Herpes simplex

Herpes simplex (synonym: herpes simplex vesicularis) is a chronic recurrent disease that manifests itself in vesicular rashes on the skin and mucous membranes. Along with skin changes, various organs and systems of the body may be involved in the pathological process.

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Causes of herpes simplex

The causative agent of the disease is the herpes simplex virus (HSV). It is a predominantly dermato-neurotropic DNA-containing virus, which also has tropism for some other tissues.

There are herpes simplex viruses of types I and II. The herpes simplex virus can be the causative agent of both genital and non-genital forms of the disease. Herpes infection is transmitted mainly by contact (sexual contact, kissing, through household items). Airborne transmission is also possible. The virus penetrates the body through the skin or mucous membranes, gets into the regional lymph nodes, blood and internal organs. It spreads in the body hematogenously and along nerve fibers. Soon after infection, antibodies to the herpes simplex virus are formed in the body.

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Histopathology

Ballooning and reticular dystrophy of the epidermis, acanthosis, acantholysis, and intraepidermal vesicles are noted. Giant multinucleated keratinocytes have viral inclusions.

Symptoms of herpes simplex

Herpes infection is characterized by various clinical manifestations, localization, and severity of the course. Depending on the course, simple herpes is divided into primary and recurrent.

Primary herpes occurs after the first contact with the herpes simplex virus. The disease occurs after an incubation period of several days to 2 weeks.

Depending on the localization of the skin pathological process, HSV infections are classified as follows:

• herpetic lesions of the skin and mucous membranes (herpes of the lips, wings of the nose, face, hands, stomatitis, gingivitis, pharyngitis, mucous membranes and skin of the penis, vulva, vagina, cervical canal, etc.);
• herpetic eye lesions (conjunctivitis, keratitis, iridocyclitis, etc.);
• herpetic lesions of the nervous system (meningitis, encephalitis, neuritis, meningoencephalitis, etc.);
• generalized and visceral herpes (pneumonia, hepatitis, esophagitis, etc.).

Acute herpetic stomatitis is one of the most common clinical manifestations of primary infection. The disease often occurs in young children. The incubation period is from to 8 days, then grouped painful vesicular rashes appear on an edematous-hyperemic base. General clinical symptoms of the disease are observed: chills, high body temperature, headache, general malaise. Blisters in the oral cavity are most often localized on the mucous membrane of the cheeks, gums, inner surface of the lips, tongue, less often - on the soft and hard palate, palatine arches and tonsils. They quickly burst, forming erosions with remnants of exfoliated epithelium. Barely noticeable point erosions are formed at the sites of damage, and when they merge, foci with scalloped contours on an edematous background. A sharp increase and soreness of regional lymph nodes (submandibular and submandibular) are noted.

In clinical practice, a recurrent form of primary herpes is often encountered. Compared to primary herpes, the intensity and duration of clinical manifestations of relapses are less pronounced and the antibody titer practically does not change with recurrent herpes.

The process is most often located on the face, conjunctiva, cornea, genitals and buttocks.

Usually after prodromal phenomena (burning, tingling, itching, etc.) grouped vesicles of 1.5-2 mm in size appear, arising against the background of erythema. The rash is often located in single foci consisting of 3-5 merging vesicles. As a result of trauma and maceration, the cover of the vesicles is destroyed, forming slightly painful erosions with scalloped contours. Their bottom is soft, smooth, reddish, the surface is moist. In case of secondary infection, purulent discharge, compaction of the base of the erosion (or ulcer) and the appearance of an inflammatory rim are noted, which is accompanied by an increase and soreness of the regional lymph nodes. Over time, the contents of the vesicles dry up into brownish-yellowish crusts, after which they fall off, slowly disappearing secondary reddish-brownish spots appear. Primary herpes differs from recurrent herpes by a sharp increase in the level of antibodies in the blood serum.

Atypical forms of herpes simplex

There are several atypical forms of herpes simplex: abortive, edematous, zosteriform, hemorrhagic, elephantiasis-like, ulcerative-necrotic.

The abortive form is characterized by the development of erythema and edema without the formation of blisters. This form of infection includes cases of the appearance of subjective sensations characteristic of herpes in places of its usual localization in the form of pain and burning, but without the appearance of a rash.

The edematous form differs from the typical form by a sharp swelling of the subcutaneous tissue and hyperemia of the skin (usually on the scrotum, lips, eyelids); vesicles may be absent altogether.

Zosteriform herpes simplex, due to the localization of the rash along the nerve trunks (on the face, trunk, limbs), resembles herpes zoster, but the pain syndrome is expressed to a lesser degree.

The hemorrhagic form is characterized by hemorrhagic contents of the vesicles instead of serous ones, often with subsequent development of ulcers.

The ulcerative-necrotic form develops with a pronounced immune deficiency. Ulcers form on the skin, extensive ulcer surfaces with a necrotic bottom and serous-hemorrhagic or purulent discharge are sometimes covered with crusts. The reverse development of the pathological process with crust rejection, epithelialization and scarring of ulcers occurs very slowly.

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Serology

The most modern diagnostic method is polymerase chain reaction (PCR) for detection of HSV antibodies.

Treatment of herpes simplex

The main objectives of antiherpetic therapy are:

• reduction in the severity or duration of symptoms such as itching, pain, fever, lymphadenopathy;
• reduction in the duration and severity of virus shedding at the affected sites;
• reduction of the period of complete healing of lesions;
• reduction in the frequency and severity of relapses;
• elimination of infection to prevent relapse.

The effect can only be achieved if chemotherapy treatment is started within the first 24 hours after primary infection, which will prevent the virus from becoming latent.

The main basic treatment is the use of antiviral drugs (acyclovir, valtrex, famciclovir). The mechanism of action of acyclovir is based on the interaction of synthetic nucleosides with the replication enzymes of herpes viruses, their inhibition and suppression of individual links in the reproduction of viruses.

Herpesvirus thymidine kinase binds to acyclovir a thousand times faster than cellular thymidine kinase, so the drug accumulates almost exclusively in infected cells.

Acyclovir (ulkaril, herpevir, zavirax) is prescribed orally 200 mg 5 times a day for 7-10 days or 400 mg 3 times a day for 7-10 days. In the recurrent form, it is recommended 400 mg 5 times a day or 800 mg 2 times a day for 5 days, or valtrex is prescribed 500 mg 2 times a day for 5 days. Acyclovir and its analogues are also recommended for pregnant women as a therapeutic and prophylactic agent for neonatal infection. It is more rational to treat recurrent herpes simplex in combination with leukocyte human interferon (3-5 injections per course) or endogenous interferon inducers. In the interrecurrent period, repeated cycles of the antiherpetic vaccine are indicated, which is administered intradermally at 0.2 ml every 2-3 days per cycle - 5 injections. The cycles are repeated at least twice a year.

In case of pronounced suppression of the T-cell link of immunity, it is necessary to prescribe immunotropic drugs (immunomodulin, thymalin, taktivin, etc.). Proteflazit simultaneously has antiviral (suppresses DNA polymerase and thymidine kinase of the virus) and immunocorrective properties. The drug is used 20 drops 2 times a day for 25 days.

For external use in herpes infection, 0.25-0.5% banaftop, 0.25% tebrafen, 0.25-3% oxalin, 0.25% riodoxol ointments are used, which are applied to the lesion 4-6 times a day for 7-10 days. A good effect is noted from local application of acyclovir (2.5 and 5% ointment) for 7 days.