genital herpes
Introduction
Introduction to Genital Herpes Genifal Herpes (GH) is a herpes simplex that occurs in the genital area and is a viral infectious skin disease. Traditional Chinese medicine belongs to the category of heat sores. It is different from herpes simplex that occurs outside the mouth and is mostly transmitted through sexual relationships. basic knowledge The proportion of illness: 0.03% Susceptible people: good for young men and women Mode of transmission: sexually transmitted contact Complications: meningitis prostatitis pelvic inflammatory disease non-gonococcal urethritis condyloma acuminata
Cause
Genital herpes etiology
Causes:
Herpes simplex virus infection:
It is herpes simplex virus (HSV). HSV is a kind of herpes virus. It is a large DNA virus with a diameter of 150-200 nm. The central globular region is the core of double-stranded DNA, and the outer covering is 162. The shell particles are arranged in a stereo-symmetric icosahedron surrounded by a lipid-containing envelope.
way for spreading:
HSV enters the human body mainly through the skin, mucous membrane or damaged area, and firstly replicates in the epidermis or dermal cells. With or without clinical symptoms, the virus infects the sensory nerve or autonomic nerve after local full replication, and the virus enters the nerve along the axon. In the nerve cells in the section, animal experiments found that the virus was found by injecting HSV from the skin mucosa into the nerve cells in the ganglion, and the infection rate was quite fast in about 2 days.
HSV-1 is usually in close contact with the respiratory tract, digestive tract and skin and mucous membranes. Therefore, HSV-1 is often lurking in the trigeminal nerve root and the superior cervical ganglion. Therefore, the clinical findings are mainly herpes on the face, and the main cause of HSV-2. Behavioral transmission, genital contact and infection, so HSV-2 is often lurking in the sacral ganglia, so the clinical manifestations of genital herpes, patients with serological positive, can have intermittent urogenital HSV activities.
Reduced cellular immune function:
4 to 5 days after the primary infection, the neutralizing antibody and complement-binding antibody against HSV can be produced in the body, so that the condition of recurrent herpes simplex is alleviated, and viremia does not occur, but the recurrence cannot be stopped. Herpes simplex Recurrence is closely related to decreased cellular immune function.
In the initial stage of infection, the virus first replicates in the ganglion and the nerve tissue in contact with it, and then through the sensory nerve to the skin that is not associated with it, the skin surface is damaged, and the virus spreads from the peripheral sensory nerve to the skin. , mucosa, this situation, can explain the large area of the epidermis infected and away from the original site of new lesions, the primary HSV infection patients often have these characteristics, and the virus found in the nervous tissue away from the inoculation site, the first time After the clinical symptoms of the disease have subsided, the infectious virus is no longer isolated in the nerve, and viral proteins are not detected on the cell surface. Various stimulating factors such as immunosuppression, fatigue, infection, trauma, and cutaneous nerve injury can be detected. Causes the virus to resurrect.
After the primary infection is relieved, the infected virus and viral structural proteins are not found in the ganglion. The viral genome in the latent infected nerve cells is different from the dominant infection. The DNA of the former HSV is circular, in the latently infected mouse nerve. RNA transcripts detected in the nucleus and in the human trigeminal ganglion can hybridize to regions encoding the early gene ICPO, which is transcribed from the DNA complementary strand encoding ICPO, which may be involved in maintaining the nerve. Latent infections, but not involved in the establishment of latent infections, the mechanism by which latent infections are maintained is unclear, and it appears that latently infected cells have only partial transcription of HSV proteins.
HSV can be divided into two antigen types, HSV-1 and HSV-2. More than 99% of HSV-1 infections occur in the mouth, pharynx, nose, eyes and skin, while HSV-2 infection is common in HSV-2 infection. GH, according to statistics, 90% of GH pathogens are HSV-2 and 10% are HSV-1, which differ in many respects.
HSV is cold and heat-resistant, can be quickly inactivated in water at 50-52 ° C, can survive for several weeks at 4 ° C, and can survive for several months at -70 ° C, but in a dry environment, the temperature can be high to survive. Extended, HSV is sensitive to commonly used disinfectants, 0.5% formaldehyde solution, l% aqueous solution of Su or soapy water can be inactivated.
Pathogenesis
HSV is present in the skin of GH patients and virus carriers, mucosal secretions, saliva and feces. It invades the body through the respiratory tract, oral cavity, genital mucosa and damaged skin, grows at the entrance, and then passes through the blood or nerves. The passage spreads, causing damage to the primary herpes simplex. If it occurs in the mouth, nose and around the eyes, it is herpes labialis, and it occurs in the genital area, which is GH, and some are asymptomatic and insidious.
