Faciclovir 0.3g twice a day.
Famciclovir 0.25g, 3 times a day.
Continuous service for 7- 10 days.
The treatment is for you, but you'd better go to the dermatology department of a big hospital for formal treatment; The following knowledge will help you fully understand. See for yourself.
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Genital herpes
Clinical manifestations of genital herpes
Genital herpes (GH) is an acute herpetic disease in urinary and genital areas caused by herpes simplex virus (HSV) infection, which is mainly transmitted through sexual contact.
Etiology of genital herpes
The pathogen of the disease is 90% herpes simplex virus type 2 (HSV-3, 10% herpes simplex virus 1 type (HSV-l). Both patients and virus carriers are sources of infection, mainly through direct contact with skin and mucosa during sexual intercourse. Herpes fluid, semen, prostatic fluid, urethra and vaginal secretions all carry viruses, which are highly contagious from the appearance of blisters to their disappearance. Herpes neonatorum infection mainly comes from parturient's birth canal.
HSV enters the body through damaged skin and mucosa, and replicates in epidermal or dermal cells. Regardless of clinical manifestations, the virus will fully infect sensory or autonomic nerve endings and transport them to nerve cells in ganglia through axons. At the initial stage of infection, the virus replicates in the ganglion and the nerve tissue in contact with it, and then moves to the surface of skin mucosa through peripheral sensory nerves, resulting in skin lesions. HSV infection is often systemic, and HSV can be isolated from almost all internal organs and mucosal surface.
(a) Growth hormone deficiency for the first time.
Because 80%-90% of primary infections are recessive infections, only a few are dominant infections, and most of them turn into latent infections after the recovery of primary infections. Therefore, patients with first onset can be divided into primary infection and non-primary infection.
Length of primary infection: first infection with HSV-2 or HSV- 1, no HSV antibody in serum, herpes damage in genital area.
(l) incubation period: ld- 10d, with an average of 6d.
(2) The most common parts: male glans penis, coronary sulcus, foreskin and penis; Women are labia majora, pubic mound and clitoris.
(3) Typical symptoms: scattered erythema, papules and water marks, several of which are above 10, can turn into pustules, erosions or ulcers. Accompanied by itching or pain. For at least 1 week -2 weeks, the injury will be infatuated with healing. Generally speaking, skin lesions will subside within 3 -4 weeks, but new lesions may appear. People with systemic symptoms often have fever, headache, fatigue and myalgia, and inguinal lymphadenitis. Female patients may have abnormal vaginal and urethral secretions and dysuria. More than 80% women infected with HSV for the first time can involve the cervix and urethra. Symptomatic herpes simplex urethritis is characterized by obvious mucus excretion and dysuria. Occasionally, HSV infection can manifest as endometritis, salpingitis and prostatitis.
2. Non-primary primary GH: there was a history of HSV infection in the past, and there were HSV antibodies in the serum. This type of symptoms are lighter than those of primary infection and heal faster.
(2) Latent infection and recurrent growth hormone
Length: Recurrence time and frequency: Neutralizing antibodies appear in the blood about 1 week after the first infection of HSV, and reach the peak in 3 -4 weeks, which can last for many years. These antibodies can remove viruses and make the body recover. However, most individuals cannot completely eliminate the virus, nor can they prevent recurrence. The virus exists in the host for a long time in a latent state. The clinical process of acute first-episode GH with different subtypes of HSV infection is similar, but the recurrence rate is different. About 90% of the first-episode GH infected with HSV-4 will have L recurrences (average 4 recurrences) within 12 months, while only 5% of the first-episode GH infected with HSV will have similar recurrences (average less than L recurrences).
The recurrence rate of genital HSV-2 infection varies greatly in the lives of different individuals and the same patient, and most of them recur 5 -8 times a year. It usually occurs within 1 -4 months after the primary herpes subsides.
