Article 157: Transmission Routes, Symptoms, and Complications of Genital Herpes

◇A Guide to Caring for Your Husband's Health as a Good Wife◇

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Treatment and recuperation of common diseases

Transmission routes

1. Sexual transmission: 50% to 60% of sexual contacts with patients with genital herpes or asymptomatic carriers can lead to infection.

2. Transmission during childbirth: If a pregnant woman has genital herpes, especially if the infection occurs in the cervix and vagina, the virus can be directly transmitted to the newborn during childbirth, resulting in neonatal herpes.

3. Placental transmission: When a pregnant woman is ill and her body's resistance is lowered, the virus can be transmitted to the fetus through the placenta.

4. Other: Transmission through swimming pools, etc.

What are the symptoms?

The incubation period is 2-10 days. In men, the affected areas are the foreskin, glans, coronal sulcus, and penis; occasionally, the urethra, prostate, and seminal vesicles. In homosexual men, it can occur in the anus and rectum. In women, it occurs on the vulva, labia majora and minora, clitoris, vagina, and cervix, and can also occur in the anus, rectum, and urethra. Before the appearance of blisters, there is burning, itching, or paresthesia at the injection site, followed by pale red macules or papules. These quickly develop into clusters of tense, clustered blisters, ranging in size from sesame seeds to mung beans. The fluid in the blisters is initially clear, gradually becoming cloudy or even purulent. The blister walls are thin and easily rupture, forming erosions or superficial ulcers. In some patients, the blisters may merge into larger bullae. The ruptured superficial ulcers are large and painful, especially upon touch. Systemic symptoms such as fever, headache, groin and pelvic pain are common. If the urethra, bladder, and rectum are involved, urinary frequency, dysuria, urinary retention, and anal burning sensation may also occur. Inguinal lymphadenopathy is often present. Primary genital herpes has a natural course of 2-4 weeks, and may leave residual pigmentation abnormalities or scars after healing.

The symptoms of recurrent genital herpes are milder than those of primary genital herpes. Vesicles usually appear at the original site of the rash, and the course of the disease is shorter, averaging about 12 days. Inguinal lymphadenopathy and systemic symptoms are rare. Frequent recurrences can cause significant psychological stress, leading to depression and sexual dysfunction.

Recurrent genital herpes can be complicated by sacral radiculopathy, manifesting as gluteal muscle pain or paresthesia, urinary retention, and erectile dysfunction. Other complications include proctitis, prostatitis, and urethritis syndrome.

complication

Genital herpes causes immense physical and psychological suffering, reducing quality of life and interpersonal skills. It can lead to a range of complications, including disseminated herpes, herpetic meningitis, prostatitis, proctitis, pelvic inflammatory disease, and spinal nerve root disorders. If a pregnant woman is infected, it can cause miscarriage, premature birth, stillbirth, and neonatal herpes, which has a very high mortality rate. In areas where HIV/AIDS is prevalent, it can also increase the risk of HIV infection.

Which diseases should it be differentiated from?

1. Fixed drug eruption of the genital area: A history of medication use and drug allergy precedes the eruption. The eruption site remains fixed each time, and the lesions are mainly dark red patches with thick-walled vesicles or bullae, leaving noticeable pigmentation after resolution. Herpes simplex virus is not found.

2. Candidal balanitis: Mild redness of the foreskin and glans, scattered red papules, accompanied by mild itching, with a small amount of cheesy discharge on the surface, and Candida albicans can be obtained by fungal culture.

3. Hard chancre: It mainly manifests as a single or a few painless hard ulcers on the genitals. Treponema pallidum can be seen on dark-field microscopy, and serological tests for syphilis are mostly positive.

How does Western medicine treat this?

There is currently no ideal method for the prevention and treatment of genital herpes. Because the disease is self-limiting, it usually heals on its own within 1-2 weeks. Except for neonatal herpes, encephalitis, meningitis, and cervical herpes, which have poorer prognoses, most patients have a good prognosis. Therefore, the goal of treatment is to shorten the course of the disease as much as possible, alleviate suffering, prevent secondary infections and complications, and reduce the frequency of recurrence.

1. General treatment:

(1) Keep the blister wall intact, clean and dry to avoid secondary bacterial infection. You can apply 2% gentian violet solution, 30%~50% zinc oxide oil, 0.5% neomycin ointment, etc. For larger areas, you can use 0.1% zinc sulfate solution or 10% aluminum acetate wet compress.

(2) If secondary infection occurs in the local skin lesions, sensitive antibiotics can be used.

(3) For those with severe local pain, aspirin or indomethacin can be used as an analgesic. If the effect is not good, local anesthetics such as 5% lidocaine hydrochloride ointment can be used.

2. Antiviral therapy: The first-line antiviral drug with definite efficacy against herpes simplex virus is acyclovir. This drug is an open-ring nucleoside analogue that selectively inhibits viral DNA synthesis but has no effect on host cell DNA synthesis. It has few adverse reactions and no toxicity.

3. Treatment of recurrent genital herpes: The treatment method for patients is determined based on the frequency of recurrence and the severity of local and systemic symptoms.

For those with mild local symptoms and infrequent attacks, treatment is generally not necessary. For those with moderate local symptoms and 2-6 attacks per year, 5% acyclovir cream can be applied topically 5 times daily for 5 days. For those with moderate local symptoms and systemic symptoms, it is best to take acyclovir orally intermittently at a dose of 200 mg five times daily for 5 days. For those with severe local symptoms and systemic symptoms, or frequent attacks (more than 6 times per year), acyclovir should be taken orally for 6 months. The dose for the first 3 months is 200 mg four times daily, and the dose for the next 3 months is 400 mg twice daily. If the damage increases or attacks occur during treatment, the treatment dose should be adjusted back to the initial dose.

It is worth noting that long-term treatment with acyclovir can lead to the development of acyclovir-resistant viral strains. Treatment for drug-resistant genital herpes can be achieved by increasing the dose of acyclovir or changing its route of administration; trisodium phosphatase or azidothymidine can also be used.