The herpes virus is a contagion that causes herpes. The main sites of virus localization are the mouth and genitals, but it may be located in different parts of the body. HSV-1 and HSV-2 are 2 types of the herpes virus. The first type of herpes virus induces sores on the face and in the mouth; the second facilitates the emergence of an inflammatory focus in the genitals.
Nobody has immunity to the virus of simplex herpes. In order to avoid this, it is necessary to strengthen the immune system. The rules are quite simple for prevention of HSV-2: safe sex life, monogamy, periodic screening of the body. If a pregnant woman knows about her infection, she should immediately tell her doctor, because the genital type of this disease is passed vertically through the birth canal. As a result, baby can get 2 kinds of infectations and complications.
The primary herpes diagnostic method used patient survey and poll, whereby identified characteristic disease symptoms. Harder made diagnosis of genital herpes, because as he is, in the majority of cases of typical symptoms of herpes does not have. For this reason, using virological methods. Actually this includes virological testing, PCR (polymerase chain reaction) and RIF (or immunofluorescence reaction). These methods provide sufficient accuracy and specificity; however, their expensiveness determines certain restrictions in use. In addition to these methods are also used techniques such as serological method, immuno-blot G-specific test. Meanwhile, and simple, and genital herpes are diagnosed in most cases without difficulty due to the presence of visible characteristic of the herpes symptoms and general nature of the disease.
PRINCIPLES OF TREATMENT OF HERPES SIMPLEX
Modern medicine does not have therapies that allow to eliminate HSV from the human body. Therefore, the aim of therapeutic measures is:
HSV suppression of reproduction in acute (mild relapse);
Formation of an adequate immune response and its long-term preservation to block reactivation of HSV outbreaks in persistence.
Currently, there are two main directions in the treatment of herpes simplex.
The use of antiviral chemotherapy, which occupies a leading position in acute herpes infection, occurring with lesions of the central nervous system and other organs and systems, as well as neonatal herpes. The significance of antiviral agents for the treatment of relapsing forms of herpes simplex skin lesions, mucous membranes. The main place in antiviral therapy given to acyclic nucleosides, and, first of all, preparations containing acyclovir (ACV). Zovirax, gerperaks, valtrex Acyclovir-Acre, Famvir, etc. In cases of intolerance AAB drugs used drugs with a different mechanism of antiviral action.
There are two fundamentally differing approaches to the appointment of chemotherapy antiherpetic:
episodic treatment – receiving ACV-drugs at the time of relapse in therapeutic doses, while respecting the multiplicity and duration of treatment;
suppressive therapy – long, sometimes long-term, chronic administration of drugs is AAB-recurrence of lower doses.
Complex method of treatment comprising immunotherapy (specific and nonspecific) in conjunction with antiviral therapy.
For the non-specific immunotherapy are used:
immunoglobulins, normal human for intramuscular injection; while HSV lesions of the CNS, neonatal herpes is recommended the use of intravenous immunoglobulin forms;
interferon (IF) (replacement therapy).
In medical practice currently used human leukocyte interferon (CHLI) in several dosage forms: 1) nasal drops; 2) Injection CHLI – mixture of alpha interferon produced by leukocytes healthy donors (Activity single dose is 100 thousand ME, 500 thousand ME, 1 million ME); 3) leukinferon (for injection) natural complex formulation comprising interferon-alpha and cytokines (one dose – 10 thousand ME);. 4) interlock (for injection), 1.0 ml – 50 thousand ME;. 5) CHLI rectal suppositories (one suppository 40 thousand. Antiviral activity of the ME).
For the treatment of various forms of recurrent herpes medications are used, containing an alpha-2-genetically engineered interferon – IFN, which is part of the domestic viferon rectal suppositories. Created kipferon combined preparation consisting of immunoglobulins and Reaferon – in the form of suppositories for rectal and vaginal administration;
preparations – interferon inducers.
Amiksin, Arbidol, alpizarin, flakozid Being IF inductors, stimulate the production of endogenous IF in the body of the patient. This explains the positive therapeutic effect of these agents in many viral diseases (recurrent herpes, influenza, adenovirus infection, and so on. D.), Which allows to recommend them in the complex treatment of herpes viral infections, especially in patients suffering from frequent colds and SARS.
The ability to induce endogenous IF has a large group of natural and synthetic compounds: levamisole (dekaris) Dibazolum, vitamin B12, pirogenal, prodigiozan, is the drug of choice for treatment of herpes;
drugs that stimulate T and B units of cellular immunity and phagocytosis.
