生殖器疱疹

　　About 85% to 90% of genital herpes is caused by type 2 herpes simplex virus (HSV-2), and 10% to 15% by type 1 herpes simplex virus (HSV-1). HSV is a DNA virus with a linear double-stranded DNA core, a molecular weight of 160×10Da, and a protein capsid with a three-dimensional symmetrical icosahedron shape on the outside, consisting of 162 capsomeres. Outside the capsid is a lipid envelope. The HSV genome encodes virus-specific core proteins and structural proteins, including glycoproteins present on the surface of the virus, which can induce the body to produce neutralizing antibodies. In addition to the specific antigenic determinants of gC in HSV-1 and gG in HSV-2, the other structures are basically similar, and the antibodies produced have cross-reactivity between types. The HSV genome also encodes non-structural proteins such as thymidine kinase (TK), DNA polymerase, etc., which are very important for viral replication. Because these viral enzymes are different from cellular enzymes, antiviral drugs such as acyclovir, which can selectively inhibit viral enzymes, are developed based on this.

　　Primary genital herpes is mainly transmitted through direct sexual contact with herpes virus carriers. HSV enters the epidermal cells through minor skin or mucosal abrasions or fissures, replicates and reproduces within them, causing balloon degeneration and necrosis of cells, infiltration of inflammatory cells, and other inflammatory reactions, and stimulating the body's immune response. The virus that invades the body enters the dorsal root ganglion of the sensory or motor nerve of the peripheral sensory nerve, establishes a latent infection, and latent infection is the root cause of recurrent genital herpes. The activation of latent viruses is related to the thymidine kinase of the virus and the immune and non-immune factors of the body. After the latent virus is activated, it descends along the axon of the peripheral nerve to the skin and mucosa, causing recurrence.

　　Genital herpes is prone to a series of complications such as disseminated herpes, herpes meningitis, prostatitis, proctitis, pelvic inflammatory disease, and spinal nerve root disease in clinical practice. In areas with a high prevalence of AIDS, the disease can also increase the risk of HIV infection. Due to fatigue, the body's resistance decreases sharply, which can lead to disseminated herpes, herpes meningitis, and even death.

　　Genital herpes is closely related to the occurrence of cervical cancer. According to research, the positive rate of hsv-2 antibodies in patients with cervical cancer is significantly higher than that in the normal population. It can promote the malignancy of chronic diseases. For example, if herpes recurrence is found after lung cancer surgery, it can be inferred that herpes was the cause of its formation in the past. If there are other diseases such as chronic active ulcers, colitis, proctitis, chronic hepatitis B and C, there may be concurrent tumors such as rectal cancer and liver cancer under the influence of genital herpes.

　　Genital herpes may also be an important factor leading to habitual abortion in women and infertility in men. In addition, genital herpes can induce viral prostatitis, which is often seen in clinical practice; it can also be accompanied by refractory herpes urethritis, refractory female vaginal inflammation, and pelvic inflammatory disease.

　　After HSV infection, the incubation period of genital herpes is about 4 to 5 days on average. The affected area of the vulva first experiences a burning sensation, followed by the occurrence of a cluster of papules, which may be a cluster or multiple clusters, and then forming blisters, which evolve into pustules after several days, forming erosions or superficial ulcers after rupture, with a sense of pain, which finally scabs and heals spontaneously, with a course of about 2 to 3 weeks. The skin lesions are commonly found on the prepuce, glans, corona, and penis in males, and occasionally on the urethral orifice; in females, they are more common on the labia majora and minora, clitoris, pubic area, and cervix, and also on the urethral orifice. Primary genital herpes often accompanied by systemic symptoms such as malaise, low fever, and headache, with enlargement of local lymph nodes. This disease often recurs, and recurrent genital herpes is usually milder than primary herpes, with smaller lesions and often without systemic symptoms. Male homosexuals may have anal and rectal HSV-2 infection, with an incidence rate second only to that of gonococcal proctitis, with clinical manifestations of anal and rectal pain, constipation, increased secretion, and tenesmus. Perianal herpes ulcers may be present, and sigmoidoscopy often shows mucosal congestion, hemorrhage, and ulcers in the lower rectum.

　　Primary genital herpes

　　The incubation period of primary genital herpes is 2 to 10 days, with an average of 6 days. The site of onset in males is the prepuce, glans, corona, penis, and occasionally the urethra, prostate, and seminal vesicle; homosexuals may have it in the anus and rectum; in females, it is the vulva, labia majora and minora, clitoris, vagina, and cervix, and may also occur in the anus, rectum, and urethra. The symptoms of primary infection are often severe, with the affected area often experiencing burning, itching, or sensory abnormalities before the blisters appear, with an increase in vaginal discharge in women, followed by pale red spots or papules locally, and then rapidly appearing in clusters of sesame to mung bean-sized tense blisters. The blister fluid is initially clear and gradually becomes turbid or even purulent. The blister wall is thin and easily ruptured, forming a large ulcer surface, with a sense of pain, which is more pronounced when touched.

