous membranes, and infects the skin mucous membranes and organs above the waist. Such as causing inflammation and herpes in the mucous membrane of the mouth and lips, nasal vestibule, conjunctiva, pharynx, and herpes around the mouth and mouth, 99% is caused by herpes virus infection type Ⅰ. It is also known as “fire” in China.
In men, HSV-II is found on the glans, coronal sulcus, urethra, penis, scrotum, thighs and buttocks. In women, it is more common in the labia, mons pubis, clitoris, perianal area or vagina. In about 90% of patients, the virus may also invade the cervix, presenting with increased vaginal discharge or lower abdominal pain, and may be complicated by cervicitis and uterine inflammation. Most patients of both sexes have bilateral enlarged inguinal lymph nodes. In later stages, when the inflammation spreads to the urethra and bladder, there may be difficulty in urination, painful urination, frequent urination, and in severe cases, urinary retention. In addition, there may be other symptoms present at the same time, such as fever, general malaise, headache, cervical tonicity, meningitis, and sacral neurological insufficiency. The disease is more common in women than in men, and the symptoms are more severe than in men.
8. What are the typical manifestations of genital herpes?
When first infected with the genital herpes virus, it usually takes about 2-10 days from the time of contact to the onset of the disease, which is the incubation period. The site of the disease first has a burning sensation, and soon 3-10 red papules occur in clusters on top of the erythema, accompanied by itching, the papules soon become small blisters, and after 3-5 days become pustules, which break down to form large vesicles and ulcers, and feel painful, and finally heal with scabs. The entire course of the disease can last about 20 days. Between 50% and 70% of patients with genital herpes do not show any symptoms. Among patients with genital herpes, male homosexuals can develop anorectal infection with rectal herpes virus type II, which is second only to gonococcal anorectitis in men. The clinical manifestations are severe anorectal pain, constipation, pus discharge and urgency, and blisters and ulcers in the anus.
9.What is an asymptomatic HSV infected person? Is it necessary to have symptoms to be infected?
Not every infected person will show discomfort or clinical manifestations after HSV infection, only 10%-20% of patients have symptoms, and the virus is still active in asymptomatic patients. This is the reason why HSV transmission is increasing year by year and is difficult to control. According to foreign studies 45% of HSV-infected patients never realize they are HSV patients. Therefore, even patients who have no clinical symptoms may infect people.
10.What is the significance of herpes simplex virus typing test?
Herpes simplex has a high infection rate, latent infection and an epidemic trend of transmission that increases year by year and is difficult to control. For pregnant women and perinatal women: detection of herpes simplex can prevent the birth of unhealthy and mentally retarded children; reduce the incidence of neonatal herpes; and provide a reference for the choice of caesarean section. For sexually active people: testing can reduce sexual contact infections. Testing of immunocompromised populations may prevent hepatitis and pediatric encephalitis in immunocompetent children and reduce mortality from acute episodes of herpes simplex in patients using immunosuppressive drugs.
Because of the cross-infection that can occur between HSV-I and HSV-II and the differences in the severity of disease and illness that each causes, it is increasingly important to provide clinical typing for diagnosis. Treatment options and prognosis differ for different types of herpes virus infections. Approximately 90% of people with first genital herpes HSV-II infection will experience a recurrence within 12 months (average of 4 recurrences), whereas only 50% of people with first HSV-Ⅰ infection experience a similar recurrence (average of less than 1 recurrence.) The recurrence rate of HSV-II infection is highly variable, with most recurrences occurring 5-9 times per year, usually within 1-6 months after the primary herpes has subsided.
11. What is the clinical significance of HSV type-specific serological tests?
HSV-specific serological tests can accurately determine the disease. Specific IgM antibodies appear about 2-3 days after the first HSV infection, and peak IgM antibodies reach about a week. The level of IgM antibodies is maintained for a period of time thereafter and decreases rapidly during the healing period, with the antibodies basically undetectable after 8 weeks of infection. Thereafter, it declines slowly until the healing period when it maintains equilibrium. Specific IgG antibodies rise rapidly upon HSV reinfection and peak within a week, after which they rapidly return to normal levels. Therefore, the combined use of HSV1 and HSV2 specific serologic tests can accurately determine the stage of progression, severity, and onset cycle of HSV infection and other important information to accurately determine the disease. Type-specific serologic antibody testing is the most feasible means of detecting subclinical asymptomatic infections, and therefore type-specific serologic diagnosis is important for preventing sexual and mother-to-child transmission of genital herpes. Type-specific serologic diagnostic methods will play an important role in clinical research, epidemiologic studies, and surveillance of genital herpes.
12. Can women with genital herpes get pregnant and have children?
First, women with genital herpes are fully capable of having a safe pregnancy and normal vaginal delivery. This is especially true in women who have been diagnosed with genital herpes before they become pregnant. In cases where a pregnant woman already has a history of genital herpes infection, antibodies are present in her bloodstream and will protect the fetus during pregnancy and delivery.
The fetus is at risk of herpes infection only in two cases.
1. A severe first episode in early pregnancy (within the first 12 weeks of pregnancy) can lead to miscarriage, which is rare. In fact, this risk is also present in the case of many other viral infections, including influenza.