When the lesions of the primary herpes simplex disappear, HSV is not eliminated, but is lurking in the mucous membrane of the human body, in the blood and sensory ganglia, in GH, HSV is often lurking in the sacral ganglia, and through saliva, blood and mucous membranes Detoxification of secretions, because nerve cells lack the specific transcriptase required for virus reproduction, HSV remains static in nerve cells, once the body's resistance is reduced, in some incentives such as fever, cold, sun exposure, emotional excitement, digestion Under the influence of factors such as malnutrition, menstruation, mechanical stimulation or radiation exposure, the latent HSV is activated and released from the posterior root ganglia to cause recurrent herpes simplex.
Prevention
Genital herpes prevention
prevention
(1) to avoid unclean sexual intercourse and improper sexual relations, active genital sores patients are absolutely prohibited from having sex with anyone;
(2) Prohibition of sexual intercourse during treatment, and the spouse shall also conduct inspections if necessary;
(3) Care for local damage should be kept clean and dry to prevent secondary infection;
(4) After the cure or recurrence, we must pay attention to prevent colds, cold, fatigue and other predisposing factors to reduce recurrence.
At present, there is no specific prevention method. Animal experiments show that the inoculation of HSV dead vaccine or live attenuated vaccine has immune effect, so the virus is closely related to certain cancers, so it is not used for routine prevention. Recently, it has been packaged with purified herpes virus. Membrane glycoprotein is used as a vaccine to avoid the carcinogenic risk of herpesvirus DNA.
ACV also has a preventive effect, and condoms may reduce the spread of the disease, especially in the asymptomatic detoxification period, but in the case of genital damage, the use of condoms can not avoid transmission.
Family self-treatment for genital herpes (emergency use, not as a treatment)
1 Half-blossom lotus, smashed on the affected area, 2 times a day.
2 appropriate amount of purslane, smashed into a velvet, external application of the affected area, dressing once a day.
3 A few slices of fresh fig leaves, washed and smashed, add appropriate amount of vinegar, mix thoroughly into a thin mud, apply to the affected area, and replace with dry.
4 raw rhubarb, berberine, cork each 30 grams, frankincense, 15 grams of myrrh, a total of research into fine, when used with sesame oil into a paste, applied to the sore surface, once a day.
Complication
Genital herpes complications Complications meningitis prostatitis pelvic inflammatory disease non-gonococcal urethritis condyloma acuminata
It can cause a series of complications such as disseminated herpes, herpetic meningitis, prostatitis, proctitis, pelvic inflammatory disease, spinal nerve root disease, etc. In areas where AIDS is endemic, the disease can also increase the risk of HIV infection.
Part of the genital herpesvirus HSV1 may be transferred into the trigeminal ganglion via the peripheral nerve along the nerve axis, and HSV2 is transferred into the sacral ganglion for a long time to lurk in the nerve cells. If the body is infected, relapsed due to trauma, high fever, allergies, menstruation, etc. Will be complicated by lumbar pneum neuritis, myelitis, radioactive pain in the buttocks and lower extremities, bladder paralysis, and genital herpes often associated with other sexually transmitted diseases such as gonorrhea, non-gonococcal urethritis, syphilis, genital warts, vaginal candida Diseases, trichomoniasis and other mixed infections, so should be paid attention to in the diagnosis and treatment.
Symptom
Genital herpes symptoms Common symptoms White malignant spotted papules Liver splenomegaly Toxic inguinal lymphadenopathy Hemorrhagic tendency High fever scarring
First, the symptoms
HSV infection is a systemic disease. The virus enters the human body through the respiratory tract, oral cavity, genital mucosa or damaged skin. It can immerse in the normal mucous membranes of the human body, blood, saliva, and local sensory ganglia and most organs. Almost all visceral and mucosal epidermis The HSV can be separated inside.
Most of the primary infections are recessive, most of them have no clinical symptoms or subclinical manifestations. Only a few (about 1-10%) can have clinical symptoms, mainly in infants with low immune function or severe malnutrition or other infections. Adults are rare. After the primary infection subsides, the virus can continue to bury in the body. About half of the normal people are carriers of the virus. They can become a source of infection through mouth and nasal secretions. Because HSV does not produce permanent in the human body. Immunity, so when the body's disease resistance declines, such as suffering from a certain febrile infection, gastrointestinal disorders, menstruation, pregnancy, infection, excessive fatigue, emotional environment changes, the body's latent HSV is stimulated Onset.
HSV-1 mainly causes herpes labialis, pharyngitis, keratoconjunctivitis and sporadic encephalitis, while HSV-2 infection mainly causes genital herpes, but it is also clinically the opposite.
