Herpes viruses: what you need to know about them and whether you can protect yourself from infection

Genital herpes is a viral disease characterized by a rapid transition to a chronic form and frequent relapses. The degree of infection is high, more than 90% of the world's population is infected with herpes simplex virus (HSV) types 1 and 2. Only 20% of them have clinical manifestations. Among STDs, herpes is second only to gonorrhea and spreptococcal urethritis, and among viral infections - only to influenza.

The pathology is transmitted predominantly sexually and affects the skin and mucous membranes: watery, painful papules - blisters - appear on them. Their usual localization in men is in the urethra, folds of the foreskin and on the head of the penis. Accordingly, the formations interfere with normal urination and intimate life, causing pain and other unpleasant symptoms.

Herpes in men is complicated because, due to the specific structure and structure of the urinary and reproductive systems, it is impossible to quickly prevent the development of pathology. Scientists have found a connection between the spread of HSV-2 and prostate cancer.

Pathogenesis

Genital herpes is defined in ICD-10 under code A60.0. According to WHO, men are infected 2 times less often than women. When infected, the virus primarily attacks epithelial cells, affecting large areas of the genitals, passing further into the genitourinary system.

In cells, viruses reproduce by budding; already 10 hours after infection, herpes is ready to create “daughter” virions - full-fledged viral particles. They penetrate various tissues, blood, lymph. The period of subsidence of the virus depends on the level of immunity. Usually it is 14-21 days.

Acellular organisms infect nerve ganglia (clusters, nodes), remaining there for life, since they cannot survive without a cell. Here they do not manifest themselves in any way until so-called trigger situations occur, which serve as an impetus for the activation of pathogenic microflora.

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Causes and risk factors

In some cases, doctors diagnose pathology in newborns. In this case, the virus is transmitted when the fetus passes through the birth canal. However, the most common cause is infection from a sexual partner during intimacy. In this case, risk factors for developing the disease include unprotected sexual intercourse, especially with frequent changes of sexual partners.

After the virus enters the body, antibodies begin to be produced, so after a short but fairly bright period of activation, herpes subsides. It is instantly activated in case of trigger situations:

• Hypothermia;
• Bacterial, fungal and viral infections;
• Traumatization of the genitourinary system;
• Surgery on the penis, testicles, prostate gland;
• Decreased immunity;
• Chronic pathologies of the genitourinary system;
• Autoimmune diseases;
• Hormonal imbalances.

Even due to climate change or lack of vitamins, genital herpes can remind itself.

Kinds

Doctors distinguish between primary and secondary types of the disease.

Primary is the one that is diagnosed for the first time. It is characterized by a bright clinical picture and a rapid course.

Secondary is one that is diagnosed more than once; these are relapses of chronic pathology. The frequency of resumption of symptoms depends on the person’s immunity; symptoms are often blurred and short-lived.

Secondary genital herpes is distinguished by the frequency of exacerbations:

• Mild form – no more than 3 relapses in 12 months;
• Moderate – up to 6 exacerbations in 12 months;
• Severe form – more than 6 relapses per year.

Doctors also classify the disease according to the specific symptoms.

Herpes viruses: what you need to know about them and whether you can protect yourself from infection

Briefly: 70 to 90% of the population is infected with herpes viruses. Only children under 3-5 years of age are healthy, due to rare contacts with adults; as soon as the child begins to attend kindergarten or school, he becomes infected within a short period.

Are herpes viruses dangerous: for healthy people they do not pose a particular threat, a person outside of exacerbations is not contagious, isolation is required only during exacerbations. They become dangerous for people at risk.

Examination of a child with frequent colds

If a child has frequent, severe colds and acute respiratory viral infections, our center will find out the cause of this condition

Is there a treatment: there is no specific treatment today, so do not believe promises to cure herpes. A vaccine is currently being developed that should help fight herpes. Research is underway in the field of gene therapy. And the existing vaccine “Vitogerpovac” only stimulates a specific reaction of antiviral immunity in general, enhancing the immune response, in particular the activity of lymphocytes.

In short: you can live happily ever after with the herpes virus. And now in more detail: how many herpes viruses exist, how they differ and who is at risk.

Question #1: Is it true that HSV type 1 is a common cold, and HSV type 2 is a genital cold?

Previously, it was believed that HSV 1 only causes colds on the lips and other mucous membranes, and HSV 2 is the culprit of rashes on the genitals. No, that's not true. Viruses of both types feel great on any mucous membrane. In other words: oral sexual activity during an exacerbation of herpes on the lips of one partner will lead to infection of the other.

Other herpes viruses

Type 3 virus causes chickenpox and shingles. Most often, at the first meeting in childhood, chickenpox occurs, and at an older age, with weakened immunity and other diseases, symptoms of herpes zoster appear. And, the more weakened the immune system, the more frequent and severe the relapses.

