Herpes simplex - simple or vesiculate deprive herpes it is known to mankind since antique times, and the name "herpes" has the Greek origin – "to creep", "creep" that completely corresponds to clinical displays of the diseases caused by the virus of simple herpes (VSH). Thanks to a typical clinical picture, diagnosis of simple herpes is rather simple task. In doubtful cases conduct a research separated herpetic vesicles. Treatment of simple herpes comes down to local or system purpose of anti-herpetic medicines on the basis of an acyclovir, if necessary immunomodulatory therapy is carried out.
Herpes simplex - simple or vesiculate deprive herpes it is known to mankind since antique times, and the name "herpes" has the Greek origin – "to creep", "creep" that completely corresponds to clinical displays of the diseases caused by the virus of simple herpes (VSH). Diseases which reason the virus of simple herpes is are quite widespread, some complications of an infection come to an end with a lethal outcome. Data of the center for control of incidence in the USA register about half a million cases of a herpetic infection a year, from here it is possible to assume that carriers of a herpetic infection are from 2 to 20 million Americans. In England growth of incidence of a herpetic infection of genitals exceeds other infections, sexually transmitted. In the Scandinavian countries, simple herpes is found approximately in 8% of the women who addressed the venereologist. In our country there are no statistical data on incidence of herpes, but the herpetic infection is widespread everywhere, on it point data of private inspections to a carriage of a virus of simple herpes.
The recurrence of a herpetic infection takes place in case of reactivation of a virus, it is possible after overcoolings, overheating, at the lowered immunity, in particular the herpetic infection is a specific complication at HIV infection. The rashes caused by a serotype of 1 virus of herpes usually are localized in nasolabial area, also the virus is shown in the form of a keratokonjyuktivit, and the rashes caused by VPG-2 are localized in genitals. But, considering features of sexual behavior, localization of rashes can be opposite. Therefore herpes demands carrying out serological researches for establishment of a serotype.
Etiology and pathogenesis
The group of viruses of herpes includes 4 virus, similar on morphology: VPG (herpes simple), varicella-zoster – a virus activator of shingles and chicken pox, Epstein-Burra's virus and a cytomegalovirus; in 1962 it is revealed that the virus of simple herpes has two serotypes – a serotype 1 and a serotype 2. Serological researches confirm that by the end of the 18th month of life, practically each person contacted to VGP-1, entrance gate as a rule, airways are. Then the virus gets into cages a gangliya of a trigeminal nerve, but during life can cause clinical displays of an infection never.
With VPG-2 the first contact usually comes in the pubertatny period at the beginning of the sexual relations. Thus after external manifestations which can not be the virus also passes into an inactive form and in cages sacral a gangliya is capable to remain a long time.
Simple herpes, especially the second type has onkogenny properties that is of great importance, considering prevalence of an infection. The incidence of a herpetic infection is approximately identical in all age groups and is equally widespread regardless of a floor. Clinical manifestations depend on localization and the size of the center of defeat, and also on the general condition of immune system.
Displays of herpes
Simple herpes is most often localized around wings of a nose, corners of a mouth, a red border of lips and in genitals, that is around natural openings. In one, less often in two-three places against the background of limited hyperaemia small bubbles appear; each center contains from two to ten and more. Bubbles are located by group and filled with transparent exudate which in several days grows turbid. In certain cases single bubbles merging, form several multichamber bubbles which have uneven scalloped edge and about 1,5 cm have a diameter.
At process localization bubbles on the sites of skin not subject to maceration and friction, shrink in a yellowish-gray crust which independently disappears in 5-7 days. And on the place of a bubble there is a pigmented site on the expiration of some time getting normal coloring.
On mucous, and also on those sites which are subject to maceration or friction bubbles are opened owing to what erosion of a polycyclic outline with a bright red bottom are formed. Rashes are followed by burning, pain and feeling of a pricking in case rashes quite a lot – there is hypostasis of nearby fabrics. The general condition of the patient at the infection caused by a virus of simple herpes does not suffer, but the fever, muscular pains and subfebrilny temperature in some cases can be noted. In general, process proceeds 10-14 days, at accession of a secondary infection duration of a disease increases.
The virus of simple herpes can cause herpetic stomatitis which clinical displays are damages of a mucous membrane of a mouth, lips, cheeks, gums and the sky. Small groups of small bubbles arise on the swelled and hyperemic mucous membrane. Bubbles are opened in the first several hours, leaving erosion which because of merge have melkofestonchaty outlines. In 2-4 days of an erosion become covered by a gentle fibrous film, and then epitelizirutsya. The herpetic stomatitis which is not complicated by other infections proceeds 6-14 days, the general condition of the patient at the same time satisfactory, but morbidity in an oral cavity and a gipersalivation is noted.
The herpes virus most often causes sharp aftozny stomatitis in children of younger and preschool age. During the short prodromalny period the general malaise, weakness, loss of appetite and slight increase of body temperature is noted. Mucous oral cavities it is sharply edematous and hyperemic, and aftoidopodobny rashes are localized everywhere. Unlike simple stomatitis of a rash have the form with the site of a necrosis in the center and sharply expressed inflammatory rim on peripheries, diameter of single rashes to 1 cm. In process of progressing of process of an afta merge and form deckle-edged extensive erosive and ulcer sites. The gipersalivation, appetite loss, temperature increase and sharp morbidity is noted.
