Genital herpes is an infectious lesion of the skin and/or mucous membranes in the genital area (and in a number of episodes, of other systems and organs), caused by herpes simplex virus. This disease is characterized by a tendency to a relapsing course.
Approximately 20% of the total population carries the virus, while signs of genital herpes are detected in 5% only, with erased or completely absent clinical symptoms in the rest.
Causes of Infection
The causative agent of the disease belongs to the human herpesviruses. Herpes simplex virus, shortly HSV, type 1 mainly affects the face, head and neck; for the first time, the pathology manifestations can be observed in infancy in the form of gingivostomatitis (inflammatory lesion of the oral mucosa), by the age of 10, the incidence of infection reaches 90%. At the same time, type 2 “prefers” the genital area and the adjacent organs. Therefore, HSV-2 is a sexually transmitted disease (up to 80% of all episodes). However, due to the prevalence of oral-genital contacts, exposure to HSV-1 or both can be possible.
The risk of transmission of genital herpes through the contact with an infected partner is on average up to 10% annually (for men the risk of such an “acquisition” is slightly lower than for women). If the disease is manifested (e.g. by specific rashes), the risk of infection reaches 75% through ordinary sexual intercourse.
After the virus enters the body through the skin or mucous membranes, it enters the ganglion (nodes, clusters) of nerve cells, where it remains until exacerbating when affected by provoking factors
The herpes virus is localized and multiplies also in the lymph nodes, propagating with the blood flow throughout the body. HSV can infect specific cells of the immune system (lymphocytes, neutrophils, macrophages) and thereby seriously reduce cellular immunity.
The virus remains in the human body for life. It can be transmitted to an uninfected partner even in the absence of rashes.
Factors that provoke exacerbation or contribute to contamination include the following:
• psycho-emotional stress;
• diseases that proceed with a fever;
• mucous/skin injuries;
• presence of other infectious pathologies, including those transmitted mainly through sexual intercourse (syphilis, HIV, hepatitis, etc.);
• exposure to UV, laser radiation;
• overheating/excessive heat loss;
• surgical/cosmetic manipulations;
• promiscuous sexual activity, etc.
Symptoms and Types of the Disease
Genital herpes in men can occur in several stages/stages:
• primary infection (that is, contamination of a person who has not been infected earlier):
- asymptomatic (also called a subclinical infection);
- with a localized lesion (the virus affects a localized area);
- with several lesions (there are several “entrance gates”)
• latent (hidden) infection, when the virus is present in the nerve ganglia, but not detected in the analyzes;
• relapse, development of signs of pathology after the previous stage (herpes is considered relapsing when the number of exacerbations is equal to or exceeds 6 episodes per year).
Clinical signs of genital herpes vary depending on the type of disease.
In a typical form, the disease will go through three stages:
• prodromal period (lasting about one or two days), accompanied by itching, tingling, or burning sensation, and soreness;
• rash period (from three days to a week), with the formation of groups of characteristic so-called vesicles, turning into erosion, with skin edema and erythema;
• regression period, with the formation of crusts, and then temporarily pigmented areas (2 to 7 days).
Genital herpes in men mostly affects the skin and/or mucous membrane of the penis prepuce and balanus. To date, in most episodes, the disease occurs in atypical or paucisymptomatic form, when the characteristic formations (vesicles) are not noticeable. There is swelling, redness, and discomfort in the affected area, as well as cracks and small spots. Sometimes, there is quite intense pain, irradiating into the adjacent organs and skin areas. Occasionally, the disease is manifested only by a slight inflammatory reddening (erythema). Since the period of having a problem lasts less than in a typical form, the patient may even not notice the symptoms.
In some of the most complicated cases, the prostate gland (prostatitis), testicles (orchitis) and/or the epididymis (epididymitis), urinary tract (urethritis), bladder (cystitis), seminal vesicles (vesiculitis) and other organs may be affected as well. In herpetic urethritis, the vesicles appear on the urethral mucosa, accompanied by urethralgia. The development of herpetic urethroprostatitis (in addition to the urethra, the virus affects the prostate gland), proctitis (rectum/sigmoid colon) is also possible.
In general, in healthy people, recurrence of the disease proceeds easily and often without any treatment, whereas in the presence of serious problems in the immune system (HIV, blood pathology, lymphoma, leukemia, etc.), extensive skin areas, internal organs, etc. can be affected.
Diagnostics and Detection of the Disease
To confirm the herpes nature of the disease, any biomaterial such as sperm, contents of vesicles, urine, blood, saliva, etc. should be tested. Diagnostic methods include:
• PCR (polymerase chain reaction), which is the most accurate technique;
• in culture-based research the virus is isolated (long, expensive, therefore more important for scientific research);
• electron microscopy, cytological diagnosis, when the impression smear from the area of rashes is analyzed (to be stained and examined under a microscope);
• ELISA (Enzyme Immunoassay) is employed in a limited number of cases only, because only antibodies are detected, which is not of diagnostic value (the majority of the adult population contacted with herpesvirus in the course of a lifetime, and they have the corresponding antibodies).