Type 4 Epstein-Barr virus causes infectious mononucleosis, most often transmitted through kissing. The peculiarity of this type of virus is that it prefers to live and reproduce in one cell. By making her “immortal,” he actually provokes oncological processes. Thus, the Epstein-Barr virus was discovered while studying Burkitt's lymphoma. Nasopharyngeal carcinoma is also closely related to herpetic exacerbations. Don’t kiss your children on the lips; that’s what their cheeks, foreheads, hands are for, and in extreme cases, their heels.

Virus type 5 or cytomegalovirus . Its maximum concentration is in urine and saliva; children in kindergartens are often infected due to insufficient hygiene skills. Basically, it is a fairly peaceful type of herpes and the initial encounter goes away like a common cold and there are no further relapses. Dangerous only for weakened people, pregnant women and HIV-infected people. There is evidence that it may increase the risks of hypertension and atherosclerosis, type 1 diabetes.

Types 6, 7 and 8 of herpes viruses are poorly studied, most likely they are the culprits of chronic fatigue syndrome and unclear rash syndrome. It is known that herpes virus 6A is common in patients with multiple sclerosis.

Important : a person poses the greatest danger during primary infection; later, during periods of exacerbation, the risk of infection is much lower. However, in many people the disease manifests itself only once. And the larger the area of ​​the rash, the worse the immune system works. There is another feature of herpes viruses - it only affects skin and epithelial cells. Typically, relapse occurs at the same site where the initial infection occurred.

Risk factors (or what triggers relapse):

1. Temperature fluctuations and sudden climate changes are why herpes often appears in the off-season and after flights.
2. Overheating and solar insolation (for people who are susceptible to frequent relapses, it is better not to sunbathe, avoid visiting baths and saunas
3. Emotional stress (breakup, interview, exam)
4. Physical overexertion (intense physical labor or sports)
5. Local injuries, surgeries, skin damage
6. Disturbances in the rhythms of life: lack of sleep, fasting or overeating, large amounts of alcohol on the menu.

Herpes is often triggered by menstruation, appearing either on the lips or like herpes zoster, but in the lower back and buttocks.

What is the danger of herpes viruses

Previously, it was believed that a herpetic rash was only an aesthetic defect, and a healthy person need not fear for his condition. Not at all. The herpes virus lives in nervous tissues; the connection between most chronic diseases of the nervous system and viruses has already been proven - Alzheimer's disease, multiple sclerosis and others. There is a close connection between liver damage and herpes viruses - the fact is that some viruses are imperfect and can only penetrate a cell that is already infected by another virus. That is, at the time of relapse of herpes, a person is more susceptible to other viral infections. It has already been proven that the herpes virus is often to blame for infertility of couples - it affects sperm, although both the man and the woman are reproductively healthy - pregnancy does not occur.

The main danger of herpes viruses: they activate and increase the likelihood of infection with other viruses, which in turn reactivate herpes, starting the process of constant relapses. In particular, such a relationship has been confirmed between the herpes viruses and HIV. This phenomenon is called epidemiological synergism, that is, herpes practically opens the gates to other viruses.

That is, even groups of relatively healthy people who do not have frequent relapses cannot be safe. Today, a connection has been identified between the presence of herpetic complications and certain genes.

Who is at risk or who is more likely to experience relapses and severe herpetic complications:

1. Patients with primary and secondary immunodeficiencies (for many of them, herpes infection can become fatal, becoming generalized).
2. Pregnant women (firstly, the woman herself is more susceptible to infection, and any illness during pregnancy is less tolerated, and secondly, there is a risk of herpetic damage to the fetus and congenital anomalies).
3. Premature babies, newborns with developmental defects or low birth weight
4. Patients receiving chemotherapy, taking drugs for the treatment of autoimmune and oncological diseases, antibiotics.
5. Patients with bacterial pneumonia.
6. Donors immediately after donation, people after blood loss and immediately after transfusion of blood and/or its components.
7. Persons who have frequent promiscuous sex life (lack of a condom, low degree of its protection against herpes, if the virus affects the skin, the high contagiousness of the virus contributes to its rapid spread)
8. People with tuberculosis, atopy, connective tissue diseases.
9. Patients after surgical interventions - often herpes worsens even after cosmetic and dental procedures, since the nerve cells in which herpes lives are injured.
10. Patients after organ transplantation.
11. People over 65 years of age.
12. People of certain professions: laboratory assistants, virologists, astronauts, miners, radiologists, dentists, pilots, coal industry workers, etc.

Symptoms and treatment

Symptoms of exacerbation can manifest themselves in different ways: from completely insignificant (when there is only a single element) to complicated - with a rise in temperature to high numbers, symptoms of intoxication. It is important which herpes virus caused the disease or complication. Now we are talking about the classical forms of HSV 1 and HSV 2.