To stimulate T and B units of cellular immunity in patients with recurrent herpes successfully applied taktivin, timalin, timogen, mielopid et al. Treatment should be under the control immunogram.
Specific immunotherapy consists in the application of domestic herpes vaccine (polyvalent, tissue, killed). The therapeutic effect of the vaccine is associated with the stimulation of specific reactions of antiviral immunity, reduction of functional activity of immune cells and specific desensitization of the body.
Methodological approaches to the provision of medical care to patients with recurrent herpes
It is known that as the genital herpes monoinfection only occurs in 22-30% of patients, in most cases, it develops into a microbial association, in conjunction with chlamydia, urea-, mycoplasma, streptococci, staphylococci, fungal flora. It is possible combined lesion genital HSV, gonococcus, Treponema pallidum, viral diseases transmitted by sexual contact, suggesting the need for a thorough examination of the patients to avoid STIs and HIV infection.
That is why the work with any patient complained of sexual sphere, should begin with the diagnosis and exclusion of concomitant sexually transmitted infections. The patient must provide up to date information about the disease, about modes of transmission in the home and the possibility of infection of the sexual partner; familiarize with the forecast of the disease and give reasoned advice on a healthy lifestyle, as well as recommendations for antiviral therapy.
The most pronounced therapeutic effect is achieved by an integrated approach to care, which should include: 1) anti-viral therapy in conjunction with immunocorrection interferonotherapy and, taking into account the data of immunological examination and study of interferon status; 2) anti-treatment of herpes vaccine in combination with immunomodulators and symptomatic use of antivirals; 3) the use of adaptogens, repeated courses of vaccine (booster dose), symptomatic use of antivirals.
The effectiveness of the therapy is assessed on the basis of reducing the duration and frequency of relapses, as well as the intensity of the disease common symptoms. Existing treatments allow in 85-93% of cases, to achieve positive results in the treatment of recurrent herpes.
HERPES AND PREGNANCY
Infection with herpes during pregnancy the fetus or directly at birth determines for him the innate likelihood of developing herpes. Infection determines approximately 50% mortality for children, as well as a sufficiently high degree of disability. Order in 60% of cases of congenital infection with herpes form of genital herpes occurs, although this does not exclude the probability of infection of herpes simplex in its active phase in the body (ie the previously reviewed herpes, manifesting on the lips, skin and mucous membranes). The risk of fetal infection with herpes in particular increases to the end of pregnancy, which is associated with the highest permeability at this time of placental barrier. So, at the beginning of pregnancy, the risk of infection is determined by approximately 10%, to attack birth – 40-60%. The transmission of infection is carried out at the time of passing through the birth canal, by ascending or transplacental. Most often in practice contamination observed during passage through the birth canal (70% of cases), this option is often relevant in the presence of maternal genital herpes. Also not ruled out the possibility of infection by a rising, especially in the case if the mother is infected with herpes simplex type II (genital herpes). Less often observed transplacental transmission path – about 8% of all cases of disease. This variant is relevant in the case of a primary infection with herpes parturient type I or II, including in the case of viremia in the blood (which implies active forms of herpes therein immunity not destroyed). Contact with the fetus infection results in the development of inflammatory and degenerative changes in the surrounding membranes and in blood vessels of the umbilical cord, resulting in fibrosis their walls become thicker and compacted. The infection entering the body of the fetus, can cause the formation of longer get into his body, thereby depriving the right of protection from the effects of other types of infections in immune block it, thereby immunoglobulins and antibodies from the mother. These factors are the cause of violations of a number of bodily functions. If you get herpes infection in the body of the fetus during the first trimester of developing degenerative changes that are incompatible with life, because of what is happening miscarriage and therefore abortions. Infection with the timing later everything does not exclude the likelihood of miscarriage or preterm birth, however, not ruled out the possibility of compensation, through which the fetus begin to develop these or other changes: changes in the central nervous system: epilepsy, microcephaly, hydrocephalus; changes in the functions of the liver: hepatitis, cirrhosis; changes affecting the eyes, retinal dysplasia, cataracts, etc .; lung infection: pneumonia (intrauterine form); skin lesions:. gingivitis, stomatitis, etc. In a generalized form of infection develop multiple organ disorders (multiple nature of the defeat of the internal organs), resembling the symptoms characteristic of neonatal sepsis. The impact of this scheme on herpes infection leads to the development of severe lesions of the central nervous system, as well as the possibility of the onset of coma and death. All this determines the worst case of a congenital form of herpes.