Principles of treatment of genital herpes
Currently, there are two main directions in the treatment of genital herpes:
- Antiviral (etiopathogenetic) therapy.
- Specific and nonspecific immunotherapy in combination with antiviral therapy.
Antiviral drugs are prescribed both occasionally (during the acute period) and as long-term suppressive therapy (beyond relapses). Their long-term use helps reduce the frequency of relapses, normalizes the functioning of local immunity, and improves the quality of life of patients.
Nonspecific immunotherapy involves the use of immunoglobulin, interferon and interferon inducers, stimulators of the T- and B-links of cellular immunity and phagocytosis.
Specific immunotherapy involves the use of a herpes vaccine.
Rice. 2. The photo shows genital herpes in men. On the left is the acute phase (rash of blisters), on the right is the healing phase.
What does herpes look like on the head in men?
Herpes infection affects not only the face - herpes on the head in men (photo 2) and other genital organs appears much less frequently, but it is this location that brings them the most unpleasant sensations. Herpes on the head looks different in men - it depends on the severity of the viral infection. With strong immunity, herpes on the head of the penis may be barely noticeable, since the development of infection is restrained by the body's defenses, and with a weak one, the infection becomes severe.
In appearance, herpes on the head of the penis at the initial stage is similar to a hyperemic spot on the head; after some time, genital herpes in men is characterized by the formation of blisters with a clear liquid inside. Single bubbles, as a rule, are larger, and small ones merge into entire colonies.
The liquid in the bubbles is transparent; at the edges, due to softening and moisture, the bubbles become slightly softened, the edges smoothly transition from the bubble to the edging. When healing, herpes capitis leaves bright red spots, exposing the repairing tissue.
Treatment regimens
The maximum effect in the treatment of genital herpes is achieved by using an integrated approach to treating the disease:
- In the acute period and during relapses of the disease, antiviral and immunotherapy therapy is carried out.
- In order to prevent the development of relapses of the disease, a herpetic vaccine is used in combination with immunomodulators. Antiviral agents are used sporadically.
- During the recovery stage, the use of adaptogens of plant origin that increase the body's nonspecific resistance is indicated: eleutherococcus, ginseng, lemongrass, leuzea, aralia, sterculin, echinacea, saparal, zamaniha and immunal.
Modern methods of treating genital herpes can achieve positive results in 85 - 93% of cases of treatment of recurrent herpes.
Rice. 3. The photo shows genital herpes (herpes zoster) in a woman and a man.
Treatment of genital herpes with antiviral drugs
Chemotherapy drugs inhibit the synthesis of viral DNA, as a result of which the process of viral replication in the cell is suspended. Antiviral drugs - nucleoside analogues - currently have evidence-based activity: Acyclovir (Zovirax), Valacyclovir (Valtrex, Valvir, Valogard), Penciclovir (Vectavir), Famciclovir (Famvir).
Acyclovir (Zovirax) is the most commonly prescribed antiviral drug. Valacyclovir is 25 - 40% superior to Acyclovir. Widely used for recurrent miscarriage in women suffering from genital herpes.
Famciclovir (Famvir) is a new antiviral drug. Has the highest bioavailability (77%).
Alpizarin and Panavir are antiviral agents of plant origin.
Rice. 4. In the photo are the herpes pills Acyclovir and FamVir.
Frequency of application
Acyclovir is used 5 times a day. Famciclovir and Valacyclovir are used 2 times a day, which greatly facilitates the treatment process for the patient.
Release forms
Acyclovir is available in the form of injection solution, tablets, suspensions, ointments and creams.
Famciclovir and Valaciclovir are available only in tablet form.
Vectavir is available only in the form of a cream for external use.
Alpizarin is available in the form of tablets and ointments.
Panavir is available in the form of a solution for intravenous administration, rectal and vaginal suppositories and gels.
Duration of treatment with antiviral drugs
Episodic therapy
The duration of episodic therapy is 5 days; if necessary, the treatment period is extended to 10 days (until the elements of the rash heal) during the primary episode of the disease.
Preventative (preventive) therapy
Preventive therapy is carried out when the frequency of exacerbations of genital herpes is 6 or more times (episodes) per year. This treatment can reduce the frequency of relapses by 75%, alleviate the clinical manifestations of the disease, and improve the psychosexual well-being of the patient.