You need to understand that regardless of the symptoms, at this moment you are very contagious and elderly people, patients with immunodeficiencies who happen to be nearby can receive their dose of the virus. At the same time, if you or your loved ones are at risk, then it is better to protect yourself and wear sterile masks.

1. During an exacerbation, avoid cosmetics and creams - along with them, you “smear” the virus over the skin and mucous membranes.
2. Do not touch your eyes and other mucous membranes - this will lead to infection (be sure to wash your hands before using the toilet, eyes and genitals).
3. Change towels, or better yet, use disposable ones.
4. Drink only from your own glassware, wash it separately or in the dishwasher
5. Do not peel off the crusts or burst the bubbles.
6. Use products for external use - they soften the skin well and promote rapid healing.

If there are symptoms of intoxication, high fever, herpetic rashes, call a doctor at home.

How to test yourself for herpes viruses

If you are over 18, you are most likely already infected. You can get tested for antibodies, do PCR diagnostics, an increase in immunoglobulins, of course, is also an indicator - but they increase in response to almost any infection.

What should I do if I am infected?

We said above that if you are over 18, then most likely you are infected. The main thing is not to fall into risk groups, avoid provoking factors, and lead a healthy lifestyle. You can make an appointment with an immunologist and check the risks of cancer and other pathologies for which a gene-disease relationship has already been identified, and follow the news to be the first to know when a cure for herpes is found.

You can undergo such diagnostic examinations at our center named after. Speransky. Our doctors adhere to the rule: the main thing is to preserve the health and natural strength of the body, and not to heal the patient until, according to tests, everything is perfect.

Symptoms of genital herpes

The incubation period of the pathology is from 2 to 14 days, then general and local signs appear progressively, then they decline.

Pathology can be suspected based on the following signs:

• The appearance of vesicles - small bubbles with a diameter of no more than 2 mm, formed in groups up to 2.5 cm in diameter;
• Itching, burning, pain in the affected area;
• Unpleasant sensations during sexual intercourse, urination;
• Local and general increase in body temperature;
• Swelling of the genital organ;
• Malaise;
• Nausea;
• Weakness.

The most common manifest form of genital herpes: severe damage by vesicles, after opening they become covered with crusts, regional lymph nodes are enlarged.

Urologists and andrologists also observe the following forms of pathology:

1. Atypical . There is a small number of vesicles, but the penis is swollen and there is severe redness. Cracks appear in the mucosa, which regenerate within 5-7 days.
2. Hemorrhagic . The main difference is that instead of a clear liquid in the bubbles, there is a dark red liquid in which blood cells are present. The head of the penis and urethra are very swollen and hot to the touch.
3. Abortive . Instead of vesicles there is an itchy spot, a papule, which ulcerates within 5-7 days.
4. Subclinical . Swelling in the affected area is accompanied by severe itching, but quickly passes.

Since herpes also affects the nerve ganglia, disturbances of the central nervous and autonomic systems are possible: pinching, pain in muscles and joints, and the spine.

When fatigue is a sign of herpes...

Herpes virus type 6 (HHV-6 or HHV-6) was discovered back in 1986. In 2012, a sensational discovery occurred: it turns out that the herpes virus type 6 in adults may not manifest itself in any way, but can still cause a painful condition

Where does it come from?

According to various sources, about 80% of people are infected with herpes virus type 6. Most often, the infection occurs in early childhood - between the ages of 6 months and 2 years. This is due to the child’s loss of maternal immunity and the high prevalence of the virus. The first meeting can occur in the form of roseola - a sharp increase in temperature, after which a rash appears after 3-4 days. This is the only specific manifestation in children that can be used to suspect HHV-6.

Alas, once in the body, any herpes virus will not leave it. In most people, the immune system quite successfully suppresses the development of herpes virus type 6. Continuing to live in the body, but does not affect anything. But this does not happen for everyone.

Always exhausted

Chronic fatigue syndrome (CFS) has long been considered an independent disease. This is not the kind of fatigue that can be “cured” by vacation, a change of job, or just normal sleep. CFS is diagnosed when a person experiences persistent fatigue and a 50% or more decrease in performance for 6 months or more. In this case, there are signs of chronic infection: low-grade fever, enlarged lymph nodes, muscle and joint pain, chronic pharyngitis, headaches.

Sleep disturbances, depression, irritability, difficulty concentrating, memory and intelligence deterioration often occur. Sometimes appetite disappears, a person suddenly loses or gains weight, problems arise in the stomach, intestines, and urinary system. Moreover, allergy symptoms or sensitivity to bright light, alcohol, medications, etc. may appear.

Before receiving a diagnosis of chronic fatigue syndrome, a person must undergo examination to rule out other diseases. Often the only objective sign of infection is the identification of herpes type 6

How to find out?

