Genital herpes: how to live a full life

Recurrent herpes of the external genitalia

Typical recurrent herpes on the skin and mucous membranes of the genital organs, usually in the same place, subjective: burning, itching manifested by repeated blistering rashes.

Atypical forms of recurrent herpes, which greatly complicate the diagnosis.

In atypical forms, either one of the stages of development of the inflammatory process in the lesion predominates (erythema, blistering), or one of the components of inflammation (edema, hemorrhage, necrosis), or subjective symptoms (itching), which give the corresponding name to the atypical form (erythematous, bullous, hemorrhagic, necrotic, itchy, etc.).

Atypical forms of herpes of the external genitalia are more common in women than in men.

The subclinical (asymptomatic) form is manifested by microsymptoms: short-term (less than a day) appearance of one or several microcracks, accompanied by slight itching. Sometimes there are no subjective sensations, which reduces the number of patients visiting medical institutions and complicates diagnosis.

The subclinical form is detected mainly during virological examination of sexual partners of patients with any sexually transmitted infection, or during examination of married couples with impaired fertility.

Clinical diagnosis of abortive course, atypical and subclinical forms of RGG is difficult and can only be made using virological research methods.

A feature of genital herpes is multifocality. The pathological process often involves the lower part of the urethra, the mucous membrane of the anus and rectum.

Organs of the genitourinary system in women and men that may be affected:

• entrance to the vagina;
• vagina;
• vaginal part of the cervix;
• cervical canal;
• urethra;
• bladder;
• anus;
• rectal ampulla;
• mucous membrane of the uterine cavity;
• body of the uterus;
• the fallopian tubes;
• ovaries;
• prostate;
• seminal vesicles;

Genital herpes during pregnancy

Is genital herpes transmitted from mother to fetus in pregnant women?
If primary infection with the virus occurs during pregnancy, especially in the first half, then there is a possibility of the virus entering the fetus with the development of intrauterine infection and impaired fetal development. This is a serious complication of genital herpes, and, fortunately, it is very rare. If the virus was present in a woman’s body before pregnancy, then her immune system, already familiar with the herpes virus, effectively protects the fetus during pregnancy, and infection is possible only during childbirth, and then with the condition that at this moment the disease is in the active phase. Therefore, it is especially important not to miss relapses of genital herpes activity during pregnancy in order to begin treatment on time and prevent transmission of the virus to the child during childbirth.

How to treat herpes

Treatment for genital herpes has the following goals:

• preventing the development of infection;
• shortening the clinical course of the disease and reducing the incidence of complications of primary infection (such as aseptic meningitis and urinary retention);
• relapse prevention;
• preventing disease transmission.

Treatment of herpes infection is a complex task and is carried out in two directions: the use of antiviral chemotherapy drugs and the use of drugs that enhance immunity.

In our opinion, a promising direction in solving the issue of treatment and prevention of herpes infection is the use of photodynamic therapy. It reduces the number of clinical manifestations of the virus and creates certain conditions in a person’s immune status to prevent relapse of the disease.

Diagnosis of genital herpes

Which doctor should I see for genital herpes?

At the Yauza Clinical Hospital, this disease begins with a clinical examination by a specialized specialist (gynecologist or urologist), and is confirmed by laboratory tests. If necessary, consultation with related specialists (immunologist) is carried out.

What tests should be taken for genital herpes?

Laboratory diagnostics solves 2 problems:

• determine the presence of the herpes simplex virus or contact with it: to do this, study the blood, vaginal discharge, urethra, sperm, urine of the patient for the presence of antibodies to the herpes simplex virus, or particles of the virus itself;
• to prove the “involvement” of these rashes with genital herpes: material taken directly from blisters or ulcers is examined.

Also, to select effective therapy, it is necessary to accurately determine the type of pathogen - this question is answered by polymerase chain reaction (PCR).

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Epidemiology

Genital herpes, being a special case of herpetic infection, is one of the most common sexually transmitted diseases, and differs from other diseases of this group in the lifelong carriage of the pathogen in the human body, which determines the high percentage of formation of recurrent forms of the disease.