If the frequency of relapses of genital herpes is more than 10 times a year, then taking Valacyclovir for 3 months to 1 year will give a good effect.
Advice for the patient
- Drugs with antiviral activity should be taken when the first symptoms of the disease appear.
- It is necessary to follow the regimen for taking antiviral drugs. If a dose of the drug is missed, the subsequent dose is not increased.
- If genital herpes is asymptomatic, it is necessary to use condoms in all cases of sexual contact.
Long-term use of high doses of antiviral drugs reduces the frequency of disease relapses, which significantly improves the quality of life of patients.
Rice. 5. Agents with antiviral activity of plant origin Alpizarin and Panavir.
Causes
In most cases, herpes in the vagina occurs after unprotected sexual contact with a partner who is a carrier of the virus. People who have multiple sexual partners and do not use a condom may show signs of the disease.
The cause of primary infection can be some methods of contraception - intrauterine devices, vaginal caps, etc. Self-infection is possible, in which the patient transfers the virus from infected areas of the body to intimate places. In more rare cases, the causative agent of the disease enters the body through household means.
People who have multiple sexual partners and do not use a condom may show signs of the disease.
Immunotherapy
The most important reason for the development of herpes infection is impaired immunity. With herpes, the number of T and B cells and their functional activity decrease, the work of macrophages and the interferon production system are disrupted. Therefore, one of the important directions in the treatment of herpes infection, in addition to antiviral therapy, is the correction of specific and nonspecific immunity, which is achieved by the use of immunoglobulins, interferon inducers, interferon preparations and the use of agents for stimulating T and B-cell immunity and phagocytosis.
Immunoglobulins
Immunoglobulin against viruses against herpes type 2 (the main culprit of genital herpes) contains antiherpetic antibodies that neutralize pathogens. Its active basis is immunoglobulin G. The drug has an immunomodulatory effect.
Immunoglobulin for intravenous administration contains an increased concentration of antiherpetic antibodies; it is used for lesions of the central nervous system, herpes of newborns and primary herpes in pregnant women.
Rice. 6. The photo shows immunoglobulin against herpes type 2. Its active basis is immunoglobulin G.
Interferons
Interferons in the human body are secreted by a number of cells in response to invading viruses and are able to suppress the replication of viruses in infected cells. Interferon preparations are indicated for patients with a high frequency of relapses and the formation of secondary immunodeficiency. They are obtained from donated blood and created using genetic engineering.
Human leukocyte interferon is widely used, which is available in the form of injections, nasal drops and rectal suppositories.
Leukinferon and Interlock are used as injections.
Reaferon, created by genetic engineering and containing alpha-2b interferon, is widely used to treat recurrent forms of the disease.
Viferon and Human leukocyte interferon are included in rectal and vaginal suppositories.
Rice. 7. The photo shows drugs for herpes interferons in injections and capsules.
Interferon inducers
Interferon inducer drugs stimulate the production of their own interferons by the patient’s body cells, thereby preventing the proliferation of viruses. The main ones are Amiksin, Neovir, Arbidol, Ridostin, Kagocel, Cycloferon, Alpizarin, Flocazid, etc.
Levamisole (Dekaris), Dibazol, Vitamin B12, Pyrogenal and Prodigiosan help induce the production of endogenous interferon.
Flavoside, Alpizarin and Helepin-D are interferon inducers of plant origin.
Rice. 8. In the photo, tablets for genital herpes are interferon inducers Amiksin and Kagocel.
Immunomodulators
Immunomodulators regulate the synthesis of cytokines, cellular and humoral immunity, and redox processes. These include Galavit, Imunofan, Imunomax, Lykopid and Polyoxidonium.
Polyoxidonium directly affects phagocytes and stimulates the production of antibodies.
Ferrovir is a biologically active substance and is an extract from the milt of sturgeon and salmon fish. The drug activates antiviral immunity, has an inhibitory effect on viral replication and corrects the production of interferons. Ferrovir has a good therapeutic effect in the combination of herpetic infection and papilomatosis.
Isoprinosine has immunostimulating and nonspecific antiviral effects.
Rice. 9. In the photo, immunomodulators are drugs for the treatment of genital herpes. On the left is Polyoxidonium for injection, on the right is Imunofan for injection, spray and rectal suppositories.
