Herpetic infection

The herpes are one of the most widespread virus infection contaminations of the human and represent a serious mediko-social problem. Over 90 % of humans of globe are infected Herpes simplex virus and to 20 % from them have those or other clinical implications of an infection contamination. Possessing neurodermotrophysm, Herpes simplex virus amazes a skin and mucosas (more often on the person and in the field of generative organs), the central excitatory system that leads to development of a meningitis and encephalitises, and also an eye (conjunctivitises, keratites). Herpes simplex virus causes a pathology of pregnancy and sorts, often leads to spontaneous abortions and pre-natal  destruction of a foetus or causes the generalised form of an infection contamination in newborns. Communication of herpetic process becomes perceptible at genital herpes with a cancer of a neck of a uterus at women and a cancer of a prostate at men.

Aetiology

The genital herpes are caused by two serotypes of a herpes simplex virus - HSV1 and HSV2; most often HSV2. Serological properties of viruses are various. The structure of a genome of Herpesviruses differs from that other DNA-containing of viruses a locating of nucleotides in a molecula of DNA of a virus. Genomes HSV1 and HSV2 on 50 % are homologous. Homologous fields are distributed on all card of a gene. The virus genome is packed into the capsid of the icosahedral form consisting of 162 capsomeres. From an outside surface the virus is covered lipid contained by the cover representing the modified cellular membrane, formed at penetration of DNA-containing of a capsid through intrinsic nuclear membrane of a host cell.

The virus replication consists of nuclear and cytoplasmatic phases. The replication initial stages include apposition, coalescence of a cover of a virus to a membrane of a cell to the subsequent liberation of a nucleocapsid in a cell cytoplasma, disintegration of a nucleocapsid and an orifice of virus DNA. After replication of a virus genome there is a nucleocapsid assemblage in a cell kernel. In process of penetration into renuclear space they become covered by a cover. In some cells at virus replication in a cell little bodies-includings of two types are formed: basphilic little bodies of a type And and an eosinophilic little body-including. Then virions are transported on a cytoplasmic reticulum and a lamellar complex to a cellular surface.

Pathogenesis

Herpes simplex virus as well as other Herpesviruses it is capable to latent existence with the subsequent reactivation which can serve as the cause of palindromias or asymptomatic abjection of a virus.

Herpes simplex virus takes root into an organism through mucosas and a skin, then it is quickly grasped by sensory nerve terminations by means of special virus receptors. After introduction in an axon of a nerve it is tolerated to the excitatory cells of dorsal roots of ganglions where remains in a latent condition. The mechanism of a latent condition of a virus with its subsequent reactivation is not quite clear yet. Assume. That the virus replication is quenched by genetical mechanisms, and the reactivation, possibly, is reached by elimination of this blocking.

The latence and neurovirulent HSV-infections is the basic properties defining its pathogenesis. Various implications of a latence, a reactivation and virulence at various patients are defined both properties of the virus, and characteristics of the master. Among virus factors the essential role is played by a neuraminidase as this enzyme is necessary for replication of virus DNA in postmitotic neurones.

The herpes have destructive an effect on immune system of the patient and are the secondary immunodeficience cause. The relapsing genital herpes, breaking sexual life of patients, quite often cause psychological disorders. Clinical implications of herpes possess the expressed polymorphism. Lesion HSV of genitals - the most frequent disease transferred sexual by.

Epidemiology

The case rate last years was considerably enlarged. 30 million adults in the USA suffer relapsing genital herpes, and every year is registered about 500000 new cases of a becoming infected. Thus, serological signs of the previous infection contamination caused by a virus are found in every fifth inhabitant of the USA. But only at 5 % of the population there are clinical implications, characteristic for genital herpes, in other cases it proceeds subclinical or is asymptomatic. The case rate genital herpes is especially important for some countries of Asia and Africa where the diseases of generative organs accompanied by ulcerations, are one of primary factors of diffusion of a HIV-infection contamination.

The risk of a neonatal becoming infected of the newborn depends on the form of genital herpes at mother and compounds from 0,01 % to 75 %. The pre-natal infection contamination caused HSV2 meets was rarely - approximately в5 % of cases. In overwhelming majority of cases the becoming infected of the newborn descends during sorts at parturient canal transit. And the transmission of infection is possible as in the presence of the locuses on a uterus and vulva neck, and at an asymptomatic carriage.

The virusemia during pregnancy can be a foetus cause of death, causing to 30 % of spontaneous abortions on early durations of gestation and over 50 % of serotinal abortions. Herpes simplex virus takes the second place after a rubella virus on a teratogenicity. The transmission of infection and development of neonatal herpes depends on a number of circumstances:

Level of the maternal neutralised antibodies which have passed to a foetus transplacental, or the aboriginal antibodies binding a virus intragenital.

Duration of the anhydrous season (4-6 hours)

Applications of various instruments at a delivery, leading to damage of a skin of the child (applying of electrodes on a foetus head).

Probably and postnatal becoming infected of the newborn in the presence of active signs of herpetic implications at mother and the medical personnel though it meets was rarely enough (5-10 %).