Transmission routes

Transmission usually occurs through close contact with a sick person or a virus carrier. The virus penetrates through the mucous membranes of the genital organs, urethra, rectum or microcracks in the skin.

In couples where one partner is infected, the probability of infection of the second partner within a year is 10%. In most cases, infection occurs when the infected partner has not had a clinically significant recurrence of genital herpes. Asymptomatic and unrecognized forms of infection play an important role in the spread of the virus. The virus can be excreted in sperm; cases of infection of women during artificial insemination have been described. Speaking about the routes of transmission of the virus, it is necessary to note the important epidemiological significance of oral-genital contacts, which are associated with an increase in the frequency of isolation of herpes type 1 from the genitourinary system.

Who gets sick more often?

Among college students, antibodies to the herpes virus type II are detected in 4% of those examined, among university students - in 9%, among representatives of the middle strata of society - in 25%; among patients in dermatovenerological clinics with heterosexual orientation – 26%; among homosexuals and lesbians – 46%, among prostitutes – 70–80%. Antibodies to genital herpes are more often detected in representatives of the Negroid race than in whites. Women are infected more often than men, with the same number of sexual partners during their lifetime. In developed countries, the virus affects 10–20% of the adult population.

Numerous studies on the general population have shown that the incidence rate increases with age: isolated cases are detected in a group of patients aged 0–14 years; the highest incidence is recorded in the age group 20–29 years; the second peak incidence occurs at 35–40 years of age.

The main risk factors for developing the virus are a large number of sexual partners throughout life, early onset of sexual activity, homosexuality in men, belonging to the black race, female gender and a history of sexually transmitted infections.

Mandatory registration of genital herpes was introduced in the Russian Federation in 1993. During the period 1993–99, the incidence of this virus in Russia increased from 8.5 cases to 16.3 per 100 thousand population. The incidence in Moscow increased from 11.0 to 74.8 cases per 100 thousand population and almost reached the level of European countries.

Treatment of genital herpes

How to treat genital herpes? Unfortunately, there is currently no way to completely destroy the virus in the body and cure genital herpes once and for all. However, specialists at the Yauza Clinical Hospital have developed a treatment regimen that keeps the pathogen in an inactive state and significantly reduces the likelihood of developing a relapse of genital herpes in men and women.

Goals of therapy:

• Removal of local manifestations - rash, painful ulcers, itching.
• Speedy relief of relapse.
• Strengthening the immune system, maintaining long-term stable remission.

The complex of treatment measures includes:

• Antiviral drugs – oral and topical, which are selected individually. One of the most effective in treating a genital virus is acyclovir (tablets, injections, cream, ointment).
• Prescription of immunomodulators, immunostimulants.
• Patients with rare exacerbations are treated with episodic therapy. For those whose disease is severe (frequent relapses due to the individual characteristics of the immune system - its low activity against the herpes virus), a long course of pharmacotherapy is indicated - systemic therapy.

Despite the fact that there are no methods for completely curing herpes yet, the doctor will select medications that will reduce the frequency of relapses. This way, you can live a full life without regular exacerbations of the disease. Make an appointment with a specialist to avoid complications and relapses.

We are well aware of such sexually transmitted diseases as AIDS, syphilis, gonorrhea. As for genital herpes, it is usually given a secondary role, but, in fact, it is no less dangerous. Just like AIDS, herpes cannot be completely cured and, once infected with this virus, a person becomes its carrier for the rest of his life. Although, unlike HIV infection, the herpes virus itself cannot cause death, nevertheless, neglected genital herpes can lead to an immunodeficiency state and cause cancer of the genital organs.

Genital herpes is a sexually transmitted disease caused by one of the many members of the herpesvirus family. This virus is a close relative of herpes simplex, which causes the well-known “lip fever.”

In terms of its prevalence, this disease ranks second among all sexually transmitted infections. According to experts, approximately every tenth Russian is infected with genital herpes.