2. When a first attack occurs in the second trimester (the last trimester), a large amount of virus is present in the mother’s body and there is not enough time to produce antibodies to protect the fetus. Transmission of the virus to the fetus can result in neonatal herpes in particular, which can lead to neonatal death. However, neonatal herpes is extremely rare in developed countries. Careful monitoring, judicious use of antiviral therapy and/or cesarean section may reduce the risk of this neonatal infection.
13. What should I be aware of during pregnancy in patients with genital herpes?
If a pregnant woman has genital herpes herself or her sexual partner, it is important to inform her doctor of this condition.
When the male partner has genital herpes and the woman has no evidence of herpes infection, the following measures may help the woman avoid acquiring the virus during pregnancy: blood tests to determine if the woman has antibodies to HSV; condom use after conception until delivery; oral antiviral medication for the male partner to suppress recurrence of genital herpes during pregnancy; if the partner has facial herpes or oral herpes If the sexual partner has facial or oral herpes, avoid oral sex during pregnancy.
During the perinatal period, regular check-ups should be performed, while the pregnant woman and her doctor can discuss the possibility of a cesarean section or the use of antiviral medication. In addition to this, the pregnant woman should follow the general pregnancy health guidelines as completely as possible. During pregnancy, good nutrition and rest are needed.
14. What should I do if I have frequent recurrences of genital herpes?
Due to the many factors affecting the recurrence of genital herpes, some patients have frequent recurrences despite paying close attention to daily life such as diet, rest and warmth, abstaining from sex and strengthening physical exercise. Such patients are often very distressed and have a heavy psychological burden. In such cases, long-term suppressive therapy is available, i.e., acyclovir and other drugs are used, and the medication is continued for at least 6 months-1 year, with discontinuation considered according to the patient’s psychological adaptation to the disease and the frequency of disease recurrence. The disease basically does not recur while taking the medication, but some patients will relapse after stopping the medication.
The safety of these drugs is very good, and long-term use of the drug will not have adverse effects on the body. If acyclovir is not effective, it can also be replaced with drugs such as valacyclovir and famciclovir. Therefore, for patients with prodromal symptoms of recurrence, i.e., local itching, burning, tingling, vague pain, numbness, perineal swelling and other discomfort in the genital or anal area for a few hours to a few days before recurrence, they can start taking the medication on their own at the onset of prodromal symptoms for 1 to 3 days, which also eliminates the suffering of recurrence and saves money at the same time. In general, the recurrence of genital herpes is mostly reduced over time, so patients can not worry too much.
15. How is genital herpes transmitted?
Genital herpes is transmitted from symptomatic patients and asymptomatic infections. Asymptomatic infections and atypical patients are the main source of infection for the disease. Most people with genital herpes contract the disease during sexual contact with sexual partners who are often unaware that they have genital herpes. It is highly contagious when symptomatic, while asymptomatic infections and the asymptomatic phase of recurrent patients can also be contagious. Genital herpes is transmitted through sexual contact and mother-to-child and mother-to-fetus transmission. Sexual contact transmission is the main route of transmission and includes genital intercourse, oral sex and anal sex. Vertical transmission refers to mother-to-infant and mother-to-fetus transmission, including intrauterine infection and infection through the birth canal. Herpes simplex virus is present in the cervix, vagina, urethra, vulva and anus of female patients and in the penis, urethra, anus and semen of male patients. When the mucous membrane of the skin of the sexual organs is rubbed during sexual intercourse, virus particles can enter the skin mucous membrane cells through tiny fissures that cannot be detected by the naked eye, and the virus replicates and multiplies within the cells and destroys them, thus damaging the skin mucous membrane.
Barrier contraception such as condoms can greatly reduce the risk of transmission of genital herpes (especially asymptomatic genital herpes), but infection can occur during sexual intercourse with skin lesions, even if condoms are used. Herpes simplex virus vaccination is the best way to prevent genital herpes, but the herpes simplex virus vaccine is currently only in clinical trials in a few countries, including the United States. Therefore, as with other STDs, being clean and eliminating multiple partners is a fundamental measure to prevent genital herpes.
16.Why do I need to treat genital herpes?
Genital herpes is a sexually transmitted disease that can cause spousal transmission, and the high recurrence rate can seriously affect the quality of life, as well as have a negative impact on fertility and may cause additional diseases or sequelae.
17. How to treat genital herpes?
Please see: Ministry of Health 2000 Genital Treatment Program and US CDC 2006 Guidelines Genital Treatment Program, specific treatment plans need to be developed by doctors according to different conditions.
18.How to prevent the recurrence of genital herpes?
Although genital herpes has a high recurrence rate, it is not an incurable disease. After treatment, the number of recurrences will gradually decrease or not recur with the strengthening of the body’s immune system. The patient needs to pay attention in daily life is not overly nervous, regular life, strengthen exercise, too much psychological burden will trigger the disease. Under the guidance of the doctor, it is reasonable to use condoms to avoid infecting the spouse or sexual partner. You should also actively mobilize your sexual partners for examination and treatment. Work or recreational fatigue or strain should be avoided, and alcohol consumption, especially drunkenness, should be avoided. If the patient is planning to get married or pregnant, he/she should first undergo standardized treatment and fully consult the doctor.