The incubation period of HSV infection is 1-45 days, with an average of 6 days. HSV-1 infection mainly occurs in the skin and mucous membrane junctions of the mouth, lips, and nostrils. It can also be seen on the face or lips. It begins to have local itching and mild tension. Feeling, occasionally accompanied by neuralgia, erythema appeared immediately, clustered small papules on the basis of erythema, rapidly changed into miliary-sized blister, the content is clear, blister surface appears after rupture, dry and crusted after a few days, conscious Itching, occasional systemic symptoms such as burnout, discomfort and mild fever, healing can leave temporary pigmentation, the whole course of 1-2 weeks.
HSV-2 infection mainly occurs in the genital area. The affected part first has a burning sensation. Soon, small groups of small blisters occur on the basis of erythema. Male foreskin, glans, coronary sulcus, penis, etc. are occasionally seen in the urethra; In the labia, clitoris, vagina, cervix, etc., the blisters can gradually become pustules, about 6 days or so to form a smash or shallow ulcer, conscious pain, patients can develop urethritis, dysuria, most people have groin Lymph node swelling and pain, some patients may have fever, muscle pain and meningitis symptoms, such as in the female cervix can form ulcer necrosis, increased vaginal secretions, may have lower abdominal pain, should pay attention to the presence or absence of cervical cancer, pregnancy Genital herpes is easy to cause miscarriage, premature or stillbirth, and easy to cause neonatal infection, newborn herpes simplex, the disease usually recovers after about 3 weeks, but often recurrent, usually 1-4 months after the original rash Internal recurrence, the symptoms are lighter than the original, the range is also small, limited to the genital area, sometimes only 1-2 herpes, the course of disease is also short, from the onset to healing 8-12 days, the disease can also be accompanied Sites other than genital infections, such as the lips, arms and central nervous system.
Second, physical signs
Skin lesions are blister or pustules or erosive and ulcerated on the basis of erythema. About 90% of female patients are accompanied by HSV cervicitis. The cervix can be seen with redness, erosion, ulcers, purulent vaginal discharge, and some patients. There may be swelling of the inguinal lymph nodes or elevated body temperature. Skin lesions may also occur in the lips, fingers, buttocks, thighs, arms, and even the eyes and throat, complicated by meningitis or transverse myelitis, usually after rash 3. In 12 days, there was a phenomenon of increased intracranial pressure such as neck stiffness.
Third, latent infection and recurrence
About one week after HSV infection in humans, neutralizing antibodies appear in the blood, reaching a peak in 3-4 weeks. These antibodies can be used for many years. These antibodies can eliminate the virus and restore the body, but most individuals cannot completely eliminate the virus and prevent recurrence. The virus persists in the host in a latent state. The clinical course of acute first-episode herpes is similar in different subtypes of HSV-infected patients, but the recurrence rate of genital lesions is different. About 90% of patients with first-on HSV-2 infection will have a recurrence within 12 months. (mean recurrence 4 times), and only 50% of patients with initial HSV-1 had similar recurrence (mean recurrence was less than 1). The recurrence rate of genital HSV-2 infection in different individuals and the same patient changed greatly during the whole year. Recurrence 5-9 times, usually occurs within 1-4 months after the disappearance of the original herpes. Some patients are relapsed due to the triggering factors such as fever, menstruation, sun exposure, cold, certain viral infections, etc. It is that each recurrence often occurs in the same site. There may be prodromal symptoms such as local itching before recurrence. There are burning and tingling in the infected area several hours before the rash.
Recurrent genital herpes (GH) has a great psychological impact on patients. Because there is no effective therapy to prevent recurrence and may have the risk of causing genital malignant transformation, it has psychological impact on patients, and patients have depression, fear and other psychological disorders. This in turn directly affects the recurrence of HSV, our treatment experience, as long as patients adhere to regular treatment, can be cured.
Fourth, HSV and HIV infection :
HSV is often infected with HIV-1 and can promote the development of the disease, causing severe local and disseminated infection. It is currently considered that HSV is a regulator that activates HIV replication. Heng has 6 cases of AIDS combined with reproductive system HSV skin damage. The patient underwent a skin biopsy and found that both keratinocytes and macrophages hybridized with HIV-1 and HSV-1, which enabled HIV-1 to retain its infectivity without being able to enter the cell without binding to CD4 molecules. In addition, HSV-1 can Stimulates latent HIV-1, while increasing HIV-1/HSV-1 co-infection and replication in tissues.
