Symptoms and treatment of genital herpes during pregnancy

• Cause and mechanism of development of pathology
• Clinical manifestations Typical symptoms of primary genital herpes
• Clinic for recurrent genital herpes

One of the leading problems in practical obstetrics and gynecology is genital herpes during pregnancy. The infection rate in men is lower compared to women. This form is widespread among the adult population, due to the presence of a high percentage of undiagnosed and asymptomatic forms of the disease. In addition to problems with preventing possible complications of the infection itself, significant difficulties arise in the question of how to treat genital herpes during pregnancy in such a way that medications do not negatively affect its development and do not harm the fetus.

Cause and mechanism of development of pathology

The source of infection is a sick person during an acute period or during an exacerbation, from which a partner becomes infected through sexual contact. The highest incidence was observed among people 20-29 years of age. Those at highest risk are those with a large number of sexual partners, as well as those who become sexually active at an early age.

The causative agent of the disease is herpes virus type 2. It is a clinical variant of herpes simplex. The incubation period is from 2 to 11 days. The entry gate for the pathogen is the skin of the external genital organs and the mucous membranes of the genitourinary system, then it enters the circulatory and lymphatic systems. But at an early stage, viruses penetrate into the endings of nerves, from there through the cytoplasm of the processes of sensitive nerve cells - to the peripheral, segmental and regional nerve nodes of the central nervous system.

In these nerve cells, herpes remains in a latent (hidden) form. The nerve ganglia of the lumbosacral spinal cord serve as a repository for the virus and a source for sexual transmission during periods of exacerbation, which occur on average in 40% of infected people.

Recurrent genital herpes is one of the most common sexually transmitted infections. Its pathogen differs from others in that it is present in a latent (hidden) form in the human body for life and is difficult to respond to specific therapy.

It targets not only nerve and epithelial cells, but also blood immunocompetent cells, which is manifested by multiple forms of clinical course and secondary immunodeficiency, which is associated with frequent colds, long-term and “unexplained” low-grade fever (37.0-37.2o ) body temperature, mental instability, swollen lymph nodes.

Recurrence of genital herpes during pregnancy can be caused mainly by factors such as:

• pregnancy itself;
• hypothermia;
• excessive exposure to sunlight;
• mental trauma;
• nervous fatigue and sleep disorders;
• hormonal changes in the body;
• chronic diseases of internal organs.

The degree of infection, exacerbation, its frequency and intensity of manifestations depend on the number and activity of microorganisms, the duration of their exposure, on the barrier state of the placenta and membranes, as well as on the degree of resistance of the organisms of the mother and fetus.

Clinical manifestations

In accordance with the international classification and depending on the clinical manifestations, primary and recurrent genital herpes are distinguished. The latter, in turn, is divided into clinical forms:

1. Typical, which is accompanied by the presence of characteristic lesions on the skin and mucous membranes of the external genitalia.
2. Atypical, or latent, presenting significant difficulties in terms of diagnosis. It is characterized by the presence of chronic inflammation of the mucous membrane of the internal genital organs in the form of colpitis, vulvovaginitis, endocervicitis, endometritis, salpingoophoritis (inflammation of the ovaries and fallopian tubes) with laboratory (bacteriological and microbiological) confirmation of the herpetic nature of these inflammatory processes, which is not always possible.
3. Asymptomatic with virus isolation - as a result of a virological examination of material (smears) from the genitourinary tract, the herpes simplex virus is sown, but there are no clinical symptoms of damage to the skin of the genitals and the mucous membrane of the genitourinary tract.

It is very important to be examined and identify genital herpes when planning pregnancy. Most often, a primary genital tract infection does not cause any symptoms, especially among people who have previously had a disease caused by the herpes simplex virus type 1. In these cases, infection with the second type of virus occurs in the form of a recurrent form or latent carriage.

At the same time, the acute phase of the disease or relapse of genital herpes during pregnancy is not always detected using standard laboratory microbiological and bacteriological methods. As a result, the woman does not receive the necessary specific treatment. She becomes a virus carrier and a source of infection of the fetus.

Typical symptoms of primary genital herpes

They, as a rule, are local in nature and manifest themselves:

1. Rashes on the labia minora and majora, on the skin in the area of ​​the anus. Rashes in the form of vesicles (vesicles) or papules (nodules), erosions or ulcers can be single or grouped, followed by the formation of crusts.
2. Itching and burning.
3. Redness and swelling of tissues.
4. Pain in the perineum and groin areas.
5. Discharge from the vagina and urethra.
6. Pain and burning during urination, dysuric phenomena.

