Genital herpes is a chronic, recurrent sexually transmitted disease caused by human herpes simplex virus (HSV) infection. Clinically, it is divided into primary genital herpes and recurrent genital herpes.
Etiology
HSV is divided into two serotypes, HSV-1 and HSV-2. 90% of genital herpes cases are caused by HSV-2 infection, but more and more genital herpes cases are now caused by HSV-1, especially among young women and gay men.
The main sources of infection for this disease are patients with genital herpes and virus carriers. After HSV invades the skin and mucous membranes, it replicates in keratinocytes, causing primary infection. HSV2 then remains latent in the host's ganglia for a long time. When factors such as decreased immunity are triggered, the virus can be reactivated, causing recurrence.
Clinical features
(1) Primary genital herpes: The incubation period is 2 to 14 days, with an average of 1 week. In women, it is most common on the labia majora and minora, but can also occur on the groin, vulva, vagina, perianal area, and even cervix. It manifests as clusters of small, red papules and vesicles that gradually rupture and crust over, accompanied by local itching and pain. Some patients may experience systemic symptoms such as low-grade fever, fatigue, and swollen inguinal lymph nodes. The course of the disease can last for 2 to 3 weeks.
(2) Recurrent genital herpes: It usually occurs 1 to 4 months after the primary rash has subsided. Similar lesions usually recur at the site of the primary rash, but the condition is milder and the course of the disease is shorter. Before the onset of the disease, there may be a tingling sensation, burning sensation or abnormal sensation in the local area. The course of the disease is generally about 1 week.
Pathological features
Intraepidermal vesicles form, ballooning degeneration occurs, and acantholysis may occur, forming vesicles, mostly unilocular, with papillary edema and superficial dermal inflammatory cell infiltration.
Differential diagnosis
Based on clinical presentation and medical history, diagnosis is not difficult. Differential diagnosis is needed, distinguishing it from fixed drug eruptions of the genital area, Behcet's disease, and herpes zoster.
1. Fixed drug eruption: There is a history of drug allergy. Vesicles, bullae, and erosions with crusts appear at a fixed site, but they are not clustered vesicles. Pigmentation remains after the rash subsides. HSV test is negative.
2. Behçet's disease: Manifests as oral and genital ulcers, eye lesions, skin folliculitis or erythema nodosum lesions, genital ulcers are large and deep, with significant pain that lasts for a long time.
3. Herpes zoster: When the varicella-zoster virus invades the lumbosacral nerves, clustered blisters may appear in the vulva, accompanied by pain. However, the blisters are usually not limited to the vulva. The overall skin lesions present a band-like distribution, accompanied by neuropathic pain, and serum HSV antibody tests are negative.
treat
1. Topical medication: Keep the affected area clean and dry. You can apply 3% acyclovir ointment or 1% penciclovir ointment to the affected area. However, the efficacy of topical medication is far inferior to that of systemic medication.
2. Systemic medication: Treatment should be carried out in accordance with the guidelines for the diagnosis and treatment of syphilis, gonorrhea, genital herpes and genital chlamydia trachomatis infection (2014).
(1) Primary genital herpes: Acyclovir 400mg, 3 times/day, for 7 to 10 days; or Acyclovir 200mg, 5 times/day, for 7 to 10 days; or Valacyclovir 500mg, 2 times/day, for 7 to 10 days; or Famciclovir 250mg, 3 times/day, for 7 to 10 days.
(2) Recurrent genital herpes: The best time to take the medication is within 24 hours of the onset of prodromal symptoms or skin lesions. Acyclovir 400mg, 3 times/day for 5 days; or acyclovir 200mg, 5 times/day for 5 days; or valacyclovir 500mg, 2 times/day for 5 days; or famciclovir 250mg, 3 times/day for 5 days.
(3) Frequently recurring genital herpes: If there are ≥6 recurrences per year, long-term suppressive therapy can be used. Recommended regimen: Acyclovir 400mg twice daily; or valacyclovir 500mg once daily; or famciclovir 250mg twice daily. Long-term continuous administration is required, and the course of treatment is generally 4 to 12 months.
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