1. source of infection
Humans are the only natural reservoir of herpes simplex virus. The source of infection of the disease is patients in the attack and recovery period, as well as patients infected with the virus but without obvious symptoms. It is mainly spread by viruses existing in blister fluid, local exudates and damaged skin and mucous membrane surfaces. The disease is mainly transmitted through sexual behavior, and less indirectly through contaminated items. In addition, mothers with genital herpes can directly transmit the virus to their newborns through the birth canal during childbirth, or get sick during pregnancy, and the virus can be transmitted to the fetus through the placenta.
2. Transmission routing
Infected people are mainly transmitted to their sexual partners through sexual contact. Men who have sex with men are also at great risk of infection. Sometimes people with herpes around their lips can infect each other with genital herpes through oral sex. Therefore, different ways of heterosexual or homosexual sex will spread genital herpes. Because infectious viruses can survive in humid environment for several hours, in a few cases, they may also spread indirectly through pollutants.
2 Etiology editor
HSV-2 is the main pathogen of genital herpes (90%), which causes primary genital herpes after infection. After the primary genital herpes subsided, the residual virus was transferred to the sacral ganglion along the nerve axis through the peripheral nerve and remained latent for a long time. When the body's resistance drops or some stimulating factors such as fever, cold, infection, menstruation, gastrointestinal dysfunction, trauma, etc. The latent virus can be activated, and the virus spreads downward to the surface of skin mucosa, causing lesions and recurrence. Humans are the only host of herpes virus. Viruses can't survive without humans. Ultraviolet rays, ether and common disinfectants can inactivate it.
3 clinical manifestations editor
1. Primary genital herpes
Primary genital herpes can be divided into primary genital herpes and non-primary genital herpes. The former is infected with HSV for the first time, and its symptoms are primary genital herpes. His condition is more serious. However, some patients who had been infected with HSV- 1 (mainly oral or facial herpes) were infected with HSV-2 again, and genital herpes occurred for the first time, not primary genital herpes, and the condition was relatively mild.
(1) The incubation period is 3 ~ 14 days.
(2) There are clusters or scattered small blisters around the external genitalia or anus. After 2 ~ 4 days, they will suddenly have erosion or ulcer and feel pain.
(3) Inguinal lymph nodes are often swollen and tender.
(4) Patients may have fever, headache, fatigue and other systemic symptoms.
(5) The course of disease is 2-3 weeks.
2. Recurrent genital herpes
The rash recurred after the primary lesion subsided, and the recurrent genital herpes was lighter than the primary systemic symptoms and lesions, and the course of disease was shorter.
(1) There was a burning sensation, tingling sensation or abnormal sensation locally before eruption.
(2) Small blisters clustered around the external genitalia or anus quickly burst to form erosion or superficial ulcers with mild symptoms.
(3) The course of disease is 7 ~ 10 days.
4 check the editor
1. Cytological examination (Zank smear)
Characteristic multinucleated giant cells or nuclear virus inclusions can be seen under the microscope by printing slides on the blister base, Wright staining or Giemsa staining.
2. Detection of virus antigen
Samples were taken from skin lesions, and the antigen of herpes simplex virus was detected by monoclonal antibody direct fluorescence or enzyme-linked immunosorbent assay.
3. Virus culture
Skin lesions were sampled for virus culture, and herpes simplex virus and cytopathy were found.
4. Nucleic acid detection
Detection of HSV-2 nucleic acid by polymerase chain reaction.
5 Diagnostic Editor
Diagnosis can generally be made according to the medical history and typical clinical manifestations. If necessary, we should make a comprehensive judgment and make a diagnosis according to the results of laboratory examination.
6 therapy editor
Antiviral therapy is mainly used. The main purpose of treatment is to relieve symptoms, relieve pain, shorten the course of disease and prevent secondary infection. At present, the treatment methods can not completely eliminate the virus and eliminate the recurrence.
1. General therapy
(1) mainly keep local clean and dry. It can be washed with isotonic saline every day, and those in pain can take painkillers orally to give spiritual comfort.
(2) Patients with bacterial infection can use antibiotic ointment for external use.
(3) If the local pain is obvious, 5% lidocaine hydrochloride ointment or oral analgesic can be used externally.
(4) psychological support, explaining the nature of the disease, the causes of recurrence and how to treat and deal with it, and enhancing the confidence in fighting the disease.
2. Antiviral therapy
Recommended treatments include: acyclovir, taken orally, 5 times a day; Or acyclovir, taken orally, three times a day; Or valaciclovir, orally, twice a day; Or famciclovir, taken orally, three times a day. If it is primary genital herpes, the course of treatment is 7 ~ 10 days; The course of treatment for recurrent genital herpes is 5 days. Patients with frequent recurrence need a longer course of treatment at a lower dose.
7 Preventive editing
The prevention of genital herpes has its own characteristics, and it is necessary to emphasize consultation and health education.
1. Consultation
(1) Explain the natural course of the disease, emphasizing the possibility of recurrence and asymptomatic detoxification, and HSV sexual transmission can also occur in asymptomatic period;
(2) Inform patients of the common causes of recurrence of this disease, avoid negative emotions such as psychological tension, depression or anxiety, and reduce recurrence by avoiding the causes of recurrence;
(3) Inform patients of childbearing age (including male patients) of the risk of HSV infection in fetuses and newborns;
(4) Inform new patients that antiviral therapy can shorten the course of disease, and antiviral inhibition therapy can reduce or prevent recurrence;
(5) Get the patient's active cooperation in the treatment to reduce the continuous spread of the disease.
2. Health education
(1) It is emphasized that patients should inform their sexual partners of their illness, get their understanding and cooperation, avoid sexual contact when recurrent symptoms or skin lesions appear, or take better barrier contraceptive measures to reduce the risk of HSV transmission to their sexual partners;
(2) Advocating barrier contraceptive measures such as condoms, condoms can reduce the risk of genital herpes transmission, but sexual intercourse in the event of skin lesions, even if condoms are used, HSV sexual transmission may occur;
(3) Changing sexual behavior, avoiding unmarried sexual behavior and eliminating multiple sexual partners are the fundamental measures to prevent genital herpes.