Symptoms of genital herpes
50 -70% of patients infected with herpes simplex virus do not complain or complain of meager pain or burning. In the clinical course of HSV, it is customary to distinguish between primary and recurrent herpes.
Primary herpes is an acutely occurring disease in the first contact of a person with HSV in the absence of specific antibodies against it.
Primary genital herpes occurs predominantly in women in the form of vulvovaginitis, but the cervix can also be involved in the process. Primary herpetic vulvovaginitis is characterized by the appearance of pronounced edema and hyperemia of the large and small labia, the vaginal mucosa, the perineal region and, often, the inner surface of the thighs. There are pain, itching and dysuria, discharge from the vagina or urethra.
In men, primary elements are often located on the head, the body of the penis, the neck of the head, the scrotum, thighs and buttocks. Grouped bubbles appear first with a clear, and then cloudy content. After the opening of the vesicles, extensive erectile erosions are formed, having a round shape. Fusing, they form extensive ulcers with a wet surface. Defects of the epithelium heal in 2-4 weeks, leaving behind hyperpigmented spots. Scars usually do not happen.
When the urethral mucosa is affected, frequent urination appears and sometimes cystitis develops. At an atypical course, vesicles may be absent, and in the foreskin, hyperemia develops, burning, itching is observed. In severe course erosive and ulcerative lesions occur, swelling of the skin, severe intoxication, fever. Frequent relapses lead to lymphostasis and elephantiasis of the genital organs.
Such prodromal phenomena with recurrent genital herpes like burning or tingling precedes the appearance of rashes. With recurrent genital herpes, the elements of the rash are the same as in the primary herpes, they are less pronounced. Hyperemic plaque 2 cm in diameter covered with vesicles. After the opening, erosions are formed, which heal after 1-2 weeks. In case of relapse, the lesions are located in men on the body and the head of the penis, in women - on the large and small labia, in the perineum and on the inner thighs. The regional lymph nodes in the second or third week become enlarged, dense, painful, there is no fluctuation, the lesion is usually one-sided. When the pelvic lymph nodes are affected, there is pain in the lower abdomen. The disease is often accompanied by headache, fever, malaise and myalgia. In atypical forms of genital herpes, one of the stages of development of the inflammatory process in the outbreak (erythema, blistering) or one of the components of inflammation (edema, hemorrhage, necrosis) or subjective symptoms (pruritus), which give the corresponding name atypical form genital herpes (erythematous, bullous, hemorrhagic, necrotic, itchy, etc.).
In women, atypical forms are more common than in men. In most patients, genital herpes is atypical and is accompanied by signs that can easily be mistaken for signs of other genital infections or dermatoses.
The course of genital herpes
In the course of recurrent genital herpes, there are 3 degrees of severity:
- mild - exacerbation 3-4 times a year, remission not less than 4 months;
- medium-severe - exacerbation 4-6 times a year, remission - 2 3 months;
- severe - monthly exacerbations.
Reactivation of the virus after primary infection during the year occurs in 50-80% of patients. Antiviral drugs only reduce the titer of the virus, which the patient secretes into the external environment, and reduce the risk of transmission of infection 100-1000 times.
Pathomorphological changes are the same as with simple bubble dyspepsia.