At the stage of making a diagnosis or to clarify it, doctors prescribe a laboratory test Antibodies to the herpes virus type VI (Herpes simplex virus VI), IgG. You can take it yourself if you are concerned about decreased performance, and then consult a doctor. For him, it is enough to donate blood in the laboratory 3 hours after eating or in the morning on an empty stomach.

Any decrease in immunity can trigger HHV-6 to become active. Most often it is triggered by stress, flu, or exacerbation of a chronic infection. Often people associate a tired-depressive state with a consequence of illness or stress, but in fact they have become a trigger for the activation of the virus. The active virus lives and multiplies at the expense of lymphocytes - the main cells of the immune system. Therefore, symptoms of infection and damage to the nervous system, which is closely related to the immune system, arise. When the HHV6 virus is activated, it can be detected by PCR in oropharyngeal scrapings or in urine. If there are skin rashes and fever, then herpes virus type 6 can be detected in the blood.

Who will need it?

Doctors identify several groups of patients who need testing Antibodies to the herpes simplex virus VI, IgG, or detection of herpes viruses in an oropharyngeal smear. These are the people who are concerned about:

• memory problems, inability to concentrate on business;
• causeless pain and sore throat;
• soreness of the lymph nodes in the neck and under the ears for an unknown reason;
• muscle pain not associated with physical activity;
• joint pain that has no objective cause (trauma, osteochondrosis, etc.);
• headaches that have never happened before;
• sleep problems;
• weakness and exhaustion after physical activity, clearly not corresponding to the expenditure of effort;
• frequent colds
• feeling of fever or chills at normal temperature

How to treat?

Antiviral drugs for other types of herpes can also be effective for HHV6 infection; the choice of treatment available in Russia is up to the attending physician (different antiherpetic drugs are registered in different countries). Therefore, symptomatic treatment plus boosting immunity is mainly carried out.

Despite all this, type 6 herpes virus is not a death sentence. You can live with it once your immune system can get it under control. Surprisingly, a healthy lifestyle can be of great help in this regard. It is imperative to improve your sleep: for those who sleep less than 6 hours a day, the risk of developing CFS is several tens of times higher.

Get tested on time, and treatment will be the least expensive!

Diagnosis of herpes

Since the symptoms are similar to other sexually transmitted infections, urologists conduct an examination only to determine the general condition of the genital organs. The doctor listens to the patient’s complaints and determines, if possible, when and under what circumstances the infection occurred. An examination of the partner is required.

Laboratory blood tests are informative methods:

• PCR (polymerase chain reaction);
• DNA hybridization;
• immunofluorescence reaction;
• identification of specific antibodies to herpes.

Additionally, related problems are identified: inflammatory processes, infections, hormonal imbalances. Urine, contents of vesicles, scrapings and mucus of the urethra, and prostate secretions are subject to examination.

To identify the general condition of the organs of the genitourinary system, doctors prescribe ultrasound, radiography and other instrumental types of examination. They help to detect complications of pathology in a timely manner.

Herpes: symptoms, diagnosis and treatment

Itching, soreness, redness of the skin, blisters... Really again? Those who have encountered it more than once will “recognize” these symptoms as manifestations of herpes. What kind of virus is this? For what reasons does he regularly harass some people?

Our interlocutor, candidate of medical sciences, dermatovenerologist at the Expert Tula Clinic, Vladislav Leonidovich Sheinkman, told us about this and much more.

— What is herpes and how common is it among the inhabitants of our country?

This is a group of diseases caused by herpes viruses. One of the most common types is the herpes simplex virus, which is divided into herpes types 1 and 2, as well as the varicella zoster virus and herpes zoster virus.

Almost all people in Russia are infected with the herpes simplex virus. Once the virus enters the body, it never leaves it. Usually it is in the body in an inactive, “sleeping” state and does not bother a person.

— Is herpes a fungus, a virus or a bacterium?

It's a virus.

— Where does the herpes virus hide in the body?

Herpes simplex viruses are usually found in the so-called nerve ganglia (for example, in the trigeminal ganglion, sacral ganglia).

— How does infection with the herpes virus occur? Who is at risk for herpes infection?

Infection usually occurs in childhood. There are several ways of infection. This is airborne, contact household (dishes, household items, etc.), sexual.

What is immunity and how to increase it? Allergist-immunologist at Clinic Expert Smolensk tells

Chemova Ulyana Vladimirovna

The risk of virus activation occurs in the presence of so-called cofactors. These include weakened immunity, emotional distress, stress, alcohol consumption, climate change (for example, travel), menstruation, prolonged exposure to the sun or hypothermia, the presence of infection (ARVI, pneumonia, sinusitis, etc.).

