“Qui bene dignoscit bene, curat – who diagnoses well, he treats well”
Herpes simplex (herpes, herpes simplex; synonym: herpes simplex, lichen zoster, herpetic fever) – the most common viral infection of a person, which exists for a long time in the body mainly in a latent form and manifests itself during an exacerbation by rashes on the skin and mucous membranes of grouped vesicles.
Etiology and pathogenesis. The causative agents of the disease are two herpes simplex virus 1 and 2 types, which are transmitted mainly by contact, rarely by airborne droplets. Both herpes simplex viruses are double-stranded DNA enclosed in icosahedral capsids with dimensions of about 180 nm. In most cases, the herpes simplex virus type 1 often affects the skin of the face and the mucous membranes of the mouth and nose, and rashes caused by the herpes simplex virus type 2 are mainly located on the genitals and in the perianal region. However, due to oral-genital contacts, the localization of lesions by both types of viruses may be inverse.
The source of infection in most cases are people who have no rash, and the virus is released into the environment (asymptomatic reactivation occurs). The herpes simplex virus is quickly inactivated at room temperature, so infection by airborne droplets, as well as through household items, is unlikely. Infection occurs by contact – in case of contact of the skin or mucous with the affected skin or the affected mucosa. Outbreaks of herpes among wrestlers (herpes gladiatorum) are described. Infection with herpes simplex virus type 1 is promoted by overcrowding and unsanitary conditions.
Specific antibodies in the serum of patients are usually formed within a few days after infection. It is known that virus neutralizing antibodies, which provide latent infection, are found in 85% of infants. The disease can develop both directly after infection (primary herpes), and during exacerbations of recurrent (after primary) herpes. In many people, a herpetic virus passes from a saprophytic state and causes a relapse of the disease when exposed to known provoking factors (insolation, acute respiratory disease, influenza, pneumonia, meningitis, focal infection, tooth extraction, menstruation, etc.).
The disease is characterized by a single-step rash of a group of vesicles the size of a pinhead – a small pea, located on a hyperemic, slightly swollen spot. Within a few days, the vesicles are crushed into crusts or opened, leaving erosion. At the confluence of the vesicles, one erosion with small-palestone outlines is formed. Consistently can pour out new groups of vesicles. In some cases, usually with secondary infection of foci, swelling of regional lymph nodes is observed. Disease duration – 1-2 weeks. Some patients have a tendency of the disease to frequent recurrence (Fig. 1-4). Herpes simplex is localized mainly on the lips (herpes labialis) (Fig. 1–2), around the nasal openings (herpes nasalis), on the cheeks, on the genitals (herpes genitalis), in their circumference, on the hips (Fig. 4). There may be a rash on the mucous membranes of the mouth, urethra, cervix, vagina. Perennial, often recurrent genital herpes can lead to malignancy and cause cervical cancer. Possible damage to the organ of vision, which is manifested by lesions of both the anterior part of the eye (blepharoconjunctivitis, keratitis, episcleritis), and the posterior (horioretinitis, uveitis, optic neuritis).