Transmission of genital herpes occurs through sexual contact in the vagina, mouth and rectum. It is most possible to infect a partner during an exacerbation of the disease, however, even in the absence of rashes, the risk of transmitting herpes remains. In addition, in approximately 80% of patients, genital herpes occurs without visible manifestations. These people do not even know that they are infected, while being the source of infection.

A typical picture of the disease looks like this: bubbles appear in the genital area, which then grow, unite with each other and, bursting, form painful ulcers. In women, the vagina itself and its vestibule, labia and cervix are most often affected. Less commonly, rashes are located on the pubis, thighs, buttocks and perineal area.

Manifestations of genital herpes are very painful. Sometimes a person gets away with an asymptomatic form, but in other cases, ulcers do not allow the patient to walk, sit, or go to the toilet calmly. Some, due to severe pain, cannot even sleep at night; in simple terms, they “climb the wall in pain.”

Psychological experiences are often added to physical suffering: irritability, fear of new rashes, thoughts about the impossibility of having healthy children, fear of infecting a loved one, a feeling of uselessness, loneliness... Suicidal thoughts may even arise.

Genital herpes not only causes physical and mental pain, but also causes weakened immunity, causes chronic diseases of the internal genital organs and can ultimately cause both female and male infertility. Genital herpes is especially dangerous for pregnant women, who may develop pregnancy pathology and become infected with the fetus and newborn.

Treatment

Unfortunately, the herpes virus tends to persist in the body throughout life. And, having declared itself publicly once, the disease can appear again and again. Therefore, we must keep in mind that modern medications can only shorten the duration of the disease and reduce its severity, but cannot “get rid of the virus once and for all.”

Classic drugs for the treatment of genital herpes are acyclic nucleosides (acyclovir, valacyclovir, famciclovir). However, recently an increasing number of viruses resistant to acyclovir (and similar drugs) have appeared. Therefore, it is recommended to alternate acyclic nucleosides with each other (for example, acyclovir with valacyclovir) or use them together with interferon drugs. Interferon is one of the most powerful antiviral proteins in the body. It recognizes the infectious agent that has entered the cell and prevents its reproduction. It is believed that it is the lack of interferon in the body that causes relapses of herpes.

It is better to use drugs that simultaneously contain interferon and acyclovir. The only product in the world that contains both acyclovir and interferon is herpferon ointment. Considering the painfulness of genital herpes, lidocaine was also included in the ointment, which provides an analgesic effect.

According to clinical studies, the use of herpferon for genital herpes in 85% of patients led to complete recovery on the 5th day. This figure was 3.5 times higher than that of the group receiving classical treatment with acyclovir. In patients who used herpferon, general malaise and headache stopped much earlier, and itching, pain and fever at the site of the rash disappeared faster.

Prevention

Prevention of recurrent infections

Repeated episodes of genital herpes appear under the influence of factors unfavorable to the immune system. These include: illness, prolonged exposure to the sun, hypothermia, the onset of menstruation, pregnancy, and taking hormonal medications. Herpes can also worsen due to stress.

Therefore, you should not neglect a healthy lifestyle, proper nutrition and taking vitamins. Existing diseases should be detected in time and treated under the supervision of a doctor. You need to avoid prolonged exposure to the sun and hypothermia, and protect yourself from stress. And, of course, maintain intimate hygiene and promptly identify and treat concomitant sexually transmitted diseases.

In any case, if you have rashes characteristic of genital herpes, you should not postpone a visit to a specialist.

Prevention for a healthy person

How to protect yourself from genital herpes? First of all, we must remember that absolutely safe sex does not exist. Even a condom, while greatly reducing the risk of infection, does not provide a complete, one hundred percent guarantee of protection against genital herpes.

A healthy person should avoid “casual” relationships, be sure to use barrier contraception methods, and preferably in combination with emergency prevention measures. After suspected unprotected contacts, it is recommended to conduct an examination to identify genital herpes and other sexually transmitted diseases.

We also must not forget about the rules of hygiene. No wonder everyone has their own personal towel. After all, for example, if you use a towel after a person with genital herpes, you can easily become infected yourself.