Is it possible to treat sinusitis without a puncture? Otolaryngologist at the Expert Kursk Clinic, Candidate of Medical Sciences Alexandra Nikolaevna Emelyanova tells

— Tell us about the most common symptoms of herpes

Herpes occurs cyclically in the body, and its symptoms depend on the stage of the process.

The first, so-called prodromal stage, is characterized by burning, itching, and a tingling sensation in the area of ​​future localization of herpes manifestations. The duration of this period can be several hours.

In the second stage, redness and thickening of the skin or mucous membrane appear in the form of a spot (erythematous stage). This stage of herpes lasts about a day.

At the third stage, small bubbles (2-3 mm in size) appear, which can “merge” with the serous or serous-purulent contents. Depending on the severity of the flow, the number of bubbles may vary.

In the fourth stage, the blisters break open and painful ulcers form in their place. This stage of herpes lasts several days and is the most contagious to others.

By the fifth stage, the ulcers dry out and form crusts.

And finally, at the sixth stage, the crusts fall off and the skin or mucous membrane is restored.

With type 1 herpes simplex virus, manifestations occur on the skin and mucous membranes of the upper half (for example, the lip area, nasolabial fold, neck), and type 2 - on the lower half of the body (otherwise it is called “genital herpes,” although Other areas may also be affected - for example, the buttock area, etc.).

In the recurrent form, the localization is usually stable.

— Is herpes on the lips contagious to others?

Absolutely yes.

— Does a herpetic infection always manifest itself with pronounced symptoms, or may a person not suspect that he is a carrier of the infection?

If a herpetic infection is also understood as a pure carrier state, then symptoms may not always be present. If a person has a strong immune system, he may not even know that he has such a virus.

The manifestations of exacerbation also vary from person to person. People with a normal but temporarily slightly weakened immune system, or those receiving some kind of antiviral treatment, may have a different severity of symptoms than a person with a severe illness (for example, tuberculosis), a severely weakened immune system (for example, HIV infection, chemotherapy, for organ transplants, etc.).

What are the symptoms of tuberculosis? Read more

— How is the herpes virus detected in humans?

Diagnosis of herpesvirus infection is primarily based on an examination by a dermatovenerologist.

To confirm the diagnosis, laboratory methods may be prescribed by the doctor. Some of them are used to detect the virus itself, while others are indicators of the immune response to the virus.

To search for the virus itself, polymerase chain reaction (PCR) is used, when material is taken from the site of the lesion and examined for the presence of virus nucleic acids.

An enzyme-linked immunosorbent assay (ELISA) is used to confirm the presence of an immune response against the virus. Imagine this situation. A person does not have any manifestations of herpes, and besides, he does not remember whether he ever had them or not. How to find out whether an organism has “met” the virus or not? If, when performing ELISA, specific antibodies are detected - immunoglobulins of class G (IgG) against the herpes virus, this means that there was once an infectious process, and the virus is currently in an inactive state. These antibodies are usually found throughout a person's life. If there is a suspicion of virus activation, then, in addition to PCR, an analysis for class M immunoglobulins (IgM) may be prescribed according to indications. The detection of this type of antibody indicates an exacerbation of the process. Outside of an exacerbation, only IgG is detected.

— For whom can the herpes virus be dangerous?

First of all, these are persons with serious diseases (for example, tuberculosis, oncological pathologies, immunodeficiencies). In them, the manifestation of herpes can be severe, affecting areas that are not usually found under other conditions (for example, the optic nerve).

— How to get rid of herpes? Is it enough to use only ointment or cauterize the wounds with brilliant green?

This depends on a number of factors - in particular the prevalence of the process, the frequency and severity of relapses. Often local treatment is not enough. There are certain standards and principles for the treatment of herpes, which consist in the use of antiviral drugs and agents to improve/correct the functions of the immune system.

— There are recommendations on the Internet to use tea bags or sage infusion to relieve itching from herpes. Do traditional methods really help in treating herpes infections?

The use of such methods may complicate the doctor’s work, i.e. making the correct diagnosis and prescribing effective treatment.

— What could be the consequences if herpes is not treated?

Mainly - frequent relapses, with the appearance of more common forms during exacerbations, with more severe symptoms.

— What specialty does a doctor treat herpes?

Dermatovenerologist.

You can make an appointment with a dermatovenerologist here

Please note: the service is not available in all cities

— Are effective methods of preventing herpes known to modern medicine?

Undoubtedly. It is necessary to identify and eliminate cofactors that lead to exacerbation of herpes. The main ones are stress, hypothermia or overheating, excessive alcohol intake, exposure to the sun, climate change and a number of others.

For reference:

Sheinkman Vladislav Leonidovich

Graduate of the pediatric faculty of the Smolensk State Medical Institute in 1994.