In patients with severe suppression of the immune system, short courses of thymus hormones are indicated: Taktivin, Thymogen, Timalin, Myelopid, etc. The drugs stimulate the T and B links of cellular immunity and phagocytosis. Treatment with stimulants of cellular immunity is carried out under the control of an immunogram.
Rice. 10. The photo shows the immunomodulators Taktivin and Thymogen.
The prescription of drugs that correct and stimulate immunity is carried out only after an immunological examination of the patient and a study of his immune status.
Antiherpetic vaccine
The herpetic vaccine activates cellular immunity. It can prevent the development of a primary infection, the emergence of a state of viral latency and alleviate the course of an existing disease. The vaccine stimulates specific reactions of antiviral immunity and restores the functional activity of immunocompetent cells.
Rice. 11. The photo shows the antiherpetic vaccine Vitagerpavak.
Tests before prescribing treatment for herpes
Often, it is not difficult for a doctor to identify genital herpes and prescribe treatment, but effective and correct therapy requires a series of studies.
First of all, the need for tests is related to the identification of the pathogen.
Often, a herpes infection visually resembles syphilitic rashes and vice versa.
To avoid prescribing erroneous therapy, the doctor will refer the patient for the necessary studies.
What tests and studies are needed to prescribe treatment for herpes?
Your doctor may recommend the following laboratory tests.
Polymerase chain reaction
PCR allows for rapid and highly specific diagnosis of diseases of infectious etiology, including those caused by bacteria or viruses.
The assay has the ability to identify slow-growing microorganisms.
The increased sensitivity of the polymerase reaction makes it possible to detect viruses almost immediately after infection and even before the onset of clinical signs of the disease.
Such early diagnosis greatly facilitates the treatment process and makes it possible to prevent the development of symptoms.
In addition, using PCR, it is possible to detect the viral load on the patient’s body using quantitative determination of the DNA of the infectious agent.
ELISA
An enzyme-linked immunosorbent assay is an immunological test used to measure antibodies, antigens, proteins and glycoproteins in biological samples.
ELISA is considered one of the most sensitive immunoassay platforms currently available.
The analysis detects antibodies to Human alphaherpesvirus 2 (genital herpes), which indicates the presence of the virus in the patient’s body.
In case of exacerbation of the infectious process, diagnostics detects a high concentration of immunoglobulin M (IgM).
In the chronic course of the disease - immunoglobulin G (IgG).
MFA (fluorescent antibody method)
Immunofluorescence is a common laboratory technique.
Based on the use of specific antibodies that were chemically conjugated with fluorescent dyes.
The analysis is widely used to determine intracellular microorganisms, therefore it is often prescribed for clinical signs of herpes virus infection.
Culture seeding
It is a fairly accurate and informative method for detecting herpes.
During the analysis process, the collected biological material is placed on a nutrient medium.
After which you can observe the activity of the virus and how it captures healthy cells.
Getting a false result in this testing is reduced to zero.
However, the disadvantage is the length of the study; You can get ready results after 10-14 days.
Serology
The test refers to the diagnostic identification of antibodies in blood serum.
This is a fairly common diagnosis of genital herpes, aimed at identifying class G antibodies.
There are several serological methods that can be used depending on the suspected antibodies.
Serological methods include agglutination, precipitation, complement fixation, fluorescent antibodies and others.
The test can determine whether a patient has ever been exposed to a particular microorganism.
But this does not necessarily indicate an ongoing infection.
Antibody detection can be used to diagnose active and previous infection or to determine immunity to reinfection with the virus.
Additional diagnostic tests:
- Immunogram. The analysis is prescribed in exceptional cases and is aimed not at searching for the herpes virus, but at determining the state of the immune system. Diagnostics may also be needed to determine and select the optimal treatment.
- Dot blot hybridization. Quantitative dot blot analysis is a method for the quantitative determination of specific DNA, RNA or protein molecules using a dot blot apparatus. The analysis is similar to a PCR study. May detect infection before clinical signs begin.
- Vulvocolpocervicoscopy. The study relates to instrumental diagnostic methods, which is based on the use of a special microscope. Using the device, the doctor visualizes the mucous tissue of the cervix and vagina in order to identify rashes characteristic of herpes.
