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, which is more dangerous and has received much attention.
HSV-2 is the main pathogen of genital herpes (90%) and is present in the exudate of skin and mucosal damage, prostatic secretions, 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.
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 the management and prevention of condyloma acuminata.
Genital herpes protection:
1, avoid unclean sexual intercourse and inappropriate sexual relations active genital sores patients are absolutely forbidden to have sexual relations with anyone;
2, during the treatment period forbidden to have intercourse if necessary spouse should also be examined;
3, the care of local damage should pay attention to keep clean and dry, to prevent secondary infection;
4.After recovery or with recurrence, attention should be paid to the prevention of colds, cold, exertion and other triggering factors to reduce recurrence.
Diagnosis and differential diagnosis
The incubation period of primary genital herpes infection is about 3 to 5 days, the affected area first has a burning sensation, erythema, and soon 3 to 10 small blisters in clusters occur on the surface of the erythema, which become small pustules after a few days, and then break down to form a vesicular surface and shallow ulcers, with local redness and burning pain. In female patients, it mostly occurs in the labia, perineum, and vagina, but about 90% of patients can also invade the cervix causing cervicitis or uterine inflammation; in male patients, it mostly occurs in the glans, coronal sulcus, urethral or penile body, and sometimes can be complicated by urethritis. Most patients have bilateral inguinal lymph node enlargement.
Genital herpes mostly occurs at the junction of the skin and mucous membranes, starting with mild localized redness of the skin, followed by clusters of small pinpoint-sized blisters with a mild itching and burning sensation, drying out in a few days and forming brown scabs, with slight hyperpigmentation after the scabs fall off, but also disappearing quickly, all in an average of one week, but recurrence is common.
Transmission route
The source of infection of human genital herpes is the patient and subclinical asymptomatic virus carrier, especially in the patient’s genital skin or mucous membrane herpes simplex virus is contained in the herpes, which can be transmitted to the spouse or other sexual partners through sexual contact, and can also be transmitted among homosexuals. Sometimes people who have herpes in or around the mouth can infect each other with genital herpes through oral-genital intercourse. Thus, heterosexual sex in different ways can also transmit genital herpes disease.
Herpes simplex can also be transmitted indirectly through contaminants because the infectious virus can survive in a moist environment for several hours. Genital herpes is a common sexually transmitted disease, and because genital herpes is contagious even when latent, it can make people unknowingly become both transmitters and victims of herpes.
Prevention and treatment of herpes simplex virus
Herpes simplex virus is the only natural host of the herpes simplex virus, and the sick patient is the source of the disease. Since the virus can infect people’s skin, mouth, nose, eyes and genitals, it may be present in the patient’s saliva, secretions from skin damage, nasal secretions, as well as vaginal secretions and feces.
According to statistics, more than 60% of normal people in the population carry herpes viruses, mainly herpes simplex virus type I. It is possible that this infection has occurred since infancy. Herpes II virus is the main virus that causes genital herpes and is usually found in the cervix, urethra, and vagina of women and in the urethra of men. Sexual transmission is the main mode of transmission of this virus, and women can be infected up to 75% of the time after having sex with a man who has an active herpes virus infection of the genital tract.
In addition, close contact in daily life, such as sharing bath tubs, towels, and toilet seats, can also cause indirect infection.
Common symptoms of the disease can be diagnosed based on the location of the rash and the characteristics of the herpes.
The main points are as follows.
1. After an acute fever, the affected area becomes itchy, tense and uncomfortable, and erythema appears immediately.
2. The erythematous spots rapidly turn into clusters of blisters of corn to green bean size, with transparent or cloudy blistering fluid.
3.After the blisters rupture, the vesicular surface is exhibited. If there is no secondary infection, it will dry and crust after a few days, and temporary pigmentation may remain after the scabs fall off.
4. The nearby lymph nodes may be enlarged.
Commonly used traditional Chinese medicine:
1.After acute fever, the herpes appears around the mouth, lips and nose, with itching and discomfort, accompanied by irritability and dry mouth, red tongue with yellow coating and floating pulse. Treatment: Relieve wind-heat. The following can be used: Yin Qiao Detoxification Pill, Antelope Qiao Detoxification Pill, Huang Lian Shang Qing Jiu, Fang Feng Tong Sheng Pill, etc.
2. Damp-heat infiltration type scar rash is found in the lower yin area, with burning and itching pain, and is accompanied by irritability, restless sleep at night, dry stool and red urine, red tongue with yellow and thick greasy coating, and a string-like pulse or pan count. Treatment: Clear the damp-heat in the liver and gallbladder. Can take: gentian diarrhea of the liver soup, for herpes special herpes without worry combination is very effective.
The disease is a common acute herpetic skin disease caused by a virus. It is mostly seen in middle-aged and elderly people, and is called “tangled waist fire dan” in Chinese medicine, commonly known as “snake dan”.
The following signs and symptoms should be noted.
① sudden onset, before the onset of the rash may have a low fever, fatigue, general malaise and other mild systemic symptoms and skin pinprick-like or burning pain in the affected area, and when the pain is severe, it can be misdiagnosed as an acute abdomen and other diseases.
