The Treatment of Modern Western - Biblio.nhat-nam.ru

34HERPES GENITALIAHerpes genitalia refers to infection of the genital or anorectalskin or mucous membranes by either of two closely relatedherpes simplex viruses, HSV-1 or HSV-2, with HSV-2accounting for 90% of genital herpes. This is the most commonulcerative sexually transmitted disease in developedcountries. It is estimated that 25% of American adults havegenital herpes. However, most do not know this becausetheir symptoms are too mild to notice. 1 Genital herpes withor without symptoms currently affects approximately one infour females and one in five males in the total U.S. populationof adults and adolescents. Within the past two decades,the number of genital herpes infections has increased 30%among Americans, with the most dramatic increase seen inyoung adults ages 20-29 and in Caucasian adolescents. 2 Infact, most persons infected with HSV-2 have no symptoms.When HSV-2 infection is symptomatic, primary lesionsdevelop 4-7 days after contact. These typically appear as asmall cluster of variably painful vesicles which then erodeand form superficial, circular ulcers with red borders. Thesesmall ulcers may also coalesce into a single, larger lesion.After several days, these ulcers crust over and generally healin 10 days, although they may also heal without crusting.Lesions may occur on the prepuce, glans penis, and penileshaft in males and on the labia, clitoris, perineum, vagina,and cervix in females. They may also occur perianally and inthe rectum in homosexual men or in women who engage inrectal intercourse. These lesions may be accompanied byfever, malaise, painful urination, especially in females,headache, joint pain, cold sores around the mouth, andregional lymph node swelling and pain. Some people reportpain and discomfort in the genital area after the lesions havehealed. This pain is postherpetic neuralgia.Approximately 40% of those infected with this virus who doshow symptoms never have a second attack. However,because the virus chronically infects the sacral sensory nerveganglia from which it reactivates and reinfects the skin,recurrences are common in the majority of those infected.Unfortunately, those antibodies which are produced early inthe course of herpes infection do not prevent recurrence ofthe active phase of this disease since they do not affect intracellularviral replication and direct cell to cell viral transfer.Many with recurrent outbreaks have 4-5 recurrences peryear. These recurrences are generally most common after sexualintercourse or masturbation causing trauma to the genitalskin, after sunbathing, and during times of physical andemotional stress. Recurrent outbreaks may also be precipitatedby faulty diet, such as ingestion of fatty meats, chocolate,and alcohol. During the initial outbreak, these lesions andtheir accompanying symptoms are typically more painful,widespread, and prolonged than in subsequent recurrentoutbreaks. In females, recurrent outbreaks are often coordinatedwith the menstrual cycle with recurrences most commonlyoccurring before, during, or immediately after menstruation.In recurrent episodes, the outbreak of skin lesionsis usually but not always preceded by itching, tingling,and/or burning and localized erythema. There may also beprodromal neurological pain radiating or beginning from thesacrum and/or perineum and traveling to the hips, genitalia,or down the legs. This pain may be severely uncomfortableand annoying. However, recurrent episodes are usually notaccompanied by fever and severe malaise. Recurrences varygreatly in their severity and frequency and may continue formany years. Herpes simplex virus infection is a lifelong illness.In patients with depressed cell-mediated immunity dueto HIV infection or other causes, prolonged or progressivelesions may last for weeks or longer.Newborns may be infected during delivery with symptomsappearing 9-11 days after birth. These may include skin blisters,red eyes, and abnormal eye discharge. If the virusspreads through the baby’s bloodstream to the brain, theremay be lethargy, irritability, and seizures. If the virus spreadsto the baby’s lungs, there may be difficulty breathing requiringbreathing assistance. However, the treatment of thesesymptoms are not discussed below. Because of fear of infec-