What is genital herpes
The virus first type is often the very firstepisode of genital herpes. Repeated manifestations of genital herpes almost always associated with HSV-2. Genital herpes usually affects the vulva, perineum and anus, and (less frequently) the vagina and cervix (vaginal and cervical herpes). In severe cases, the infection may progress in the body of the uterus and its appendages (uterine tubes and ovaries).
How common is genital herpes in women
Herpes simplex virus types 1 and 2infected up to 90% of the adult population of the Earth. After infection, herpes simplex virus enters nerve nodes located near the spinal cord, and remains there for a lifetime. However, symptoms of genital herpes appear only a small proportion of infected individuals.
In the US, 3% of the population reported having episodesgenital herpes at least one time in life, but the analysis showed that HSV-2 infected over 20% of the population. The overall incidence of herpes transmission during pregnancy - 2 per 100,000 births (data in Europe).
The main route of transmission of genital herpes -sexual. herpes virus is transmitted at ordinary genital contacts (typically HSV-2), and at oral (HSV-1) and anal intercourse (HSV-2). Infection is possible in the absence of a sexual partner of any symptoms of the disease more than 50% of cases. Domestic way of infection (eg through personal hygiene items) for genital herpes is rare. The probability of infection is higher if you have symptoms of herpes, or damage to the skin and mucosa (lesions, fractures). The overall probability of being infected by an infected male partner for women - about 17%. Condom use reduces the probability of almost 2-fold.
Who suffers most genital herpes
Genital herpes is more common in people exposed to one or more risk factors:
- low immunity (for example, afterhypothermia in the treatment of corticosteroid hormones or chemotherapy). Immunosuppression causes activation of dormant in the ganglia of the virus and the appearance of symptoms of the disease.
- multiple sex partners. This increases the likelihood of a primary or re-contracting the virus. Repeated infection can also cause activation of infection
- unprotected sex (without a condom). Condom use reduces the chance of infection
What are the symptoms of genital herpes in women
The main symptoms of genital herpes include:
- the formation of small, filled with muddybubble liquid. They may appear on the inside of the thighs, around the anus in the crotch surface of the external genitalia, in the urethra, vagina and cervix. The appearance of vesicles is preceded by redness and itching of the skin. After 5-7 days, the bubbles burst. In place of the burst of bubbles formed erosion or ulcers, which are gradually exfoliated, and within 1-2 weeks replaced by healthy skin
- itching, burning and pain in the area of the emergence of bubbles
- itching and tingling sensation during urination (sometimes with the defeat of the urethra)
- an increase in the inguinal lymph nodes
- fever, muscle aches, malaise
These symptoms occur only during exacerbations of genital herpes, which usually last 1-2 weeks. Throughout the rest of the time there are no symptoms of infection.
How to diagnose genital herpes in women
Consulting an experienced gynecologist anda thorough examination is very important, because similar signs and symptoms may be observed in other genital infections, or a combination thereof, as well as some non-infectious diseases of the skin and mucous membranes. In addition to the patient's complaints and gynecological examination different laboratory methods used to diagnose genital herpes.
The most reliable methods arevirological and gene diagnostics. When the content of bubbles virological study were placed on a special cell or the medium in chicken embryos, in which there is multiplication of the virus. However, the problem of virology and laboratory diagnosis of low quality cell cultures often cast doubt on the results of such studies with herpes offered in Russia at the moment.
When gene diagnostics (PCR is commonly used,polymerase chain reaction) determine the presence of viral DNA in secretions from the patient. PCR differs almost 100% sensitivity (ability to detect the virus) and specificity (the ability to distinguish between herpes simplex virus from other viruses). In modern laboratories, manages to differentiate herpes simplex viruses 1 and 2 of types. It is important to determine the prognosis of the disease, as HSV-2 is much more likely to give repeated exacerbations.
The use as auxiliary methodsdetermination of antibodies to the virus in the blood by enzyme immunoassay (EIA) and immunofluorescence (IFA). Antibodies to HSV-1, many people have, their detection does not speak about the presence of genital herpes, or the fact of the sexual transmission of the virus.