2. Causes of recurrence: fever, overwork, menstruation, rain, sun exposure, cold, certain virus infections, etc.
3. Characteristics of recurrence: Every recurrence is often in the same place. There may be local itching before recurrence, and burning sensation at the infected site several hours before eruption. At present, there is no effective way to prevent recurrence, and inducing genital malignant tumor may be dangerous, so it will bring psychological influence to patients and produce psychological obstacles such as depression and fear.
(3) herpes simplex virus proctitis
It is more common in homosexual men and heterosexual women who have anal sex. Symptoms include anorectal pain, discharge of secretions, and acute diarrhea.
Heavy feeling and constipation. Colonoscopy revealed an ulcer at the distal end of the rectum. AIDS patients may have extensive anal herpes or DHV proctitis.
Fetal and neonatal infections
HSV can infect the fetus through placenta, affect the mitosis of embryonic cells, and cause fetal malformation and mental retardation. During delivery, if the fetus passes through the birth canal with herpes lesions, it can also be infected with HSV, causing neonatal pemphigus. About 70% of neonatal HSV infection is caused by HSV-2. Infants who mostly occur within 3-30 days are prone to visceral and central nervous system infections. If not treated in time, the mortality rate can reach 65%. However, less than 10% of newborns with central nervous system infection can develop normally.
(5) Herpes pruritus and gangrene
Whitlow, namely HSV infection of fingers, is a complication of primary genital or oral herpes. The virus can enter the skin tissue through the damaged finger, and the infected finger appears erythema, edema and tenderness, and the blisters and pus scars on the fingertip are difficult to distinguish from various bacterial infections. There are many elbow fossa and axillary lymph nodes with fever, swelling and pain.
Laboratory examination of genital herpes
Length cytological examination: A small amount of tissue was scraped from the bottom of the blister or ulcer surface for smear, Wright-Giemsa staining or Pap staining, and the eosinophilic inclusions in the multinucleated giant cells infected with HSV could be detected. However, HSV infection and varicella-zoster virus infection can not be distinguished, and the sensitivity is only 60% of virus isolation.
2. Cell culture is the most sensitive and specific method to isolate virus from the bottom of blister, and it takes 5- 10d. Because of its high technical requirements and high price, it can not be widely used at present.
3. Antibody detection method: Western blot method is commonly used, and gD2 can also be used as antigen to detect HSV-2 antibody, which has the advantage of high sensitivity and can distinguish HSV-l from HSV-2.
4. Antigen detection method: Taking PCR as an example, it has high sensitivity and specificity, which can greatly improve the ability of HSV diagnosis in patients with genital ulcers. However, due to the influence of operating technology and laboratory conditions and equipment, it is expensive and prone to false positives, thus affecting its accuracy in clinical diagnosis.
Differential diagnosis of genital herpes
Growth hormone ulcer should be differentiated from chancre and chancre. Genital diseases that should be identified also include contact dermatitis, herpes zoster, pustulosis and so on.
Prevention of genital herpes
(1) Avoid unclean sexual intercourse and improper sexual relations, and patients with active genital sores are absolutely forbidden to have sexual relations with anyone;
(2) Sexual intercourse is prohibited during the treatment, and spouses should also check if necessary;
(3) Nursing local injuries should be kept clean and dry to prevent secondary infection;
(4) Those who relapse after cure should pay attention to inducing factors such as cold prevention, catching cold and fatigue to reduce recurrence.
At present, there is no specific prevention method. Animal experiments show that both HSV dead vaccine and attenuated live vaccine have immune effects, so the virus is closely related to some cancers, so it is not used for routine prevention. Recently, using purified envelope glycoprotein of herpes virus as vaccine can avoid the cancer risk of herpes virus DNA.
ACV also has a preventive effect. Condoms may reduce the spread of diseases, especially during the asymptomatic detoxification period, but when genital injuries occur, condoms cannot avoid the spread.