It must be borne in mind that during oral contact, herpes from the lips easily spreads to the genitals. Therefore, you need to engage in oral sex using special latex wipes. And when rashes appear on the face and lips, you should abstain from this pleasure altogether.

There may be cases of self-infection with genital herpes, when the virus is transferred from the lips by dirty hands to the genitals. And here again the banal rules of personal hygiene come to our rescue. Thorough hand washing (especially during the onset of fever on the lips), having separate towels for the face, hands and body will protect you from such trouble.

Emergency prevention

The use of barrier contraceptives, especially during an exacerbation of genital herpes, does not exclude the possibility of infection. Therefore, after suspicious sexual contact or contact with a carrier of the herpes virus, in addition to a condom, special means should be used for emergency prevention of the disease. One of these drugs is the drug herpferon. If you use herpferon ointment within 1-2 hours after intimacy, the likelihood of avoiding infection with genital herpes will increase significantly.

Treatment of genital herpes during pregnancy

First of all, it should be noted that there is a group of antiviral drugs that can be used with complete safety for the developing fetus.

Indications for treatment:

• primary infection during pregnancy,
• relapses of the disease and
• prevention of relapses before childbirth.

Taking into account the possibility of an asymptomatic course of the disease during a relapse, it is necessary to conduct periodic examinations of the woman throughout pregnancy and, especially in the last weeks before childbirth.

By contacting the Clinical Hospital on Yauza, you are guaranteed to receive qualified advice from a specialized specialist, an accurate diagnosis of your condition, effective treatment of the identified disease, and prevention of exacerbations of genital herpes and its complications. Take care of your health - make an appointment with a gynecologist or urologist right now!

Symptoms

A characteristic sign of the appearance of herpes in the intimate area (see photo) are rashes in the form of small blisters filled with liquid. They are capable of bursting (thus, the rash spreads to healthy areas). After infection, symptoms appear after 21 days. The primary signs are considered to be redness, inflammation, burning, swelling and itching. Pain and pain when urinating are also possible. The precursors of rashes on day 7 are fever and general irritability.

In women, the symptoms of genital herpes are more pronounced than in men. First signs after infection:

• weakness;
• temperature;
• enlarged lymph nodes;
• joint pain.

After this, blistering rashes are already noticed on the buttocks, vulva, vagina, perineum and thighs. During this period, the skin of the genitals turns red and swelling occurs. Then the bubbles burst, leaving wounds that take up to three weeks to heal. During sexual intercourse, bloody discharge is possible. Then problems with urination appear. The disease develops intensively over 10 days and can last up to a month.

How to prevent getting genital herpes

People with outbreaks of genital herpes are highly contagious. During the active phase of the disease, any sexual contact should be avoided, especially if there are ulcers. Using a condom does not prevent the spread of the disease because not all sores are covered by a condom.

Although the likelihood of infection is greatest when ulcers are present, people who have had HS can always be contagious to some extent, even if they have received medical treatment. The virus can be activated and transmitted to a sexual partner even when the skin looks completely normal.

For this reason, safe sex practices (using a condom) should be practiced between outbreaks to reduce the risk of spreading the disease to a sexual partner. There is no vaccine to prevent genital herpes infection.

Types of herpes simplex virus

HSV-1, or herpes simplex labialis
(so-called fever on the lips), is transmitted by airborne droplets or contact (with particles of infected saliva from coughing and sneezing, from kissing, using someone else's cups, spoons, etc.). It can be asymptomatic or with rashes on the mucous membrane of the mouth, on the lips and on the wings of the nose. After the obvious signs of the disease disappear, the herpes virus does not die, but penetrates the trigeminal ganglion through sensitive fibers and is integrated into the genetic apparatus of nerve cells. When hypothermia, stress and other negative influences lead to a weakening of the body’s immune forces, the pathogen provokes relapses of the disease.

HSV-2, or genital herpes

, affects the external genitalia and leads to the development of nonspecific diseases of the urogenital area. In this case, infection occurs through unprotected sexual contact. Just like type I herpesvirus, the pathogen penetrates into the nerve cells located in the lumbar region and remains there in a dormant state until a certain point. In addition, in recent decades, due to the spread of the practice of oral sex, HSV-1 becomes the cause of genital herpes in 10–30% of cases.