One detection of antibodies to HSV in the bloodnot enough for the diagnosis of genital herpes, which is sometimes doctors forget. This should not be introduced into the patient's delusion, the more that women find antibodies to HSV-2 is more likely (at an average rate of 25% in Europe). Only the presence / absence of antibodies against HSV-2 (and even more so - against HSV-1) can not clearly confirm or deny infecting women with genital herpes without data PCR or virus isolation. From the moment of infection to the appearance of antibodies in the blood can take 6-12 weeks. Various tests have their sensitivity and specificity.
However, the determination of antibodies is very important in the diagnosis of individual cases of complex, in the periods of pregnancy, to determine the characteristics of the disease.
Direct immunofluorescence method (PIF) for the detection of viral antigens in a smear is less sensitive and specific, and today is used less often, usually when PCR is unavailable.
Why treat genital herpes? Risks for Women
All cases of genital herpes require mandatory treatment. Otherwise, you may develop complications, most important of which are:
- symptoms preservation for a long time (from a few weeks to several months)
- acute urinary retention due to dysuria or neuropathy
- infected sexual partner (the probability of 4%)
- spread through the body from infectionpenetration into the brain and the massive defeat of internal organs. This rarely happens in immunodeficiency. Most observed extragenital herpes skin on different parts of the body (hands, buttocks, breasts), mucous membranes of the eyes, oral sex - herpetic pharyngitis, stomatitis, cheilitis.
- together with the human papilloma virus herpes simplex virus increases the likelihood of developing cervical cancer.
Long term complication of genital herpes inWomen may be psychological and psychosexual problems - more than 70% of women in Europe have noted a variety of experiences and a tendency to depression after the first episodes of genital herpes. It is therefore important psychological support for the ailing woman, her training and positive motivation that emphasize all the modern study of herpes problem.
Genital herpes and pregnancy
Infection of the fetus with the herpes virus from an infectedmother can occur during pregnancy, although the probability of transfer is generally quite low. However, the primary genital herpes, this probability can be as high as 50%. Most often, the infection occurs during birth (perinatal), during the passage of the fetus through the birth canal infected with herpes. However, caesarean section does not exclude the transfer of newborn herpes.
Infection of the fetus may cause severe damage to the nervous system (35% of cases of infection), skin and eyes (45%) and lead to the child's disability and even death.
The total frequency of herpes transmission from infected mothers to newborns up to 5%. The presence of antibodies to HSV-2 is associated with a lower risk of herpes infection during pregnancy.
The approach to the management of pregnant women with the infection,caused by herpes viruses should be very careful. Active herpes antiviral therapy during pregnancy is not always possible and is conducted only for the purpose of the attending physician and under his supervision.
Genital Herpes Treatment
Treating genital herpes does not lead to the complete disappearance of the virus in the body, but can quickly eliminate the symptoms of the disease and can reduce the incidence of new exacerbations.
The main method of treatment of genital herpes in both men and women is the use of special antiherpetic drugs: antiviral chemotherapy.
Prove the effectiveness of herpes have 4preparation: acyclovir (Zovirax and its analogues), valacyclovir (Valtrex), famatsiklovir (Famvir), and Penciclovir (denavir). Of those registered in Russia only the first 3 of the drug. The most common use of acyclovir. The earlier the prescribers, the greater the effectiveness of the treatment. Maximum efficiency is achieved at the beginning of treatment in the first hours after the onset of rash or just before their appearance.
When frequent exacerbations (more than 6 times a year)spend long prophylactic (supportive) treatment for several months. This treatment reduces the relapse rate by 75% and reduce the severity of recurrent exacerbations. Since the treatment to be complex and long-term decision on the selection and appointment of agents to prevent relapse is received by the attending physician considering various factors, including pskhilogicheskie aspects and motivation of the patient.
Selection of any particular therapeutic agents in addition to antiviral therapy must be justified.
It is widely practiced in our country assignmentother drugs (immunomodulators, adaptogens, interferon inducers, etc.) is not an evidence-based practice, and often does not, and no scientific basis. We urge you to be wary of proposals to boost immunity or completely clear the body of herpes - at least ask, on what basis can we expect from these effects, and how they were investigated with herpes.
Vaccines against herpes, which has proven efficacy and safety in the genital infection also exists.
If genital herpes is possible symptomatic therapy: topical treatment that reduces the symptoms of herpes (pain, burning, itching), you can use a mild analgesic.
Remember that the 100% guarantee full and one-time cure genital herpes is unreal, and it offers can talk about incompetence or bad faith approach to treatment.