Pathogenesis and treatment of genital herpes
This disease is caused by herpes virus infection. Because of the 50% difference in nucleotide sequence, the virus is divided into two serotypes, I and II. Genital herpes belongs to type II virus (HSV-II). Herpes virus infection is very common in people, and people are the natural reservoir of the virus. Patients with herpes or healthy people infected with the virus (asymptomatic after infection) are the source of infection, and direct and close contact is the main route of infection. The virus can enter uninfected (healthy people) through respiratory droplets, oral contact or genital mucosal damage. Genital herpes is a type II herpes virus that spreads through sexual contact. Of course, when the virus infects the body, it may not appear immediately or completely. The immune status of infected people is negatively correlated with the incidence. The strong can lurk and not get sick, and the weak will get sick in a few days or a week.
Genital herpes can be divided into two types: primary infection and recurrent injury. The former usually starts from the incubation period of about one week after sexual contact, and red papules appear at the infected site, which quickly turn into bullae, and some develop into pustules or bullae. Generally, scabs heal in about 10-14 days.
Recurrent genital herpes recurs more than after the initial infection, and the recurrence rate is extremely high, almost reaching 2/3. Generally, it recurs within 65,438+0-4 months after the primary injury, 4-6 times or more in the first year, and then gradually shortens, rarely delaying for more than one week. Inguinal lymph nodes are rarely swollen and have systemic symptoms.
The virus of primary or latent HSV infection in pregnant women is activated, which can infect the fetus through the placenta and induce abortion, premature birth, stillbirth or congenital malformation. Genital herpes in pregnant women may cause 50% newborns to be infected during delivery through the birth canal. For example, 6% of newborns may be infected about 4 hours after cesarean section. In the case of low immunity, viruses may spread, diseases may develop, and the central nervous system or important organs may be attacked. The mortality rate may reach more than 90%, and survivors often leave serious sequelae. To tell the truth, although most diseases are mild or harmless to personal health, in the long run, they are indeed careless.
For experienced doctors, it is not difficult to diagnose the disease by combining the medical history, and it is easier to make a definite diagnosis by combining the laboratory virus antigen and antibody determination. Treatment should be active without delay, especially the treatment of primary injury, which is of great significance for eliminating virus and inhibiting virus replication. The combination of traditional Chinese and western medicine has a good effect on HSV-II medicinal synergistic drugs, such as Dubiqing, Shiduqing, Xieliting 1, acyclovir, famciclovir and valaciclovir. If the immunomodulator rifapei capsule is added, it can enhance the immunity and repair the mucosal barrier, and levamisole cream can also be used externally.
For this disease, we should keep a good attitude, avoid direct sunlight, prohibit alcohol and irritating food, and avoid unprotected sex without control. Women are prone to relapse during menstruation, which is related to their low disease resistance. On the other hand, keeping the reproductive organs dry and avoiding dampness is beneficial to the prevention and control of diseases.
Harm of genital herpes
Recurrent genital herpes occurred within 1-4 months after the first infection. Nearly 60% of the patients relapsed within one year after the first infection with herpesvirus type II, and relapsed 4-6 times in the first year. The number of times will be reduced in the future. Recurrent patients have fewer systemic symptoms than primary patients, and the course of each attack is shorter. Usually, the skin lesions subside about 10 days. Some scholars have found that only 14% of patients with herpes simplex virus type I relapse, which is much lower than that of patients infected with herpes simplex virus type II. Recurrence is usually in the same place, but the number, duration and self-conscious symptoms of blisters are lighter than those of the primary one, the lymph nodes are not enlarged, and the systemic symptoms are less. Recurrent genital herpes mostly occurs in vulva, vagina, cervix and glans penis, and the incidence of urethra is rare. Recurrent genital herpes is difficult to control, and sometimes the pain is severe, which leads to the mental burden of patients, but it produces psychological obstacles, such as fear of cancer, fear of infecting sexual partners, avoidance of sexual life with sexual partners, and unwillingness to associate with the opposite sex, leading to sexual dysfunction, affecting family harmony and even depression.