The most common sites are the chest (intercostal nerve distribution area), the frontal area (trigeminal nerve distribution area), followed by the neck, abdomen and extremities.
The rash is characterized by clusters of shiny blisters of mung bean to rice grain size with a red base, distributed unilaterally along the peripheral nerves and arranged in a band, with normal skin between the clusters of blisters, which break down in about 1-2 weeks, crust or absorb and dry, leaving pigmentation after decrusting. Individuals with severe disease can be generalized, called generalized herpes zoster.
④Neuralgia is one of the characteristics of the disease, paroxysmal, pinprick-like; burning-like or sensory hypersensitivity, the degree of pain increases with age, and the pain is severe and even unbearable in elderly patients.
⑤ The duration of the disease is 3 to 4 weeks, and recurrence is rare. About half of elderly patients have residual neuralgia after the skin fades, often lasting 2 to 6 months or longer.
Symptoms and course
Main symptoms
On average, about 4-5 days after genital herpes HSV infection, there is a burning sensation in the affected area of the vulva, followed by the development of clusters of papules, which can 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, the lesions are most often found on the labia, clitoris, mons pubis, cervix, etc., and also on the urethra. Primary genital herpes is often associated with systemic symptoms such as general malaise, low-grade fever, headache, and enlarged local lymph nodes. The disease often recurs, 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 ulceration in the lower rectum.
Clinical manifestations of primary genital herpes
The incubation period is 2 to 10 days, with an average of 6 days. The site of onset is the foreskin, glans, coronal sulcus, and penis in men. Occasionally, it can occur in the urethra, prostate and seminal vesicles, and in homosexuals, in the anus and rectum; in women, in the vulva, labia majora and minora, clitoris, vagina, cervix, and also in the anus, rectum and urethra.
The symptoms of primary infection are often more serious. Before the appearance of blisters, there is often burning, itching or abnormal sensation at the inoculation site, increased leucorrhea in women, followed by the local appearance of light red spots or papules, on the basis of which sesame to mung bean-sized clusters of tense blisters quickly appear, the blistering fluid is clear at first, and gradually may become cloudy or even purulent. The walls of the blisters are thin and easily break down to form larger ulcers, which are painful and more pronounced when touched.
Clinical manifestations of recurrent genital herpes
Often occurs within 1 to 3 months after primary genital herpes. Those caused by HSV-2 infection have a higher recurrence rate and a higher frequency of attacks. About 60% of patients have a recurrence within 1 year after the first infection, and the number of episodes in the first year is 4 to 6, with some as many as 10 or more. The symptoms of recurrent genital herpes are less severe than those of primary genital herpes.
Recurrent genital herpes can be combined with sacral radiculopathy: manifested by pain or abnormal sensation in the buttocks or femur, urinary retention, and inability to get an erection. Other comorbidities include proctitis, prostatitis, and urethritis syndrome. The risk of cervical cancer in women is 5 to 10 times greater than in the general population.
Sources of genital herpes infection
Humans are the only natural host of herpes simplex virus. Patients during the onset and recovery period, as well as so-called healthy carriers who do not show symptoms, are the source of the disease. Transmission occurs mainly through the virus present in the blistering fluid of the lesion, saliva and feces. The disease is transmitted mainly through sexual intercourse and less frequently through indirect transmission from contaminated objects.
In addition, mothers with genital herpes can transmit the virus directly to their newborns through the birth canal during childbirth, or during pregnancy, when the body’s resistance is low, the virus can be transmitted to the fetus through the placenta. Certain factors such as emotional stress, fever, menstrual flow, and sexual activity can activate the virus latent in the ganglia and then travel down the peripheral nerves to the epidermal cells causing localized lesions.
The source of infection of genital herpes is the patient and the person with the virus, especially in the genital skin or mucous membrane of the patient contains herpes simplex virus, which can be transmitted to the spouse or other sexual partners through sexual contact, and can also be transmitted among homosexuals. Sometimes people who have herpes in or around the mouth can infect each other with genital herpes through oral-genital intercourse.
Thus, different modes of heterosexual sex can also transmit genital herpes disease. Herpes simplex can also be transmitted indirectly through contaminants because the infectious virus can survive in a moist environment for several hours. Because genital herpes is also contagious in latency, it can make a person a transmitter and victim of herpes without even knowing it.
The doctor suggests that regardless of whether your sexual partner is safe and healthy, it is best to use condoms and to use them throughout the entire process; in addition, it is best to avoid situations such as complicated sexual partners in order to avoid genital herpes infection, and if you have a sexual disease, you must also treat it with your sexual partner in order not to infect each other again and again, and how to treat it can not be cured.
Male genital herpes symptoms
On the glans, coronal groove, urethral opening, penis, scrotum, thighs and arms. Most male patients have enlarged lymph nodes in the groin bilaterally. 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 a pustule, broken to form a large erosion and ulcers, self-conscious pain, and finally crust healing. Finally, the scab will 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 involves the mouth and 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. If the infection is transmitted to the newborn during delivery, the fetus will have encephalitis, so the risk of sexually transmitted diseases to women is much more serious than to men.
