In Russia, more than a quarter of adults are carriers of genital herpes. Recurrence of genital herpes is a repeated manifestation of a viral disease, which approaches imperceptibly, flows painfully, is difficult to treat for a long time, creates intimate discomfort and makes a full sexual life impossible.    

On the patient’s skin, affected areas periodically appear, emitting the virus into the external environment. This poses a threat of infection to people in contact with the virus release .

The insidiousness of the herpes virus is also in the fact that it erodes the immune system of a man and provokes an exacerbation of chronic diseases.

Hello dear readers. This is Alexander Burusov , and in this article we will continue to talk about the genital virus. This article will focus on the recurrence of this disease.

Content

Disease classification

Recurrence of genital herpes is distinguished by the form, severity and characteristics of the course.

The diagnosed form is characterized by typical manifestations, accounting for approximately 20% of all cases.  

In the atypical form, the clinical picture is erased, other diseases are disturbing (cystitis, urethritis, sciatica, rectal fissures), but due to the absence of typical manifestations, it is difficult to determine the root cause.   

In the asymptomatic form, there are no complaints or manifestations, only the pathogen is released in the scraping and biological fluids during the study. The virus carrier is unaware of his illness and that he is contagious.   

According to the severity of the course, a mild degree is distinguished – exacerbations 2 – 3 times a year, between them at least 4 months, moderate – up to 6 relapses per year with an interval of at least 2 months, severe course – monthly exacerbations with remission of up to 6 weeks.       

By the nature of the frequency of episodes of the disease, there are three types of recurrence of genital herpes:

• The arrhythmic type is characterized by the fact that remission can last from a couple of weeks to 6 months, its distinctive feature is the pattern: the longer the period of remission, the more severe the manifestation of relapse. 
• The monotonous type is a uniform alternation of exacerbations and attenuation of symptoms. 
• With a subsiding type of the course of the disease, remissions are long-term, exacerbations are not frequent, in general, the prognosis is more favorable than in the two previous types.  

Reasons for the activation of the virus

The reason for the exacerbation of the disease is a decrease in general and local immunity.

General immunity suffers from somatic diseases, chronic processes, excessive physical and mental stress, unfavorable temperature factors (overheating or hypothermia).

Decrease in local, contribute to the lack of intimate hygiene skills and sexual contact with a virus-releasing agent .

Symptoms

A typical recurrence of genital herpes goes through four stages of development, like the manifestations of primary herpes, only in a somewhat smoothed form:   

• The prodromal (first) stage is represented by the so-called harbingers: the patient is worried about local itching and burning. In the overwhelming majority of cases, the localization of local manifestations is focused on the site of the primary process: the penis, thighs, anus, and urethra. There may be a slight increase in body temperature and general malaise. 
• At the second stage , pain, swelling appears, inflammation increases, and bubbles filled with transparent liquid appear on the tense skin. The pain can respond in the lower back, buttocks, scrotum. 
• At the third stage, the contents of the vesicles become cloudy, their membrane is opened. Small ulcers are exposed, which are subsequently covered with a scab. Soreness persists. 
• The fourth stage – the crusts fall off and the manifestations disappear without a trace. Scars can remain in the event of a bacterial infection or frequent mechanical damage to the healing ulcers. Subjective sensations subside. 

The symptomatology of the disease is purely individual and can take the form of several clinical forms:

1. The manifest form is characterized by violent symptoms that develop in accordance with the stages of the disease.  
2. The atypical form is limited to symptoms of inflammation: edema, redness and local temperature increase, accompanied by itching and burning. Small cracks may form on the skin or mucous membrane, healing under the scab within a week. 
3. The interrupted (abortive) form has a distinctive feature: bubbles do not appear. The disease is expressed in the formation of an itchy, hyperemic spot, which resolves after two to three days. This form occurs in patients undergoing suppressive therapy or immunoglobulin treatment.  
4. With an asymptomatic form, there are no manifestations.  

Recurrence of genital herpes can manifest itself as rashes not only on the genital organs, but also on the lips, nasal mucosa.

Complications

The development of complications of genital herpes is slow. The disease affects the male reproductive organs and progresses without timely and adequate treatment.

The consequences of the disease are expressed in the inflammatory processes of the urinary tract and the prostate gland. Less commonly, viral aggression spreads to the rectum, bladder and seminal vesicles.

A clear time dependence makes it possible to suspect a herpetic causation of these diseases. Their manifestations occur simultaneously with the symptoms of the underlying disease and disappear together with the attenuation of the herpetic process.

Treatment

When the first local symptoms appear, relief is provided by an ice compress , delivered according to the rules of asepsis (wrapped in a clean or even sterile napkin). 

It is possible to use local baths at room temperature (2 teaspoons of salt per liter of boiled water) or extracts of chamomile, celandine. They dry out the vesicles and reduce inflammation and tension in the affected skin. For the same purpose, antihistamine ointments (Fenistil) are used.    

At an elevated temperature and headache, it is appropriate to take anti-inflammatory and analgesic tablets (Pentalgin, Nurofen ).

There are three types of therapy for the disease:  

Specific (antiviral) treatment is represented by two blocks: episodic therapy and suppressive therapy .  

Episodic therapy means separate treatment for each recurrence that occurs. A course of treatment with antiviral agents is carried out, with the disappearance of symptoms, the reception is stopped. Recommended for patients with mild to moderate exacerbations, up to five per year. Its purpose is to reduce or completely attenuate all manifestations of this relapse. The drug of choice is Acyclovir and its analogs; if the virus is immune to the virus, Fanciclovir is used to it .  

Suppressive (suppressive, prophylactic) therapy involves the daily intake of antiviral drugs for a long course – months, possibly years – regardless of the presence of clinical manifestations. The constant blood level of the drug prevents the virus from activating and causing a relapse. It is important to strictly adhere to the treatment regimen: skipping the pill reduces the content of the drug in the tissues and creates favorable conditions for the aggression of the virus. The goal of suppressive therapy is to nullify episodes of exacerbations or significantly reduce their frequency and intensity.  

The indications for the appointment of suppressive therapy are: the course of the disease with a frequency of more than six exacerbations per year, if the disease has an extremely negative effect on intimate and family relationships, critically affects the psychological health of the patient, in order to improve the quality of life of a man.

In suppressive treatment, Acyclovir has proven itself well : the choice is due to the fact that its effect extends only to cells affected by the virus, bypassing healthy tissue. Valacyclovir is no less effective .  

The dosage and frequency of admission is determined by the doctor depending on the individual characteristics of the patient and the course of the disease.

Prophylaxis

The main methods of prevention include the following:

• It is advisable for the patient to keep a diary of the disease, in which it is necessary to note the dates of relapses and an analysis of the possible causes of their occurrence. This will help eliminate provoking factors and reduce the frequency of exacerbations.
• To exclude casual sexual contacts, use combined protection: a condom during coitus and irrigation of the genitals with an antiseptic (Chlorhexidine, Betadine ) after it.
• Careful observance of general and intimate hygiene.
• Preventive examinations by a urologist to identify possible complications.