Genital herpes virus is closely related to genital malignant tumor. As early as 1960s, it was suggested that herpesvirus II, which caused genital herpes, might be a potential carcinogen of cervical cancer. In recent ten years, it has been found that cervical cancer is related to sexual activity. Herpes ⅱ virus is a common pathogenic factor among sexually active people. The cervix is often the replication site of the virus, and genital herpes is often complicated with cervical cancer. Women who have had genital herpes are 5- 10 times more likely to have cervical cancer than women who have never had genital herpes. Recently, the specific antigen of herpesvirus II was found in cervical cancer tissues, exfoliated cells or precancerous cells. It shows that herpes virus type ⅱ plays an important role in the occurrence of cervical cancer. In addition, herpes simplex virus-like particles were also observed in the biopsy materials of penile cancer patients. However, the direct evidence that herpes simplex virus is the pathogenic factor of genital malignant tumor is not sufficient and needs further confirmation.
In recent years, people have also noticed the seriousness of pregnant women and type II herpes infection. For pregnant patients or asymptomatic detoxification, the most important thing is to infect newborns. In the early pregnancy, pregnant women with genital herpes will affect the fetus, leading to abortion or stillbirth. Babies are born with congenital infection, and herpes zoster, seizures and hepatosplenomegaly may occur at birth. If retrograde infection is caused by birth canal infection or premature rupture of amniotic membrane, there may be no obvious clinical symptoms within a few days or even weeks after birth. Early symptoms may be poor breastfeeding and excitement, followed by viremia or encephalitis. In severe cases, disseminated genital herpes virus infection may occur, including high fever, dyspnea, bleeding and central nervous system lesions, with poor prognosis.
Genital herpes, also known as pudendal herpes, is a sexually transmitted disease caused by herpes virus (HSV) invading genitals, skin and mucous membranes, causing inflammation, blisters, erosion and ulcerative lesions. About 60% patients relapse after the initial skin damage subsides. In foreign countries, the incidence of genital herpes is second only to gonorrhea and syphilis in sexually transmitted diseases, ranking third in sexually transmitted diseases and first in sexually transmitted diseases caused by viruses.
Human is the only natural host of herpes simplex virus, and the infection rate of the population is as high as 80-90%, and 10% is asymptomatic. In recent years, the number of patients with genital herpes has been increasing all over the world, especially among sexually active people, about 30% people suffer from genital herpes, especially among young people, and the incidence of this disease is even higher than gonorrhea.
Second, how is genital herpes spread:
1, the disease is mainly transmitted through sexual organ contact. Herpes simplex virus (HSV) enters the human body through mucosal or skin damage, first grows and reproduces at the entrance, and then spreads through blood or nerve channels. Patients and asymptomatic carriers are the main sources of infection. Among adults, the positive rate of genital herpes virus antibody is high. Generally, it is about 10-70%, which mainly changes with social and economic status and sexual life. According to the survey, the excretion rate of genital herpes virus in vagina among women with low socioeconomic status is 0.4- 1.33%. When a group of prostitutes did reproductive tract examination, it was found that the excretion rate of genital herpes virus was as high as 12%, and 70% prostitutes carried genital herpes virus. Therefore, the occurrence of genital herpes is obviously related to sexual contact. This disease is highly contagious.
2. About 60-80% of women who have one-time contact with men with penis herpes will be infected. This disease will happen. This disease is very harmful and has a high recurrence rate. At present, there is no specific therapy, which can still cause female infertility, abortion or neonatal death. At present, many scholars also believe that the incidence of cervical cancer and penile cancer is closely related to genital herpes virus infection, which has attracted great attention.
3. A few items that can be contaminated are infected.
4. Newborns can be infected through birth canal.
The diameter of herpes simplex virus is about 120- 150 micron. It consists of a core with DNA in the middle and three concentric structures, namely, envelope, body cover and capsid. The shell surface is a 3:3:2 icosahedron composed of 162 shell particles, and the body is composed of fibers. The envelope sometimes comes from the nucleus and sometimes from the cell membrane. It is unstable to both high temperature and low PH, can survive for several months at low temperature, and is inactivated at 50℃ and 90℃ for 30 minutes.