The incubation period of HSV infection is 2-10 days, with an average of 6 days.
HSV-1 infection and HSV-2 infection: primary genital herpes infection is HSV-1 type, after a certain period of quiescence, followed by recurrent lesions as HSV-2 type, forming periodic recurrences. The duration of each episode is also short and can usually subside without medication for about 7 days, followed by recurrence. Fever, menstruation, mental trauma, alcohol, food and medication may all lead to a faster recurrence time. HSV-1 mainly causes herpes of the mouth and lips, pharyngitis, keratoconjunctivitis and disseminated encephalitis, while HSV-2 infection mainly causes genital herpes, although the opposite is also clinically true.
HSV-1 infection occurs mainly at the corners of the mouth, lip margins, nostrils and other skin-mucosal junctions, but also on the face or lips, starting with localized itching and mild tension, occasionally accompanied by neuralgia. Erythema appears immediately, followed by clusters of small papules on the basis of erythema, which rapidly turn into blisters of corn to green bean size, with clarified contents, and vesicles appear after the rupture of the blisters, which dry and crust after a few days. Itching, occasional fatigue, discomfort and mild fever are the systemic symptoms. The total duration of the disease is about 1-2 weeks.
HSV-2 infection mainly occurs in the genital area, the affected area first has a burning sensation, soon on the basis of the erythema of a group of small blisters, mostly seen in the male foreskin, glans, coronal groove, penis, etc., occasionally seen in the urethra; women commonly in the labia, clitoris, vagina, cervix and other places. The blisters can gradually turn into pustules and break down in about 6 days to form vesicles or shallow ulcers, which are painful to feel. Patients may develop urethritis and have difficulty urinating.
Most people have painful swollen inguinal lymph nodes, and some patients may develop fever, muscle pain, and meningitis symptoms. If it occurs in the female cervix, ulcers and necrosis may form, vaginal discharge may increase, and lower abdominal pain may be present. Attention should be paid to the occurrence of cervical cancer. Genital herpes during pregnancy can cause miscarriage, premature birth or stillbirth, and can easily infect newborns with neonatal herpes simplex.
The disease is usually cured after about 3 weeks, but there are often recurrent episodes, usually within 2 to 5 months after the primary rash, the symptoms are lighter than the primary, the scope is small, limited to the genital area, sometimes there are only 1 to 2 herpes, and the course of the disease is short, from the onset to healing 6 to 10 days. The disease can also be associated with infections in areas other than the genital area, such as the mouth, lips, arms and central nervous system.
Types of genital herpes
Among patients with initial genital herpes infection, 80% to 90% have latent infection, i.e., no clinical symptoms, and only a minority have overt infection, with most turning into latent infection after recovery from either initial overt or latent infection. The latent period is 1 week to 2 months.
1, primary genital herpes incubation period of 2 to 7 days, the primary damage is one or more small and itchy red papules, quickly become small blisters, 3 to 5 days later can form pustules, break down to form vesicles, ulcers, crusting, accompanied by pain. The lesions may be solitary or fused, and in men they are more likely to occur on the glans, coronal sulcus, penile body or urethral orifice, while in women they are more likely to occur on the labia, perineum or vagina, and about 90% invade the cervix at the same time. It is often accompanied by fever, headache, malaise, myalgia, inguinal lymph node enlargement and pressure pain. The symptoms last 1 to 2 weeks, and the lesions usually crust and heal in 3 to 4 weeks.
2. Recurrent genital herpes mostly recurs within 1 to 4 months after the primary infection. The clinical manifestations of recurrent genital herpes are similar to those of the primary, but the symptoms are mild, the rash is small in extent, and the duration of the disease is short, usually healing spontaneously within a few days. One to two days before recurrence, there are often local prodromal symptoms such as tingling or burning sensation. The vast majority of patients with recurrent genital herpes seen clinically are men, and female patients often do not come to the clinic due to the lack of obvious symptoms. Recurrence is associated with fever, menstruation, sun exposure, cold, and certain viral infections.
3, rectal-anal herpes virus infection occurs in men who have sex with men. The patient has anorectal pain, anal discharge, and a feeling of urgency during stool.
4, pregnant women, neonatal HSV infection primary genital herpes in pregnant women can often lead to miscarriage, premature birth, fetal abnormalities or even stillbirth. 50% of neonatal infections occur during delivery through the birth canal of a pregnant woman with primary infection, which can result in high fever, herpes, enlarged liver and spleen lymph nodes, encephalitis, or even sepsis, which can lead to death. In the case of a recurrent infection in a pregnant woman, the chance of infection in the newborn is only 5%.
How to diagnose genital herpes recurrence
It is a very common viral skin disease, and its recurrence is quite strong, but many people will mix it with other diseases, so for how to diagnose genital herpes recurrence, in fact, recurrent genital herpes occurs mostly in the vagina, cervix, glans and vulva and other parts, and the onset of the urethra is less common.
The recurrence is usually in the same place. The systemic symptoms are milder, and the number of blisters and their duration and self-consciousness are less severe than in primary cases.