Genital herpes is a chronic, recurrent, incurable STD caused by herpes simplex virus (HSV) infection of the genitourinary and perianal skin mucosa. the incidence of this disease has been increasing over the last 30 years and has become the leading cause of genital ulcers in many countries and regions.
Genital herpes can cause a range of complications including disseminated HSV infection, viral meningitis, pelvic inflammatory disease, and in pregnant women, fetal infection and neonatal herpes. In areas where HIV is endemic, genital herpes increases the risk of HIV infection, while HIV infection also changes the epidemiological profile and clinical features of genital herpes. Female genital herpes is also strongly associated with the development of cervical cancer.
Transmission routes
HSV is present in the exudate, semen, prostate fluid, cervical and vaginal secretions and is transmitted mainly through sexual contact.
Clinical presentation
The disease occurs in sexually active men and women between the ages of 15 and 45. The prevalent sites are the genitalia and perineum. In men, it is more common in the foreskin, glans, coronal sulcus and penis; in women, it is more common in the labia majora and minora, mons pubis, clitoris and uterus; in rare sites, it is more common in the perineum, groin, buttocks and scrotum; in male homosexuals, it is more common in the anus and rectum.
There are three clinical types: primary, recurrent and subclinical. The severity of clinical symptoms and frequency of recurrence are influenced by the virus type and the immune status of the host.
1. Primary genital herpes is the first infection with HSV-1 or HSV-2.
The incubation period is 2 to 14 days, with an average of 3 to 5 days; the lesions are clusters or scattered small blisters, which break down after 2 to 4 days to form vesicles or ulcers, and then heal spontaneously with crusting; they are painful. It is often accompanied by inguinal lymph node pain, fever, headache, malaise and other systemic symptoms. The duration of the disease is usually 2 to 3 weeks.
2.Recurrent genital herpes
This refers to the recurrence of genital herpes within 1 to 4 months after the primary genital herpes lesions have subsided, and the lesions usually appear at the original site. The lesions are similar to primary genital herpes, but the disease is lighter, the course is shorter, and there are often prodromal symptoms (such as local burning sensation, pins and needles or abnormal sensation, etc.) before the rash develops; the course of the disease is usually 7 to 10 days; it can recur several times at intervals of 2 to 3 weeks or months. In male homosexuals, the anus and rectum can be involved, manifesting as local pain, constipation, urgency, perianal ulcers, etc. Sigmoidoscopy can reveal mucosal congestion, bleeding and ulcers in the lower rectum.
3. Subclinical genital herpes
Fifty percent of HSV-1-infected patients and 70% to 80% of HSV-2-infected patients lack typical clinical manifestations and are the main source of genital herpes infection. The atypical lesions may appear as tiny fissures and ulcers in the genital area and are easily overlooked.
Genital herpes during pregnancy can cause intrauterine growth retardation, miscarriage, premature birth or even stillbirth, and birth can also cause fetal infection. Genital herpes can cause a series of complications such as disseminated HSV infection, viral meningitis, and pelvic inflammatory disease.
Diagnosis and differential diagnosis
The diagnosis of this disease is mainly based on medical history (history of sexual contact or spousal infection, etc.), typical clinical manifestations and laboratory test results. The disease should be differentiated from contact dermatitis, herpes zoster and leukoaraiosis.
Treatment plan
Patients should pay attention to rest, avoid drinking alcohol and excessive sexual life; avoid sexual life when clinical symptoms appear; genital herpes during pregnancy should be delivered by cesarean section if the disease becomes active before delivery.
1, internal drug treatment
(1) Primary, recurrent: vaxilovir 2000mg/d in 2 oral doses for 10 days; or famciclovir 750mg/d in 3 oral doses for 5 days.
(2) Frequent relapsers (6 relapses in 1 year): To reduce the number of relapses, viral suppression therapy can be applied, and valacyclovir 500mg/d orally, generally need to be taken orally for 6-12 months continuously.
2.Topical drug treatment
The affected area should be kept clean and dry. The lesions can be treated with topical 3% acyclovir ointment, 1% penciclovir cream and phthalamide cream, etc.
Cost
The price of valacyclovir and famciclovir is about 30 yuan.