Herpes simplex virus can be divided into two types: type I and type II. Herpes type I mainly spreads through close contact with respiratory tract, skin and mucous membrane, and infects skin, mucous membrane and organs above waist. For example, it can cause inflammation and herpes of oral mucosa, nasal vestibule, conjunctiva and throat. 99% of oral herpes is caused by herpes virus type I infection. Herpes ⅱ virus mainly exists in women's cervix, vagina, vulva skin and men's penis and urethra, and is the chief culprit of genital inflammation and herpes. According to relevant statistics, 90% of the pathogen of genital herpes is herpes type II virus, and only 10% is herpes type I virus. After contact with sexual organs, it lurks for about 2-20 days (average 6 days). Immunodeficiency, such as immunosuppressants, kidney transplantation, severe burns, severe malnutrition, malignant tumors of blood and lymphatic system, can lead to herpetic eczema, recurrent corneal ulcer, and even systemic disseminated herpes, which is fatal. Neutralizing antibodies and complement-binding antibodies are produced in vivo after 1-3 weeks of infection, and the residual virus may transfer to trigeminal ganglion (herpes virus type I) or sacral ganglion (herpes virus type II) along the nerve axis and enter a static state for a long time. When some inducing factors, such as anxiety, trauma, cold, sun exposure, hair blowing, trauma, infection, drug allergy, high fever, menstruation, pregnancy, etc. Disturbing the physiological balance of the body, the specific transcription enzyme needed for virus proliferation appears in nerve cells, activating the virus and causing recurrence. Humoral antibodies can not prevent the recurrence of herpes virus, and weakened cellular immunity has a great influence on the recurrence.
The clinical manifestations of genital herpes can be divided into primary and recurrent. It takes about 2- 10 days from exposure to onset, which is the incubation period. The affected area had a burning sensation first, and soon a 3- 10 red papule appeared on the basis of erythema, accompanied by itching. The papules quickly turn into blisters and become pustules after 3-5 days. After rupture, a large area of erosion, ulcer, conscious pain, and finally scab healing. The whole process can last about 20 days.
Men are common in glans penis, coronary sulcus, urethral orifice, penis, scrotum, thigh and arm. Women are prone to labia, pubic mound, clitoris, perianal region or vagina. About 90% patients, the virus can invade the cervix at the same time, leading to increased leucorrhea or lower abdominal pain, and can be complicated with cervicitis and metritis. Most male and female patients have bilateral inguinal lymphadenopathy. When inflammation spreads to urethra and bladder in the later stage, dysuria, dysuria, frequent urination and urinary retention may occur in severe cases. In addition, other symptoms may occur at the same time, such as fever, general malaise, headache, neck stiffness, meningitis and sacral nervous system insufficiency. There are more women with this disease than men, and the symptoms are more serious than men. Among the patients, about 10% suffered from pharyngitis, and 10% of men and 26% of women with primary genital herpes were accompanied by extragenital lesions, mainly in arms and fingers. The second week after herpes occurs in common genitals, it is mostly caused by self-inoculation of virus in infected genital parts.
Among patients with genital herpes, homosexual men can suffer from anorectal infection of rectal herpes virus type II, which is second only to male anorectal proctitis caused by Neisseria gonorrhoeae. The clinical manifestations are severe pain in anus and rectum, constipation, pus discharge, acute internal pain, and blisters and ulcers in anus.
Third, what are the manifestations of recurrent genital herpes?
The inducement of recurrent genital herpes is mostly related to fever, menstrual cramps, sexual intercourse, emotional excitement, climate change, fatigue and staying up late. Precursor symptoms, such as local tingling, mild pain and itching, occur during the attack. At first, the lesion is a person or pustule, and then the ulcer scabs. Recurrent genital herpes occurred within 1-4 months after the first infection. Nearly 60% of the patients relapsed within one year after the first infection with herpesvirus type II, and relapsed 4-6 times in the first year. The number of times will be reduced in the future. Recurrent patients have fewer systemic symptoms than primary patients, and the course of each attack is shorter. Usually, the skin lesions subside about 10 days. Some scholars have found that only 14% of patients with herpes simplex virus type I relapse, which is much lower than that of patients infected with herpes simplex virus type II. Recurrence is usually in the same place, but the number, duration and self-conscious symptoms of blisters are lighter than those of the primary one, the lymph nodes are not enlarged, and the systemic symptoms are less. Recurrent genital herpes mostly occurs in vulva, vagina, cervix and glans penis, and the incidence of urethra is rare. Recurrent genital herpes is difficult to control, and sometimes the pain is severe, which leads to the mental burden of patients, but it produces psychological obstacles, such as fear of cancer, fear of infecting sexual partners, avoidance of sexual life with sexual partners, and unwillingness to associate with the opposite sex, leading to sexual dysfunction, affecting family harmony and even depression.
