Genital herpes is a sexually transmitted disease caused mainly by herpes simplex virus II (HSVII). Its incidence in Western countries is second only to gonorrhea and non-gonococcal urethritis. The disease is highly prevalent and can infect newborns through the placenta and birth canal, leading to miscarriage and neonatal death, and is also associated with the development of cervical cancer.
Etiology
HSV-2 is the main pathogen of genital herpes (90%) and is found 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 hosts of herpes virus, and the virus cannot survive outside the body. UV light, ether and general disinfectants can inactivate it.
Principles of treatment
The principle of treatment is the timely and adequate use of antiviral drugs to reduce symptoms, shorten the course of the disease and control the transmission and recurrence of herpes. It is recommended to judge the healing and prognosis of the affected area with complete regression of herpes damage, disappearance of pain, abnormal sensation and swollen lymph nodes. Although prone to recurrence, healing is good and management and prevention should be reported in cases of genital herpes diagnosed for the first time. The rest can be referred to Management and prevention of condyloma acuminata.
Symptoms of genital herpes in men
On the glans, coronal groove, urethral opening, penis, scrotum, thighs and arms. Most male patients have bilateral enlarged inguinal lymph nodes. The clinical manifestations of genital herpes can be divided into primary and recurrent, primary refers to the first infection with the virus, generally from contact to the onset of about 2 to 10 days, that is, the incubation period, the existing burning sensation at the site of the disease, soon on the basis of erythema 3 to 10 clusters of red papules, accompanied by itching, papules soon become small blisters, 3 to 5 days later into pustules, rupture to form a large vesicles and ulcers, self-conscious pain, and finally crust healing. Finally, the scabs heal.
The entire course of the disease can last about 20 days. In men, it is more common on the glans, coronal sulcus, urethra, penis, scrotum, thighs and arms. In the 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 that appear at the same time, such as fever, general malaise, headache, neck tonicity, meningitis and sacral neurological insufficiency.
Female genital herpes symptoms
Female genital herpes symptoms are associated with low-grade fever, chills, abdominal pain, nausea, enlarged inguinal lymph nodes, and complications of cervicitis and uterine inflammation. In addition, female genital herpes symptoms may be accompanied by other symptoms, such as fever, general malaise, headache, cervical tonicity, membranous inflammation and sacral neurological insufficiency.
Genital herpes can cause herpes simplex on the lips if it affects the lips. If a pregnant woman is infected with the herpes virus, it can be transmitted from the placenta to the fetus, resulting in microcephaly, congenital heart disease, limb loss, and microphthalmia in the offspring. The risk of sexually transmitted diseases to women is much more serious than that to men.
Common treatments for genital herpes
For the treatment of genital herpes, general treatment, treatment is not yet able to completely remove the virus, nor can it stop the recurrence of the disease. The purpose of treatment is mainly to relieve symptoms, reduce pain, shorten the course of the disease and prevent secondary infections.
The current treatment is divided into general treatment, antiviral treatment and Chinese herbal medicine treatment, all of which are necessary. General treatment is in fact symptomatic treatment, while antiviral treatment is causative treatment, and Chinese herbal medicine treatment mostly treats both symptoms and root causes through evidence-based treatment, effectively stopping recurrence.
(1) General treatment
① Mainly to keep local cleanliness, dryness and herpes wall intact. It can be cleaned with isotonic saline every day, and painful people can take oral painkillers and give mental comfort.
(2) For complications of bacterial infection, topical antibiotic ointment can be used.
③ For obvious local pain, 5% lidocaine hydrochloride ointment or oral painkillers can be used.
④Spiritual reassurance about the causes of recurrence and how to treat and handle it.
⑤ Female recurrent genital herpes should undergo gynecological examination to exclude cervical cancer.
(2) Anti-viral drug treatment
①Acycloguanosine (acyclovir tablets) is considered to be the most effective anti-HSV drug at present. In severe cases, it can be given intravenously at a dose of 5mg per kg of body weight once every 8 hours for 5-7 days. For general patients, it can be given orally at 200mg per dose, 4 to 5 times daily for 7 to 10 days. In severe cases, it can be injected intravenously and the affected area can be rubbed externally with acyclic guanosine ointment.
②Triazole nucleoside is an analogue of guanine nucleoside, which has anti-DNA and RNA viral effects. 800mg per day for 10 days can reduce pain and shorten the course of the disease.
③Immunostimulants Oral levamisole has certain efficacy, but some reports are less certain. In vitro interferon was found to have an inhibitory effect on HSV, and the clinical therapeutic effect is still under study.