Complications of GG

People with genital herpes face an increased risk of contracting and passing on other STDs. This is because the ulceration that occurs as a result of a herpes infection makes the skin and mucous membranes of the genitals more vulnerable to sexually transmitted infections. Patients with symptomatic HH face a 2-4 times higher risk of acquiring and transmitting HIV infection.

Complications are rare:

• In some cases, the infection can spread to other parts of the body, such as the liver and eyes, even to the lining around the brain, causing meningitis.
• 1% of patients with primary HH develop autonomic dysfunction with urinary retention, erectile dysfunction, constipation, and sensory loss. Sometimes (intermittent) catheterization is necessary over several weeks.
• Mild meningitis is relatively common in primary herpes (13-20%). Herpetic encephalitis occurs less frequently and has a mortality rate of about 70%.
• Neonatal herpes simplex may develop after vaginal delivery and may be accompanied by local infection (skin, eyes, or mouth), disseminated manifestation (visceral organs), or central manifestation (CNS).

Symptoms may be especially severe in people with weakened immune systems due to existing HIV infection or immunodeficiency. An infection that affects the eyes can lead to blindness. This occurs mainly in people with weak immune systems who have had the virus for a long time. With a weak immune system, herpes increases the risk of bacterial infections, which can lead to further complications.

Another possible complication affects pregnant women. During childbirth, women can pass the virus to their newborn. Women at risk for STIs often get tested in the early weeks of pregnancy to prevent complications. A pregnant woman with symptomatic genital herpes is at risk of miscarriage or premature birth.

The infection can be transmitted to the fetus, and the baby may develop neonatal herpes. The risk of complications is especially high if a woman contracts the infection in the last trimester of pregnancy. If she has active genital ulcers near the time of delivery, a cesarean section is usually recommended to avoid exposing the newborn to the virus.

Clinical features of herpetic infection in women

Herpes of the urethra and bladder

Herpetic urethritis in women is subjectively manifested by pain and cramping at the beginning of urination, and a frequent urge to urinate. With herpetic cystitis, hematuria, pain at the end of urination, blood in the urine, and pain in the bladder area appear.

Herpetic cystitis

In a woman, the first and only sign of HSV infection may be in the genitourinary tract. It often occurs in the first 1-3 months after the start of sexual activity or a change of sexual partner.

Herpes of the anal area and rectum

The lesion in the anal area usually represents a recurrent fissure, which is often a reason for diagnostic errors. Such patients with an erroneous diagnosis of “anal fissure” end up with surgeons. The itchy form of herpes anus and herpetic lesions of hemorrhoids are also difficult to diagnose.

The list of diseases etiologically associated with HSV is constantly growing. According to the literature, in 3.6% of women suffering from treatment-resistant colpitis and cervical leukoplakia, HSV is one of the etiological factors of the disease. A new form of latent intrauterine HSV-II infection with localization of the pathological process in the glandular epithelium of the endometrium is described. It has been proven that HSV can cause the development of endometritis and salpingoophoritis.

The asymptomatic form of herpes of the internal genitalia is detected in 20-40% of women suffering from herpes of the buttocks and thighs. This important circumstance must be taken into account when planning pregnancy in women with this form of GC due to the existing likelihood of developing complications of HSV infection during pregnancy.

The etiopathogenetic role of HSV in cervical cancer has been established. The above emphasizes the growing etiological role of HSV in the structure of diseases of the pelvic organs in women.

Herpes and pregnancy

The prevalence of HSV among pregnant women in the United States is 22-36%, in Europe 14-19%. Viremia in women during pregnancy can cause fetal death, stillbirth, and premature birth. Herpes viruses cause up to 30% of spontaneous abortions in early pregnancy and over 50% of late miscarriages; they are second only to the rubella virus in terms of teratogenicity (the development of fetal deformities).