Genital herpes virus is closely related to genital malignant tumor. As early as 1960s, it was suggested that herpesvirus II, which caused genital herpes, might be a potential carcinogen of cervical cancer. In recent ten years, it has been found that cervical cancer is related to sexual activity. Herpes ⅱ virus is a common pathogenic factor among sexually active people. The cervix is often the replication site of the virus, and genital herpes is often complicated with cervical cancer. Women who have had genital herpes are 5- 10 times more likely to have cervical cancer than women who have never had genital herpes. Recently, the specific antigen of herpesvirus II was found in cervical cancer tissues, exfoliated cells or precancerous cells. It shows that herpes virus type ⅱ plays an important role in the occurrence of cervical cancer. In addition, herpes simplex virus-like particles were also observed in the biopsy materials of penile cancer patients. However, the direct evidence that herpes simplex virus is the pathogenic factor of genital malignant tumor is not sufficient and needs further confirmation.
In recent years, people have also noticed the seriousness of pregnant women and type II herpes infection. For pregnant patients or asymptomatic detoxification, the most important thing is to infect newborns. In the early pregnancy, pregnant women with genital herpes will affect the fetus, leading to abortion or stillbirth. Babies are born with congenital infection, and herpes zoster, seizures and hepatosplenomegaly may occur at birth. If retrograde infection is caused by birth canal infection or premature rupture of amniotic membrane, there may be no obvious clinical symptoms within a few days or even weeks after birth. Early symptoms may be poor breastfeeding and excitement, followed by viremia or encephalitis. In severe cases, disseminated genital herpes virus infection may occur, including high fever, dyspnea, bleeding and central nervous system lesions, with poor prognosis.
Four, how to treat and prevent genital herpes:
Antiviral drugs such as 1 and acyclovir are the first choice for the treatment of genital herpes. For patients who have relapsed more than 6 times in a year, if the dose of each inhibitory treatment is maintained according to the doctor's advice, the curative effect is more certain.
2. Human leukocyte interferon can inhibit virus reproduction and reduce the recurrence rate of genital herpes.
3. Patients don't have to be overly nervous, live a regular life and strengthen exercise. After treatment, with the enhancement of the body's immune ability, the number of recurrences will gradually decrease or not recur.
4. Sexual partners are often asymptomatic virus emitters, and they should be actively mobilized for examination and treatment.
5. Avoid fatigue, drinking and sexual life during treatment. Please use condoms when necessary, but you should know that condoms can't completely block the spread of genital herpes.
6. Pregnant women with genital herpes are best delivered by caesarean section.
7. Both parties who are ready to get married and get pregnant have to wait until they are completely cured.
8. Disinfection and washing should be strengthened for daily necessities susceptible to viruses.
9. In order to reduce reinfection, unsafe sexual behaviors should be changed.
What are the hazards of verb (verb's abbreviation) genital herpes?
Pregnant women with genital herpes can cause fetal malformation, miscarriage and stillbirth. Genital herpes may be closely related to genital malignant tumor. It is reported that women who have had genital herpes are 5- 10 times more likely to have cervical cancer than women who have not had genital herpes.
6. Why is genital herpes a recurrent and incurable viral disease?
Because HSV can lurk in the root area of sacral nerve, when stimulated by some factors, the virus will revive and move along the affected nerve to the skin and mucosa, causing disease recurrence. At present, there is a lack of specific drugs and methods.