　　Recurrent genital herpes

　　Recurrent genital herpes often occurs within 1 to 3 months after the primary genital herpes. Those caused by HSV-2 infection have a higher recurrence rate and frequency of outbreaks. Approximately 60% of patients will recur within one year after the first infection, with 4 to 6 outbreaks in the first year, and some may have more than 10. The symptoms of recurrent genital herpes are usually milder than those of primary genital herpes. Recurrent genital herpes can be accompanied by sacral nerve root disease, manifested as pain or sensory abnormalities in the buttocks or thighs, urinary retention, and inability to achieve an erection. Other complications include proctitis, prostatitis, and urethritis syndrome. The risk of cervical cancer in women with recurrent genital herpes is 5 to 10 times higher than that in general women.

　　Genital herpes is a sexually transmitted disease caused by HSV virus infection. Within one year after the first infection with Type 2 herpesvirus, nearly 60% of patients will recur, with 4 to 6 recurrences in the first year, and the frequency will decrease thereafter.

　　There is currently no specific preventive method for genital herpes. Animal experiments show that vaccination with HSV dead vaccine or attenuated live vaccine has an immunogenic effect, so the virus is closely related to certain cancers, and therefore it is not used for routine prevention.

　　Type 2 herpesvirus can潜伏 in the spinal nerve ganglia, and there is currently no specific effective drug for the virus. Therefore, when the body's resistance decreases, the virus will replicate and reproduce in large quantities in the ganglia, and then reach the original skin lesion site along the nerve bundle to cause recurrence again. The following measures can prevent genital herpes:

　　1. Avoid unclean sexual intercourse and improper sexual relationships; active genital herpes patients are prohibited from having sexual relations with anyone;

　　2. Abstain from sexual intercourse during treatment, and the spouse should also be examined if necessary;

　　3. Pay attention to the care of local lesions, keep them clean and dry, and prevent secondary infection;

　　4. After recovery or recurrence, attention should be paid to preventing colds, catching a chill, fatigue, and other triggering factors to reduce recurrence.

　　5. Condoms may reduce the spread of the disease, especially during asymptomatic shedding periods, but even when there are genital lesions, the use of condoms cannot prevent transmission.

　　Currently, the diagnosis of genital herpes mainly relies on medical history, symptoms, and signs. In some large hospitals with conditions, viral isolation can be performed, using immunofluorescence to check viral inclusions, electron microscopy to check viral particles, enzyme-linked immunosorbent assay or radioimmunoassay to detect viral antigens. The laboratory examination of genital herpes is as follows:

　　1. Cytological examinationTake a small amount of tissue from the base of the blister or ulcer surface for smearing, Wright-Giemsa staining or Papanicolaou staining can detect the eosinophilic inclusions in the characteristic multinucleated giant cells of HSV infection, but cannot distinguish between HSV infection or varicella-zoster virus infection, with sensitivity of only 60% of viral isolation.

　　2. Antibody detection method:The commonly used protein immunoblotting method can also be used to detect HSV-2 antibodies with gD2 as antigen, which has the advantages of high sensitivity and the ability to distinguish between HSV-1 and HSV-2.

　　3. Antigen detection method:If the DNA of Herpes Simplex Virus (HSV) in skin lesions is detected by PCR, it has high sensitivity and specificity, which can greatly improve the ability to diagnose HSV in patients with genital ulcers. However, it is expensive and the accuracy is affected due to the influence of operation technology, laboratory conditions and equipment, and it is prone to false positives.

　　For patients with genital herpes, necessary dietary restrictions are necessary to prevent recurrence. Eating spicy and irritating foods, smoking, and drinking are all harmful to the recovery of genital herpes, especially drinking can promote the recurrence of the disease and worsen its symptoms, so, after being diagnosed, it is absolutely necessary not to drink alcohol.

　　Eating foods rich in vitamins and proteins is helpful for the recovery of the disease, such as fresh vegetables, fruits, and milk, eggs, etc.

　　Abolish unhealthy sexual life, and both sexual partners should be treated at the same time to avoid cross-infection.

　　The treatment of genital herpes is still many unresolved issues, and the treatment cannot completely clear the virus or prevent the recurrence of the disease. Currently, treatment is divided into general treatment and antiviral treatment, as follows.

　　FirstlyGeneral treatment

　　1. Keep the local area clean, dry, and maintain the integrity of the vesicle wall. Saline solution can be used for daily cleaning, and analgesics can be taken orally for pain relief, along with psychological comfort.

　　2. For those with concurrent bacterial infections, topical antibiotic ointments can be used.

　　3. For those with obvious local pain, lidocaine hydrochloride ointment at 5% or oral analgesics can be used.

　　4. Psychological comfort, explaining the cause of recurrence and how to treat and deal with it.

　　5. Women with recurrent genital herpes must undergo gynecological examination to exclude cervical cancer.

　　SecondlyAntiviral drug treatment

　　1. Acyclovir: It is considered the most effective antHSV drug currently available. For severe cases, intravenous administration can be given at a dose of 5mg per kilogram of body weight, once every 8 hours, for a total of 5 to 7 days. General patients can take it orally at a dose of 200mg, four to five times a day, for a total of 7 to 10 days.

　　2. Ribavirin: It is a guanine nucleoside analog and has antiviral effects against DNA and RNA viruses. It is taken orally at a dose of 800mg per day for a total of 10 days, which can alleviate pain and shorten the course of the disease.

　　3. Immunostimulants: Oral levamisole has certain efficacy, but there are reports that the effect is not very certain. Interferon has been found to have inhibitory effects on HSV in vitro, and its clinical therapeutic effects are still under study.