I. Definition
Genital herpes is a sexually transmitted disease caused by infection with the herpes simplex virus. It is called “hot sores on the pubic area” in Chinese medicine. It mainly damages the skin and mucous membranes of the genitalia of men and women. It is characterized by localized clusters of small blisters, vesicles, and self-conscious burning pain. The disease is a chronic recurrent process, and there is no complete cure.
Pathogens
There are two types of herpes simplex viruses: HSV-1 and HSV-2, and most genital herpes is caused by HSV-2. HSV is a double-stranded DNA virus belonging to the alpha subfamily of human herpes viruses, and humans are the only natural host of HSV.
Latent site: sacral ganglion area
Clinical manifestations
(A) Primary genital herpes
1. Incubation period: 2 to 7 days.
2. Typical: clustered blisters, pustules, ulcers and crusts
3, atypical: non-specific erythema, papules, fissures, nodules, folliculitis, skin abrasion, erythema oozing foreskin glansitis
4. Prevalent sites: male: prevalent in foreskin, glans, coronal groove, penis; female: often occurs in vulva, labia majora and minora, clitoris, vagina, cervix; male homosexuals – anus, rectum.
5. Accompanying symptoms: old lesions fade, and new ones appear next. It is often accompanied by systemic symptoms such as fever, headache, fatigue, myalgia, tenderness and swollen and painful inguinal lymph nodes.
(B) Recurrent genital herpes
Most recurrences occur within 1 year after the primary rash, usually with an interval of 3 to 4 weeks to 3 to 4 months. Fever, cold, premature birth, mental factors, indigestion, chronic illness, fatigue and other factors leading to low resistance often become triggering factors. The clinical manifestations of recurrent genital herpes are similar to the primary and lighter than the primary. 50% of patients have prodromal symptoms such as local itching, burning sensation and tingling at the recurrence site, and the lesions generally subside and heal in 7 to 10 days.
4. The effect of herpes on the fetus in pregnant women
1. Pregnant women infected in the first trimester of pregnancy: babies often have congenital malformations
2. Primary HSV infection occurs in the second trimester: about 50% of infants develop neonatal HSV infection
3. Recurrent genital herpes in pregnant women: the risk of causing HSV infection in newborns is low and usually does not cause preterm birth or low birth weight
4, mother-to-child transmission mostly occurs when the fetus passes through the birth canal, infection of the fetus through the placenta is rare, if there are active lesions should be delivered by caesarean section.
V. Common complications
Meningitis, encephalitis, sacral radiculitis and spinal spondylitis, herpetic dactylitis, and widespread infection of the genitourinary system, etc.
Sixth, laboratory tests
1. Cytological examination (tzanck smear) microscopically reveals multinucleated giant cells or intranuclear viral inclusion bodies.
2, Viral culture with herpes simplex virus and cytopathic lesions. (Gold standard)
Differential diagnosis
The noma is also a painless ulcer, but the base of the noma ulcer is harder; syphilis spirochetes can be detected and the syphilis seropositive.
2. Soft chancre: deep, painful ulcers that do not subside on their own without treatment; swollen and painful lymph nodes that can be punctured; more grayish-yellow or pus-like secretions from the ulcers; soft chancre bacteria can be detected.
3. Contact dermatitis: history of contact allergy, no history of unclean sexual intercourse, redness, papules, papules, blisters, even large blisters and erosion at the contact site; remove the cause and it can be cured in 1 to 2 weeks.
VIII. Diagnosis
1.History of contact
2.Clinical manifestations
3.Recurrence
4.Laboratory tests are generally not recommended
IX. Treatment
There is no specific cure for this disease, and the principles of treatment are to shorten the course of the disease and reduce symptoms; to prevent secondary infections and complications; and to prevent recurrence of the disease.
Some experts point out that primary genital herpes can be treated with antiviral drugs to block the virus from entering the ganglion, which may cure the disease, but once the virus enters the ganglion and turns into recurrent genital herpes, it is difficult to cure.
Western medicine treatment mainly includes local medication, antiviral therapy and improving the immunity of the body.
Chinese medicine emphasizes the identification and treatment, support the righteousness and eliminate the evil, which can not only improve the body’s resistance, but also directly inactivate and remove the virus.
Acyclic guanosine is the most effective anti-herpes simplex virus drug in Western medicine at present, which is taken orally 200mg each time, 4 to 5 times a day. In severe viral cases, it can be given intravenously at 5mg/kg once every 8 hours for 5 to 10 days. Recurrent ones can be used for up to 6 months; other antiviral drugs are also available.
Primary genital herpes can be given as famciclovir capsules, 2 capsules/time, three times a day, orally for 7 to 10 days, and 1 capsule/time, three times a day orally for recurrent cases.
Topical acyclovir ointment, penciclovir ointment, recombinant human a-2b interferon ointment (Andafen, Yuzhinan) in appropriate amounts, with infection can be added erythromycin eye ointment, Bactrim and other drugs.
Ten, prevention and care
1, establish the correct sexual concept, sexual morality, cleanliness, prevention of infection.
2, the use of condoms during sexual intercourse in the quiescent period of infection, and prohibit sexual intercourse during the active period.
3, early pregnancy women with the disease should interrupt the pregnancy, late infection is appropriate to carry out a caesarean section.
4, patients should pay attention to local cleanliness and hygiene.
5, careful living, regulate the mood, in order to reduce recurrence.
6, strengthen nutrition, enhance physical fitness, improve the body’s ability to resist disease.
7, pay attention to the observation of sexual partners, it is best to carry out treatment at the same time.