The most severe forms of neonatal herpes develop when a newborn is infected with the herpes simplex virus during childbirth. With primary herpes in the mother, from 30% to 80% of children are infected, with recurrent herpes – 3–5%. Infection of the fetus during delivery, if the mother had herpetic eruptions at the end of pregnancy, occurs in 50% of women with RGG; however, 60–80% of infected children develop encephalitis.

Forecast and prevention of genital herpes

As a preventative measure to prevent primary infection of HS, it is recommended to use condoms during sex, especially during casual sexual intercourse. But you should know that the use of protective contraception does not reduce the risk of infection through microcracks and other damage in areas of the skin not covered by a condom. If you suspect the penetration of a virus, you can treat the skin with local antiseptic preparations.

GG is characterized by relapses with decreased immunity. To prevent the disease, you should adhere to the following recommendations:

• adhere to a healthy lifestyle;
• take vitamins;
• get enough rest and eat right;
• observe the rules of personal hygiene;
• the area of ​​blisters and ulcers should be dry and clean to avoid infection;
• If symptoms appear, consult a doctor promptly.

People infected with this virus should try to avoid direct contact with others to protect them from infection. Avoid scratching or touching herpes lesions as this may spread the infection to other areas of the skin.

Folk remedies

Herpes in an intimate place is treated with folk recipes in combination with medications. It is imperative to coordinate the chosen treatment with a specialist.

1. Compresses with arnica. A decoction of arnica inflorescences is prepared from 12 g of herb and 400 ml of water. The product is infused for an additional 2 hours, pieces of natural fabric are soaked in it and applied to the inflamed areas.
2. This recipe is for women. Candles made from beeswax with the addition of aloe and kalanchoe are very useful. Making them at home is not difficult. The plants are crushed, vitamins are added in ampoules B1 or B12, poured with molten wax and mixed thoroughly. The resulting product is laid out on a piece of bandage and a small candle is formed. Inserted into the anus or vagina. Depending on which organs the rash has formed on: in the back of the perineum or on the labia, you need to approach use specifically for each place.
3. Infusion of birch buds. The drug is prepared from 25 g of phyto-raw materials and 1 glass of 70% alcohol. It is infused in the dark for 2 weeks, then filtered and used to rub herpes blisters.
4. There is an effective folk method to strengthen the immune system. You need to extract juice from apples and onions. The proportions are taken 1/1. Dilute the liquid with pumpkin juice and consume a tablespoon 3 times a day. These products contain vitamins that have a positive effect on the immune system.

The simplest and most affordable recipe at home is aloe juice. The plant leaf is washed, cut and applied to the areas of infection. If there is a rash on the labia. You can grind aloe into a paste, apply it to the affected area, secure it with a bandage, and put on underwear on top. Compresses are changed after 1-3 hours.

Features of treatment for pregnant women

The herpes virus poses the greatest danger to pregnant women; it can cause serious disruptions during pregnancy and provoke the appearance of abnormalities and deformities in the unborn child. Therefore, in the acute form, especially if it is a primary infection, you need to start treatment as quickly as possible. During pregnancy there are some nuances during therapy.

Acyclovir and its analogues are used only in exceptional cases due to possible harm to the pregnant woman and the fetus. The following drugs are used with caution:

• Panavir;
• Zovirax;
• Vivorax and others.

The acute phase immediately before childbirth is dangerous, including. As long as the fetus is inside the womb, infection is unlikely. Most newborns become infected during childbirth, passing through the birth canal or touching the mother's genitals. Therefore, if an exacerbation or relapse occurs at the expected time of delivery, a cesarean section is offered.

Prevention

To prevent the disease from occurring after therapeutic treatment, it is necessary to adhere to preventive standards:

• use contraceptives;
• monitor the hygiene of the intimate area;
• undergo preventive examinations from a specialist;
• exclude the possibility of sexual intercourse if there are rashes on the genitals;
• maintain a healthy lifestyle, eat well;
• strengthen the immune system;
• during the season of exacerbation, you can use immunomodulatory suppositories.

Not a single type of treatment, even the most effective, can completely eliminate the virus from the body, and therefore it is important to carefully follow preventive measures, not to have sexual relations before the age of 18 and to avoid unprotected acts.