Resolution of the rash elements occurs within 6-12 days, followed by epithelization of the affected areas. As a rule, there are no traces left on the skin and mucous membranes after the crusts are rejected. In some cases, redness and swelling may persist in the area where the blisters appear.

The general well-being of a pregnant woman often suffers, which is manifested by headache, malaise, sleep disturbances, and a slight increase in body temperature. The maximum severity of general symptoms is observed the day before and the first 2 days after the appearance of the rash. Subsequently, it gradually decreases and disappears within 1 week.

With the atypical course of genital herpes, which is about 60%, the only symptom may be vaginal discharge or unexplained pain in the lower abdomen.

Isolation of the pathogen from the urethra and cervical canals appears along with the first rash and lasts on average about 5 days, but can last a long time even in the absence of lesions.

Causes of genital type

Among the reasons that served as prerequisites for the exacerbation of HHV, the following can be identified:

• physiological changes during pregnancy, hormonal changes;
• weakening of the body's protective functions caused by vitamin deficiency, lack of a balanced diet and the presence of chronic diseases that aggravate the course of pregnancy;
• infection during pregnancy through unprotected sexual intercourse;
• the presence of sexually transmitted diseases acquired before conception;
• frequent abortions and use of intrauterine contraceptives;
• stressful situations, the number of which exceeds the maximum permissible norms.

As we see, there are few reasons, which indicates the possibility of avoiding such troubles. Treatment of genital herpes during pregnancy should be done as quickly as possible. This gives every chance of a successful outcome and reduces the risk of infection of the child at the time of birth.

You also need to read the article - genital herpes in women.

Is genital herpes dangerous during pregnancy?

Herpes virus type 2 is in second place in terms of the degree of danger to the fetus after the causative agent of rubella. Its presence in the body of a pregnant woman can lead to infection of the embryo, fetus and newborn child in various ways:

• through the fallopian tubes from the pelvic cavity and ovaries (transovarian);
• ascending infection from the external genitalia or birth canal;
• transplacentally, that is, through the placenta (with a significant concentration of the pathogen in the blood);
• through the cervical canal (transcervical);
• during childbirth;
• after childbirth during contact between the child and the mother, which can lead to generalization of the process in his body with damage to various parts of the nervous system and internal organs.

The effect of infection on pregnancy and the fetus is due to the following mechanisms:

1. Possibility of infection of the placenta, membranes, amniotic fluid and the fetus itself. This can cause damage to the placenta and membranes, disruption of the intrauterine development of the embryo or fetus, the development of generalized or limited damage, as well as latent infection of the fetus with subsequent manifestation of the disease in the child after birth.
2. The possibility of hormonal imbalance, as well as the development of a septic condition in a pregnant woman with impaired function of the placenta and the body’s self-regulation system.

This leads to early or late spontaneous miscarriage or delayed fetal development, its hypoxia (oxygen starvation) and developmental abnormalities, premature birth, etc.

A particularly high risk for the fetus is infection of expectant mothers who have never had herpes before pregnancy and are getting it for the first time. As a result of studying the effect of this infection on pregnancy, on the development of the fetus and on the newborn child, it was found that for all stages of pregnancy, the maximum danger is posed by generalized forms of this pathology, as well as primary infection. In the latter option, the woman secretes the virus for 8-10 days, and often up to 3.5 months.

The fetus or newborn child becomes infected in both primary and recurrent forms. However, infection with herpes infection in the first case ranges from 40 to 50%, while in recurrent forms it is only 5%.

When comparing data from clinical observations and laboratory studies of women with genital herpes, for example, at the 5th week of pregnancy and at the 19th week of pregnancy, it was found that with increasing period there is an increase in both the frequency of recurrence of the disease and the frequency and duration of virus shedding in asymptomatic cases.

These rates reach their peak in late pregnancy. By the beginning of labor, among pregnant women with seropositive reactions, from 2 to 5% develop an exacerbation of the disease, and in 20%, asymptomatic isolation of the pathogen is detected by polymerase chain reaction.

This is explained by the fact that during relapses of the disease, the body produces specific antibodies against the virus (found in 25% of women). Their presence, although not fully, still largely suppresses its activity. Therefore, in recurrent forms of genital herpes, the intensity of virus release is much less and the duration is shorter.

However, as the duration of pregnancy increases, the degree of immune suppression (decreased activity of the immune system) also increases, reaching its maximum at the onset of labor, which leads to an increase in the amount of virus released and the number of exacerbations.