Local treatment of genital herpes
Local treatment occupies a special place in the complex treatment of genital herpes. Its importance increases many times in cases of development of resistance to antiviral drugs. When applied locally, antiviral agents ensure their high concentration in the affected areas. In this case, there is no toxic effect of drugs on the entire body. They help restore local immunity, reduce the duration of viral shedding and the healing time.
Antiviral drugs
Contain the antiviral substance acyclovir, preparations for external use: Acyclovir ointment, Acyclovir-Acri, Gevisosh, Acyclovir HEXAL cream, Zovirax (UK), Acyclovir Belupo, Ciclovir (India), Supraviran, Virolex (Slovenia), Famvir analogue Fenistil® Pencivir, Viru-gel Merz, Epigen aerosol, Bonafton ointment, Vectavir and Devirs cream.
Creams are applied every 4 hours (5 times a day) for 5 - 10 days.
Rice. 12. In the photo there is a cream for topical use Fenistil Pencivir and Zovirax.
Rice. 13. The photo shows Acyclovir ointment for herpes and Acyclovir HEXAL cream.
Rice. 14. Herpes cream Vectavir. Has antiviral activity. It is used at any stage of the disease from the age of 16 for 4 days every 4 hours (5 times a day).
Rice. 15. Bonafton ointment is used to treat genital herpes. Apply to the lesions in the form of applications 4 - 6 times a day.
Rice. 16. Cream with antiviral activity Deviris with ribaverin. In the treatment of genital herpes it is used in the form of applications. The maximum effect is achieved when used simultaneously with systemic antiviral drugs.
Rice. 17. The photo shows an ointment for the treatment of genital herpes of plant origin with an antiviral effect Alpizarinovaya and Panavir gel (also available in the form of rectal and vaginal suppositories).
Interferons
For the treatment of genital herpes, hydrogel-based ointment Vireferon is used. The drug contains interferon alpha-2b. Lubricated areas should be dried for 15 minutes, during which a protective film will form.
Viferon in suppositories is used in the treatment of herpetic colpitis and cervicitis in women.
Kipferon is a combination drug (a combination of interferon with immunoglobulin drugs). It is used in the form of suppositories for herpes cervicitis and colpitis.
Ointment for genital herpes Interferon alpha-2 recombinant is used for 3 - 5 days every 12 hours (2 times a day).
Rice. 18. In the photo there is an ointment for herpes with interferon Vireferon and suppositories Kipferon.
Interferon inducers
For local treatment of genital herpes, the interferon inducer liniment Cycloferon and lyophilisate Poludan are used.
Cycloferon is used for 5 days. Liniment is applied to the affected areas 1 - 2 times a day. In women, the drug is used for herpetic colpitis and cervicitis. In men and women with herpetic urethritis (according to the Poldanan treatment regimen).
Poludan is used in the form of applications, for which the contents of 1 bottle (200 units) must be dissolved in 4 ml of water. Moisten a cotton swab with the prepared solution and apply it as an application to the affected areas for 5 - 7 minutes. The duration of treatment is 2 - 4 days. 2-3 procedures are performed daily.
For herpetic urethritis, Poludan is used in the form of instillations into the urethra, for which 400 units. The product is diluted in 10 ml of water. Treatment is carried out once a day for 5 - 7 days.
Poludan is also used for herpetic proctitis, for which 400 units. The product is diluted in 10 ml of water. Treatment is carried out once a day for 10 days.
A solution of Poludan or Cycloferon liniment in the form of total instillation is used after traditional local manipulations - bougienage of the urethra and prostate massage. A more pronounced effect is obtained when low-frequency laser therapy is connected.
Rice. 19. In the photo, the interferon inducer liniment Cycloferon and lyophilisate Poludan.
Suppositories for genital herpes
In the treatment of genital herpes, rectal and vaginal suppositories are widely used. They are prescribed to children and adults when injectable drugs are contraindicated. Dissolving under the influence of heat, they promote the penetration of active substances into surrounding tissues.
- Panavir suppositories have an antiviral effect.
- Suppositories Genferon, Viferon and Human leukocyte interferon belong to the group of interferons.
- Galavit suppositories have an immunomodulatory effect.
Rice. 20. In the photo there are Panavir and Viferon candles.