Antibodies to the herpes virus are detected in the following cases only:
• in order to confirm primary contamination;
• with negative results of PCR/culture-based study and simultaneous presence of symptoms;
• if the other partner has genital herpes;
• in persons living with HIV;
• in persons who have frequent casual sex, homosexuals (i.e. those in the highly vulnerable group).
Treatment of Herpes
The current methods of treatment do not completely eliminate the herpes simplex virus from the body. Therapeutic intervention aims at accelerated healing of rashes, reducing the risk of recurrence, reducing the excretion. Therefore, the answer to the question of how to treat genital herpes and whether it should be treated at all can only be given by a professional doctor.
The only group of drugs effective for therapy includes abnormal nucleosides, which inhibit the production of viral RNA/DNA. These antiviral medicines include systemic, taken per os, acyclovir-based drugs or more advanced (and expensive) ones, which contain Valaciclovir, Famciclovir. Local treatment (creams/ointments) in isolation is ineffective, but can be used as an additional measure to alleviate the patient’s condition.
The medication should begin at the early stages of the disease (in the first two days). Before rash has appeared, with burning and soreness felt only, you can prevent rash. At later stages, these antiviral agents somewhat shorten the healing time. The doctor shall select/adjust the dosage and regimens, in most cases, starting with prescribing of acyclovir for 10 days (5 times a day) in the situation with the initial episode of infection. In the presence of immunosuppressive conditions (causing a decrease in immunity) dosage can be doubled as compared to standard regimen.
If the relapses (relapsing course) are frequent, the so-called “suppressive therapy” with the same drugs may be resorted to. Drugs are taken daily for six months or more. Usually a year later, effectiveness of the treatment is evaluated, with monitoring the occurrence/absence of relapses, after the drug is discontinued. Patients with immunodeficiency and/or some serious chronic disorders have to undergo such therapy on an almost continuous basis.
The doctor may recommend such agents as Amixin, Cycloferon, Viferon, and the like. However, safety or performance of these drugs in genital herpes has not been clinically proven, nor these are used in foreign medical practice (although some patients note the alleviation of symptoms in the therapy with these drugs).
Also, sometimes bracing agents and physiotherapy treatment can be additionally prescribed. Traditional practitioners offer their own methods to fight the genital herpes, but such measures can be taken exclusively if agreed upon with the attending physician-urologist, and only in addition to the basic treatment. Traditional medicine recommends the following:
• green onions with olive oil for vitamin enrichment of the body, daily;
• a tincture of Echinacea diluted with water;
• applications with a mixture of essential oils (lavender, eucalyptus, etc.) with water or with the infusion of chamomile and bee glue to the affected areas;
• taking baths with violet elixir;
• applying the cut aloe leaf to the rash area;
• make lotions of decoctions of the oak bark, lemon balm, etc.
Complications of genital herpes in men are due to the development of bacterial inflammatory processes against the background of a decrease in the body defenses induced by a herpes infection: prostatitis (lesion of the prostate gland), urethritis (of the urethra), vesiculitis (of the seminal vesicles) and others.
It is important to understand that due to the fact that genital herpes is mostly a sexually transmitted disease, there is a risk of other pathologies caused by the causative agents such as ureaplasma (ureaplasmosis), mycoplasma (mycoplasmosis), chlamydia (chlamydia), fungi (mycosis), gonococci (gonorrhea), etc. According to the latest medical research, the presence of HSV-2 in the body increases the risk of contamination with the immunodeficiency-associated virus. The influence of HSV-infection on the development of male infertility has been debated a lot.
However, the most terrible threat posed by this disease is the transmission of the virus (primary infection) to a pregnant woman. The causative agent can induce both the interruption of pregnancy and development of various pathologies of the fetus. If the pregnant woman is primarily contaminated, the risk of infection of the fetus is 50% (for a relapse, it is less than 4%). Further, herpetic infection of newborns (infants become infected at childbirth) is fraught with a fatal outcome.
There is no specific prevention treatment of genital herpes. The primary measures to prevent contamination, or, in some cases, exacerbation of the disease, include:
• use of condoms;
• abstaining from casual sex;
• abstaining from oral sex (especially when a partner is pregnant);
• general bracing measures;
• detection and elimination of foci of the chronic infection;
• normalization of the psycho-emotional state;
• healthy lifestyle.
An experimental vaccine “Herpevac” has been developed, which demonstrated a high level of protection of women against contamination with genital herpes.
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