Such data are the reason for recommending a woman to have a cesarean section for primary and generalized forms of genital herpes. This completely eliminates the possibility of infection of the child. In cases of recurrent genital herpes in the absence of its exacerbation and the absence of the virus in repeated smears from the genitourinary tract taken on the eve of the upcoming birth, it is possible to carry out the latter naturally.

Genital herpes in the early stages of pregnancy most often leads to spontaneous abortion or missed abortion. According to statistics, up to 30% of spontaneous abortions in the early stages and half of miscarriages in later stages are provoked by the genital herpes virus.

In addition, infection of the fetus in the first trimester, when the laying and beginning of organ development occurs, may cause the formation of encephalitis, combined with microcephaly (underdevelopment of the brain) and hydrocephalus (dropsy of the brain), the development of anomalies of the digestive organs, malformations of the heart and vessels, etc.

The 2nd and third trimesters are also dangerous due to spontaneous abortion, intrauterine death, malnutrition, anemia and sepsis in the fetus, the development of hemorrhagic syndrome with bleeding and thrombosis, meningoencephalitis, epilepsy, cerebral necrosis, pneumonia, damage to the eyes, hearing aid, skin, mucous membrane oral cavity, liver damage with the development of jaundice, etc.

The primary disease also poses a threat to the pregnant woman herself, since dissemination of the virus (spread throughout the body) can occur with the subsequent development of acute hepatitis, meningitis or encephalitis (inflammation of the membranes of the brain). In the case of generalization of the infection and in the absence of effective specific therapy, this form ( in 70-80%) ends in death.

Risks

The child became infected.
Genital herpes during pregnancy can be of a different nature, actively manifesting itself and causing harm, or easily disappearing. With proper and timely treatment, only 2% have a negative result; 98% of the female half of the population successfully resist the virus even in pregnancy.

Let's look at the main risks that arise when manifested:

1. Miscarriage. Natural interruption only due to exacerbation is impossible. For this, there must be accompanying factors that, together with herpes, lead to a miscarriage. Diagnosis of the genital type of virus in the early stages allows for rapid treatment and preservation of pregnancy.
2. Slowing of intrauterine development. With prolonged absence of treatment, it is able to penetrate all tissues and organs of the fetus, causing non-mutations at the cellular level. In this regard, mental retardation, delayed growth and weight, and hydroencephaly (dropsy of the brain) may occur.
3. Premature birth. Just like miscarriage, premature birth cannot be caused by the presence of a single virus. Usually this process is complex, so it is recommended not to avoid scheduled consultations with a doctor.

There is an opinion that the activation of genital herpes in the last stages and immediately before childbirth jeopardizes natural delivery. At the time of natural childbirth, there is a risk of infection of the child, but it is small. Therefore, before giving birth, a sick pregnant woman is prescribed a shortened course of an antiviral drug, which helps to quickly localize the source of inflammation and carry out the birth naturally.

Treatment of genital herpes during pregnancy

Modern methods of therapy do not allow the genital herpes virus to be completely eliminated from the body. Therefore, treatment is aimed at achieving less frequent exacerbations and eliminating or correcting the disorders caused by the disease.

Its main principles are the use of antiviral drugs in combination, if necessary, with specific and nonspecific immunotherapy. For clinical manifestations of the disease (in cases of the primary form and in case of relapses), Acyclovir is prescribed 0.2 grams 5 times a day or 0.4 grams 3 times a day for a week. It is possible to use analogues of Acyclovir (Zovirax, Acyclovir-acri, Gerpevir, Gerperax, Valtrex, Famvir, Valacyclovir, etc.) in appropriate dosages.

Another approach is long-term (several years) suppressive treatment at lower dosages in the absence of exacerbation.

Immunotherapy is carried out using human interferon, natural leukinferon, interlock, viferon in suppositories. Local treatment is carried out by applying drugs to the affected area. What should I apply to the affected area? To do this, it is best to use Acyclovir cream 8 times a day or ointment containing Viferon (for a less pronounced process).

Thus, herpetic infection is a high risk factor for the development of pregnancy itself and the birth of a child with various pathologies, and sometimes for the life of the woman herself. On average, 42% of pregnant women with genital herpes had a threat of miscarriage, almost 29% had developmental delay, and 30% had a chronic form of fetal hypoxia (according to studies in 2000 and 2005). Careful examination and treatment during planning and during pregnancy in many cases allows you to avoid possible complications.