From 1994 to 1995, he completed an internship, and from 1996 to 1998, a clinical residency in the specialty “Dermatovenereology”.

Has an academic degree of Candidate of Medical Sciences.

Currently working at Clinic Expert Tula LLC as a dermatovenerologist. Provides reception at the address: st. Boldina, 74

Complications

First of all, the herpes virus causes the appearance of small blisters and accompanying symptoms. If proper therapy is not started in time, an inflammatory process develops against the background of pathogenic microflora:

• balanoposthitis - in the tissues of the head and foreskin of the penis;
• urethritis – in the urethra, urethra;
• cystitis - in the bladder;
• prostatitis – in the prostate gland;
• pyelonephritis – in the structural elements of the kidneys.

Each of the diseases poses a threat to the genitourinary system: urination, reproductive function, erectile function. The development of radiculopathy and viral meningitis is possible due to the involvement of nerve nodes in the pathological process.

Experience with Panavir treatment of herpes viral infection in patients with rheumatic diseases

Eliseeva L.N., Samorodskaya N.A., Malkhasyan I.G., Vasinova Yu.V. Kuban State Medical University, Krasnodar

One of the most pressing problems of modern healthcare is the almost universal increase in the prevalence of viral infections. According to statistical studies in Russia and other countries, clinical manifestations of viral lesions are detected in each resident on average 4-6 times a year [1]. The most common and poorly controlled in humans is the herpes viral infection. To date, more than 80 representatives of the family of herpes viruses (Herpesviridae) are known, of which 8 types of DNA-containing viruses with a single morphology that cannot be differentiated by electron microscopy are pathogenic for humans.

When entering the body of a person with a normal immune system, herpes simplex viruses (HSV) can circulate in tissues asymptomatically and are concentrated in the paravertebral sensory ganglia in a latent state in the form of L-PREP particles, but in people with immunosuppression they cause severe recurrent diseases [2] . The herpes virus has polytropic properties and various tissues can be involved in the pathological process with the development of various clinical forms of the disease in the form of lesions:

• skin (herpes of the lips, wings of the nose, face, hands, buttocks);
• mucous membranes (stomatitis, gingivitis, pharyngitis);
• eye (conjunctivitis, keratitis, iridocyclitis, uveitis);
• genitalia (inflammatory, vesicular and ulcerative damage to the penis, testicles, vulva, vagina, cervical canal);
• nervous system (meningitis, encephalitis, neuritis, menigoencephalitis);
• visceritis (pneumonia, hepatitis, esophagitis) [3].

Frequent relapses and insufficient effectiveness of therapy cause severe psychological discomfort in patients, and in some cases are a trigger for the formation of autoimmune diseases and neoplastic progression.

The most pressing issue is the fight against viral infection in rheumatology patients. Almost all rheumatic diseases (RD) are pathogenetically associated with disorders of the immune status, and patients are doomed in most cases to constant use of immunosuppressive drugs (glucocorticosteroids, cytostatics) as mandatory (basic) or symptomatic (prescribed for a short time). Being mainly vital for patients with RD, these groups of drugs, on the one hand, reduce antiviral protection and induce the replicative phase of a viral infection, on the other hand, they can be life-threatening when taken against the background of a viral infection (for example, cases of death have been reported while taking methotrexate in patients with herpes viral infection).

Particular problems arise in patients with rheumatoid arthritis (RA) receiving anti-cytokine drugs (genetically engineered biological agents) - against the background of which herpes infection is activated or clinically manifested for the first time, which prevents adequate therapy for RA. Thus, out of 28 patients observed by us in the registry of patients with rheumatoid arthritis receiving infliximab, 12 people had a new or recurrent herpetic infection, which required in 2 cases to abandon anti-cytokine therapy after the 7th infusion, and in the remaining patients to increase the time between drug administration.

The drugs currently used to combat the virus are conventionally divided into 3 groups based on their chemical composition, mechanism of action, spectrum of activity and duration of clinical effect: 1) etiotropic chemotherapy drugs; 2) interferons and their inducers; 3) immunomodulators. Drugs of the first group mainly have specific antiviral activity; drugs of the second and third groups nonspecifically protect the body’s cells from viral aggression [4].

In recent years, the issue of ambiguous sensitivity of patients to the drugs used has been discussed; development of virus resistance to drugs; the need to use combination therapy, which determines the relevance of the search for effective and safe antiviral drugs.

The new domestic antiviral drug Panavir is attracting special attention. The active substance of Panavir is a plant biologically active polysaccharide from the class of hexose glycosides consisting of glucose (38.5%), galactose (14.5%), rhamnose (9.0%), mannose (2.5%), xylose (1. 5%), uronic acids (3.5%). Currently, dosage forms are registered for clinical use in the form of a 0.004% solution for intravenous infusion, rectal suppositories 200 μg and gel for external and local use.