Balloon-like degeneration of epidermal cells, which can be seen as eosinophilic inclusions, the epidermis began to be a multi-atrial blister formed by reticular degeneration, and later aggregated into a single atrial blister, the dermal papilla layer has mild edema, and the severity of inflammatory Cell infiltration can cause severe vasculitis when the reaction is severe.
Examine
Genital herpes examination
Cytological examination
Direct smear after the material is taken for Wright staining, Giemsa staining or Papanicolaou staining, which is helpful for diagnosis when eosinophilic inclusion bodies are found in the nucleus of multinucleated giant cells.
The sensitivity of this method is only 50% to 80%, and it is not specific. The positive rate of the disease is high at the early stage, and the positive rate is low at the later stage.
2. Pathogen examination
(1) HSV examination: The fluorescein-labeled anti-HSV-1 and anti-HSV-2 antibodies were used as direct immunofluorescence assays to distinguish HSV types.
(2) HSV antigen test: HSV antigen can also be detected by indirect immunofluorescence assay, enzyme-linked immunosorbent assay, Western blot assay or radioimmunoassay.
(3) HSV nucleic acid test: including nucleic acid probe detection method and nucleic acid amplification detection method, the latter is divided into PCR and LCR, and the sensitivity and specificity are strong, and it is fast and simple, and has low requirements on the detection material.
(4) HSV culture separation: commonly used cell culture method, mainly used for further identification of HSV.
(5) Electron microscopy: Take blister fluid or diseased brain tissue and observe the virus particles under electron microscope. The positive rate is 50%, but HSV is indistinguishable from other herpesviruses. Immunoelectron microscopy is more specific.
3. Serological examination
It is mainly used for detecting anti-HSV-1 and anti-HSV-2 antibodies, diagnosing primary infection of HSV, and conducting sero-epidemic investigation of HSV infection. Immunofluorescence assay, enzyme-linked immunosorbent assay, immunoblotting assay and radiation can be used. Immunoassay and other methods. In modern times, HSV-2 gD2 glycoprotein is used as an antigen to detect anti-HSV-2 antibodies, and HSV-1 gDl or gC glycoprotein is used as an antigen to detect anti-HSV-1 antibodies. The sensitivity is high and can be distinguished. Anti-HSV-1 and anti-HSV-2 antibodies, however, such tests can only indicate that the patient has developed a dominant or latent HSV infection.
Diagnosis
Diagnosis of genital herpes
diagnosis
The diagnosis of HSV infection should be based on medical history, clinical manifestations and laboratory results. There is a history of unclean sexual intercourse, and skin erythema and primary blisters appear in the genital area. It is easy to relapse and is easy to diagnose. If necessary, it can be used as blister fluid. Smear, culture, inoculation, immunofluorescence, serum immunoassay, etc., are all helpful in diagnosing and determining the type of virus.
Depending on the history, symptoms and skin or mucous membrane performance, it is generally not difficult to make a diagnosis and, if necessary, a laboratory test to identify the pathogen.
TCM syndrome differentiation
Wet hot bet type
The main card: blisters in the affected area, smashed, itchy joints, constipation, short red urine, red tongue, yellow greasy moss, slippery pulse string.
Dialectical: hot and wet bet, exogenous poison.
2. Liver and kidney loss type
The main card: repeated episodes of the disease, both upset and less, backache, dizziness, less food, boring, dry mouth, pale tongue, fine pulse.
Dialectical: clearing away heat and dampness, nourishing the liver and nourishing the kidney.
Genital herpes is mainly associated with hard chancre and soft chancre :
Hard chancre is a single hard ulcer, no pain, no history of recurrence, experimental examination of USR (+) or RPR (+), syphilis spirochete visible, soft chancre is a soft ulcer, local pain, but no recurrence history The test was positive for streptococcus.
1. Fixed drug eruption has a history of drug allergy, a history of useful drugs before rash, each time the disease is fixed and not limited to the vulva, other skin, mucosal junction is also damaged, the skin lesions are mainly dark erythema with thick blister or Bullae.
2. Behcet syndrome may first appear oral or external genital ulcers, positive acupuncture test, and may be accompanied by iridocyclitis and nodular erythema of the extremities.
3. Syphilis hard squat incubation period of 2 to 4 weeks, local induration, ulcers, no symptoms, pallidum and syphilis seropositive.
4. 2 to 5 days before the onset of soft chancre, there is a history of sexual disorder, damage to the vulvar ulcer, soft base, accompanied by pain and tenderness, unilateral inguinal lymph nodes, tenderness, ulceration and pus discharge, Ducrey can be detected Haemophilus.
Other genital skin diseases such as contact herpes zoster, Behcet's disease, and impetigo are sometimes similar to genital herpes, which can be distinguished from medical history and examination.