Clinic

Excrete following kinds of a herpetic infection:

• The primary infection contamination when the human faces for the first time with Herpes simplex virus and does not possess antibodies to it. It can be accompanied by symptoms or proceed asymptomatically as it descends in most cases. Clinical implications of a primary infection contamination proceed 18-22 days with increase of semiology within the first week. Disease is characterised by long abjection of a virus, the genital and extragenital lesions, accompanied by aboriginal and general symptoms which show for 2-14 day. To the general symptoms carry a fever, a headache, a malaise and a myalgia; to aboriginal - an itch, a pain, a dysuria, abjections from a vagina, development of lesions on a skin and mucous, an inguinal lymphadenopathy. Sometimes there are complications which demand hospitalisation-sacral a radiculopathy, a serious aseptic meningitis or a disseminated infection contamination. Thus, the general duration of implications compounds almost 6 weeks.
• The nonprime infection contamination is observed at the patients already having antibodies to one of types Herpes simplex virus. There is a variant of nonprime genital herpes, when the human is more often. Already having antibodies to HSV1, for the first time it is infected HSV2. It proceeds is less expressed: duration of clinical implications approximately 16 days. Asymptomatic abjection of a virus till 7 days is less often observed.
• The relapsing infection contamination is diagnosed for the patients having simultaneously symptoms of genital herpes and an antibody to reactivate to a type of a virus. Clinical symptoms are even less expressed and in overwhelming majority of cases the given disease proceeds asymptomatically. The recuring is promoted by immune responsiveness depression, a frigorism or an organism overheating, the intercurrent diseases, some mental both physiological conditions and medical manipulations.

The genital herpes are localised at women in the field of small vulvar lips, a vulva, a clitoris, a vagina, a uterus neck more often; at men-in of range of a balanus, a prepuce and an urethra.

The genital herpes are characterised by periodic appearance on a skin and mucosas of the locuses of a lesion with a various degree of manifestation and active abjection Herpes simplex virus, that shows in the form of various clinical forms:

• demonstrative
• atypical
• abortal
• subclinical

For the demonstrative form typical development of herpetic elements in the lesion locus is characteristic. Constant signs of disease are blisters, erosions, ulcers, an exudation, relapsing character of disease. Patients often complain of a febricula, a headache, sometimes on subfebrile temperature, sleep disturbance, nervousness. Usually in the disease beginning the sense of a burning sensation and an itch in the field of genitals becomes perceptible. The struck place slightly swells, reddens, then on the hyperemic establishment there is a bunch of fine blisters in diameter of 2-3 mm. Transparent contents of blisters grow turbid subsequently, become purulent. In some days blisters are dissected and start to die in thin crusts which in process of a cuticularization of the locuses of a lesion disappear, abandoning a time hyperemia or secondary pigmentation.

The atypical form shares on hydropic and itching. The lesion locus can be presented deep relapsing fractures of a mucosa of a vulva and subject tissues of small and big vulvar lips. Fractures independently epithelisate within 4-5 days.

The abortal form usually meets at the patients receiving earlier antiviral treatment and vaccinotherapy. The lesion locus can show in the form of pruritic maculae or a papule, it is authorised for 1-3 days.

For the subclinical form the microsemiology or its full absence is characteristic.

In flow of genital herpes three stages are secured:

1. A lesion of outside generative organs
2. Herpetic colpites, urethrites and cervicitises
3. A herpetic endometritis, a salpingitis or a cystitis

The herpetic relapsing infection contamination can amaze not only range of outside generative organs, but also a mucosa of a vagina, a neck of a uterus and to inpour ascending by into a mucosa of a uterus, a tube, appendages, an urethra and a bladder, causing their specific lesion.

Diagnostics

Cytomorphological methods, registration of the immune answer apply to diagnostics to Herpes simplex virus and an assessment of the immunologic status of patients virologic assays of detection and herpes simplex virus identification, molekuljarno-genetic diagnostics, revealing of antigens Herpes simplex virus.

Treatment

For treatment of the first episode of genital herpes prescribe an aciclovir of 5 times of 200 mg a day within 5-10 days or before achievement of clinical remission.

At relapsing genital herpes it is possible to apply as incidental treatment by an aciclovir on 400 mg of 5 times a day within 5 days, and a method suppressive therapies by an aciclovir (daily 400 mg 2 times a day within months and even years)

Also such preparations, as a valaciclovir, a famciclovir, a foscarnet, Alpisarinum, Flacosidum, Helepinum, Ribavirin, Methisazonum are applied. Besides apply preparations of interferon and its inductors, such as an interlock, Poludanum, Leukinoferonum. To outside (aboriginal) treatment apply Vira-MP, a panthenol, Megosinum.

The aciclovir is applied to treatment of pregnant women in standard dosages. The Cesarean section as preventive maintenance of neonatal herpes is necessary in the presence of herpetic rashes or at a primary genital herpetic infection at mother 1 month prior to sorts. In other cases probably natural a delivery.

The herpetic vaccine is applied to preventive maintenance of relapses of 0,2 ml intradermally in 2-3 days in number of 5 injections not less than 2 times a year. In the presence of an immunodeficiencyy bacterination is spent on termination of an immunocorrection. It is necessary to abstain from sexual life before disappearance of clinical implications.