Panavir has been successfully tested in many medical institutions and research institutes of the Russian Federation. It has been proven that the drug Panavir does not have mutagenic, embryotoxic, teratogenic, pyrogenic and hemolytic properties, has low toxicity, and a large therapeutic range. In medical practice, Panavir is recommended for the treatment of herpesvirus infections (the substance Panavir is registered in the Ministry of Health of the Russian Federation, R No. 00022999/02-2001) [5,6,7].

However, in the group of patients with rheumatic diseases, the effectiveness and safety of their use in relation to the RD itself has not been sufficiently studied. There are a few studies confirming the effectiveness of Panavir in RA [R.M. Balabanova, 2006; HE. Egorova, 2007; N.E. Lopatina, 2009; Y.A.Katz, 2010]. Despite the small group of patients examined, they open a new path to the prevention and treatment of immunocompromised patients, such as patients with rheumatic diseases.

In light of the above, we studied the effectiveness and safety of Panavir in 25 patients with rheumatic diseases with manifestations of herpes viral infection, comparing them with control groups differing in treatment regimen and concomitant diseases.

Materials and methods

The study involved 37 patients, of whom three groups were formed: the main group, the first, the second and the third comparison groups:

The first group consisted of 25 patients with rheumatoid arthritis (RA) and herpes infection (HI), who, against the background of unchanged basic therapy for RA, received Panavir according to the standard regimen;

The second group included: 5 with herpetic infection without RA receiving Panavir;

Third group: 7 patients with RA and HI not receiving Panavir treatment.

The viral infection was represented by the following types: in the first group, 25 patients were examined with clinical signs of herpes infection, which manifested itself in 16 (64%) people - herpes simplex, 6 (24%) people - herpes zoster, 3 (12%) patients - genital herpes against the background of rheumatic diseases.

In the first group, 17 (68%) patients with rheumatoid arthritis (RA), eight of whom were on anticytokine therapy with Remicade (3 after the fifth and 5 after the seventh infusion), were diagnosed with systemic lupus erythematosus (SLE) in 4 (16%) patients. , 3 (12%) patients with systemic scleroderma (SSc), 1 (4%) patient was diagnosed with eosinophilic pneumonia.

The second group for Panavir consisted of 5 patients without rheumatic diseases, in whom herpes labialis developed after hypothermia, as well as prolonged emotional and physical stress.

The third group consisted of 7 patients with RA on the background of basic therapy with methotrexate, with an aggravated herpes viral infection; antiviral therapy was not used in the treatment due to the patients’ refusal of additional treatment.

Panavir was administered intravenously at a dose of 5.0 ml, intravenously, No. 5 per course: the interval between injections for the first three was 48 hours, the next two were 72 hours. The duration of observation was 2 months.

The severity of the febrile syndrome, the volume (area) of the lesion, the severity of the pain syndrome according to VAS (0 – no pain, 100 mm – the most severe pain), and the rate of dynamic change were assessed visually. The general condition of the patient on a 100-point scale (0 - very poor condition, 100 - excellent condition), the presence of side and undesirable effects. Additionally, changes in the nature of the course of rheumatic disease and the need for basic and NSAID therapy were analyzed.

results

The typical clinical picture of a herpes viral infection (in people without severe somatic diseases) is characterized by the appearance of edematous erythema of varying degrees of intensity. Against the background of this erythema, grouped bubbles (vesicles) with a diameter of 1 to 3-4 mm2 with a tense tire and serous transparent contents quickly appear. The number of such vesicles varies significantly - from single elements to several dozen. After a few days, the contents of the bubbles become cloudy, they open and erosions with fine scalloped outlines form.

After 3-5 days, honey-yellow loose crusts form at the site of collapsed blisters and erosions, after which epithelization occurs. In the normal course of herpes, the process lasts 1.5-2 weeks, occasionally extending to a month. Clinical manifestations of relapse are usually less pronounced. Relapses of herpes simplex occur with a frequency of 1-2 times a year to several times a month. Provoking factors are other infectious diseases accompanied by fever, hypothermia, UV irradiation, mental or physical stress, acute dysfunction or cyclical (menstruation) changes in hormonal status [4].

In the second group of patients we examined who did not have rheumatic diseases, typical clinical manifestations of herpetic infection were noted (Table 1). The total average area of ​​the lesion was 1.5 ± 0.6 cm2, body temperature was 37.6 ± 1.3 g, pain at the site of the lesion on the VAS scale reached 6.2 ± 1.3 cm, the general condition was assessed by patients on average as 57.8 ±3.4 points. After prescribing Panavir, improvement was observed on average after 3.8±1.3 days, and patients noted complete recovery on average after 7.1±2.1 days. On the fourth day of observation, body temperature completely normalized, the total area of ​​the lesion decreased by 73.3%, the severity of pain decreased by 53.2%, and overall health improved by 43.9%.