At some patients a recurrence of a herpetic infection depending on seasonality or without communication with season is possible; at the lowered immunity a recurrence can arise several times a month. Clinical displays of recurrent herpes depend on localization, the general condition of the patient, but do not differ from displays of herpes simple.
Basis of pathogenesis of recurrent herpes are the contributing factors: overcooling or an overheat of an organism, the general and catarrhal diseases, earlier postponed infectious diseases, and also all diseases which weaken cellular immunity. At women communication between the periods of a menstrual cycle and aggravations a recurrent herpetic infection is observed.
Diagnosis of herpes
The diagnosis of diseases caused by a virus of simple herpes is possible and in typical cases clinical manifestations allow to make the exact diagnosis. But at localization in genitals, herpetic ulcers can have similarity to a firm shankr. The erosion caused by a herpes virus has polycyclic outlines and the tendency to merge of melkopuzyrkovy elements is observed, there is no infiltration, specific to a shankr, on the basis of it and there is their differentiation. Simple herpes, unlike syphilis, proceeds sharply and in most cases has recidivous character. In doubtful cases resort to laboratory diagnostics and test separated erosion on existence of a pale treponema.
The herpes which is localized on mucous a mouth and proceeding as stomatitis should be differentiated from a vulgar puzyrchatka and from a mnogoformny ekssudativny eritema which has a seasonal current and recurs in the spring and in the fall. Diagnosis of herpetic stomatitis is based on clinical manifestations. Hypostasis and hyperaemia mucous a mouth, emergence of the large bubbles inclined to merge is characteristic of the stomatitis caused by a virus of simple herpes. Bubbles within several hours are opened, and on their place there are erosion with scalloped edge from above covered with a fibrous film. If the red border of lips is surprised, then exudate from serous quickly passes in bloody, rashes shrink in uniform bloody crusts. Appetite loss, a gipersalivation and morbidity at meal is noted. Rashes at a puzyrchatka ordinary settle down is single on not inclined to puffiness mucous, the epitelization and formation of a fibrous film also does not occur, in dabs from an erozirovanny surface find akantolitichesky cages, and Nikolsky's symptom positive that at infection with a virus of herpes is not observed.
If confirmation of the diagnosis on presence of a virus of herpes is required, then in the first few days from the beginning of a disease cytologic researches are most informative. Material undertakes by method of scrape and is painted according to Romanovsky-Gimz, after coloring huge multinuclear cages with bazofilny cytoplasm are accurately visible. Kernels in cages are located densely, forming stratifications, and resemble a uniform conglomerate superficially. If there was an indistinct coloring, then kernels can not have accurate outlines that does not complicate confirmation of the diagnosis simple herpes. The PTsR-research on a virus of simple herpes, immunofluorescence reaction (REEF) and a research to antiherpetic antibodies by the immune and fermental analysis (IFA) is in addition conducted.
Treatment of herpes
Treatment of recurrent herpes consists in immunorehabilitation of patients, it helps to achieve decrease in a recurrence or permanent remission. Herpes idle time does not suffer monotherapy as it is inexpedient, resort to it only for treatment of a sharp phase of a disease. If to use similar therapy as the only method of treatment, then constant administration of drugs like an acyclovir and a valatsiklovir, use of ointments remind a vicious circle from which it is impossible to escape, and stressful situations only aggravate a condition of the patient.
Complex treatment of the infection caused by a virus of simple herpes in short terms allows to stop process and to lead to permanent remission. In an initial phase of a recurrence the rate of medicines of supressor, for example an acyclovir, is appointed. Acceptance of these medicines within 5-7 days sharply reduces quantity of viruses of herpes in an organism. After that imunnoterapevtichesky medicines, in the form of courses of recombinant alfainterferon or/and immunomodulators are appointed. Duration of a course depends on weight of an infection and on a condition of immune system of the patient. In hard cases alpha interferon is accepted by 10 days and more. On the expiration 1-2 months after process knocking over expedient are application of a herpetic vaccine that allows to achieve permanent remission.
Efficiency of vaccination depends on a condition of immunity, on the appointed scheme and on frequency rate of introduction of medicine. The vaccine is entered vnutrikozhno with formation of a specific "orange crust" on the place of introduction. But lack of a timely revaccination significantly reduces efficiency of all months-long course of treatment therefore it is necessary to carry out a revaccination against a virus of simple herpes, without skirting deadlines.
Independent application of the herpetic inactivated vaccine has to be excluded as, despite all simplicity, the procedure demands certain conditions and knowledge of medical personnel, and the instruction for application does not contain all necessary information. The negative opinion on a vaccine is based that it increases possibility of a tumor a little, but the persistiruyushchy infection caused by a virus herpes simple is capable to do more serious harm to immune system.
The inactivated VPG-1 and VPG-2 viruses which, as well as usual serotypes of simple herpes can be transformed that according to the conclusions of some researches it is capable to induce uterus neck cancer in isolated cases are a part of a vaccine. But the vaccine and the virus which is present at an organism have identical ability to induce development of oncological processes, and therefore, to patients in whom herpes is found, vaccination does not bear additional danger of development of the induced cancer. For prevention of formation of tumors a reliable way is application of preventive specific anticarcinogenic vaccines. From physiotherapeutic methods in treatment of simple herpes apply Ural federal district radiation, laser therapy, OKUF, infrared radiation, etc.