When comparing the effectiveness of treatment in the first group with herpes infection and with rheumatic diseases, an earlier improvement in the condition of patients treated with Panavir was noted. So the improvement is 2 days earlier, and complete recovery is 3.9 days earlier. In the first group of patients with RA + HI, by the fourth day the area affected by herpetic infection decreased by an average of 55.6% (versus 32.4% of patients in group 3 with RA + HI without antiviral therapy). The severity of pain changed similarly (in the observation group it decreased by 51.6% in the first group, versus 19.7% in the third comparison group). The general condition in the first group by the fourth day of observation improved by 36.0% (versus 17.0% in the third comparison group).

Table 1. Panavir in the treatment of herpes infection in rheumatological patients

When Panavir was used by patients in the group with rheumatoid arthritis and herpes simplex virus and in the group of patients with herpes infection without rheumatoid arthritis, no side effects or adverse events were identified in any case. No disturbances were identified during the course of rheumatic diseases. None of the patients with RA required changes in the basic and symptomatic therapy regimen.

Thus, the use of Panavir in patients with rheumatic diseases and concomitant herpetic infection contributes to a more rapid elimination of the clinical symptoms of the underlying disease and viral infection, does not aggravate the course of the rheumatic disease, and does not cause side effects or adverse events. Panavir for systemic administration can be recommended for use in the clinical practice of a rheumatologist.

Literature

1. Panavir. Experience of application in medical practice. Sergienko V.I., Podzolkova N.M., Osadchev V.B., Zhislina I.B. and others. M.2009.39p.

2. Batkaev E.A. Kitsak V.Ya., Korsunskaya I.M., Lipova E.V., Viral diseases of the skin and mucous membranes. Textbook, M., 2001.

3. Kolomiets A.G., Malevich Yu.K., Kolomiets N.D. The many faces of herpes: clinical and pathogenetic polymorphism of herpetic infection. - Minsk, 1988.

4. Chernova N.I. Herpetic infection: clinical picture, diagnosis, treatment. Methodological recommendations No. 38. M.2009. 20s.

5. Balabanova R.M., Egorova O.N., N.E. Lopatina et al. Comparative effectiveness of the drugs Panavir and Acyclovir in the complex therapy of rheumatoid arthritis complicated by herpetic infection // Sovrem. rheumat. – 2009; 2:42–47.

6. Egorova O.N., Balabanova R.M. Antiviral therapy for rheumatic diseases // Farmateka. – 2007; 6:90–94.

7. Sergienko V.I. Antiviral properties of the drug Panavir. – M., 2005.

8. Kats Y.A., The effectiveness of Panavir in some comorbid conditions // Doctor-2010;6: 47-48.

SUMMARY

We examined 25 patients with rheumatic diseases who were prescribed Panavir according to the traditional regimen for herpes infection. The comparison groups were 5 patients with herpes infection without rheumatic diseases treated with Panavir and 7 patients with herpes viral infection against the background of rheumatoid arthritis, in whose treatment antiviral therapy was not used. It has been established that the use of Panavir in patients with herpetic infection against the background of rheumatic diseases contributes to a more rapid elimination of the clinical symptoms of a viral infection, does not change the course of the rheumatic disease, does not cause side effects and undesirable effects and can be recommended for use in the clinical practice of a rheumatologist.

Key words: Panavir, herpes infection, rheumatic diseases.

Information about authors:

1. Eliseeva Lyudmila Nikolaevna, Doctor of Medical Sciences, Professor, Head of the Department of Faculty Therapy, Kuban State Medical University 350020. Krasnodar, st. Gavrilova 23.apt.45
2. Samorodskaya Natalya Anatolyevna Candidate of Medical Sciences, assistant at the Department of Faculty Therapy of KSMU
3. Malkhasyan Irma Gagikovna – graduate student of the department of faculty therapy
4. Yulia Viktorovna Vasinova – graduate student of the Department of Faculty Therapy

Reviews about Panavir, questions, doctor's comments

Treatment of herpes

It is recommended that both sexual partners undergo therapy. Urologists prescribe antiviral drugs during relapse and during remission: there may be one drug, but the dosage is reduced during the lull period.

Ointments, gels and creams that contain an antiviral component, as well as substances that reduce symptoms: painkillers, decongestants, anti-inflammatory, antipruritic, have proven themselves well.

However, in difficult cases, doctors prescribe intravenous or intramuscular administration of antiviral and immune-supporting drugs. And ointments that relieve symptoms are used additionally.

In difficult situations, doctors add plasmapheresis to the treatment program - the elimination of the viral component from the blood plasma. In a centrifuge, the plasma is separated from the total blood composition, purified, and then administered to the patient.