Herpes simplex (herpes infection) - Symptoms

There is no generally accepted clinical classification of simple herpes (herpetic infection). A distinction is made between congenital and acquired herpetic infection, the latter is subdivided into primary and recurrent. Depending on the localization of the pathological process, herpetic lesions of the mucous membranes, skin, eyes, nervous system, internal organs, genitals, and generalized herpes are distinguished.

The course and symptoms of herpes simplex (herpes infection) depend on the localization of the process, the age of the patient, the immune status and the antigenic variant of the virus. Primary infection is often accompanied by systemic symptoms. Both mucous membranes and other tissues are affected. In primary infection, the duration of clinical manifestations and the period of virus excretion are longer than in relapses. Viruses of both subtypes can cause lesions of the genital tract, oral mucosa, skin, and nervous system. Symptoms of herpes simplex (herpes infection) caused by HSV-1 or HSV-2 are indistinguishable. Reactivation of genital tract infection caused by HSV-2 occurs twice as often, and relapses are 8-10 times more often than with genital tract lesions by HSV-1. Conversely, relapses of oral and skin lesions with HSV-1 infection occur more often than with HSV-2 infection.

Congenital herpes infection is observed when pregnant women have active clinical manifestations of the disease, accompanied by viremia. Depending on the timing of infection, various fetal malformations (microcephaly, microphthalmia, chorioretinitis, intrauterine death) or death of the newborn with clinical manifestations of generalized herpes infection are possible.

Acquired herpes infection is possible in newborns when infected during passage through the birth canal, and then at various periods of life, most often in childhood. The earlier the infection occurs, the more severe the disease, but asymptomatic infection is also possible (antibodies to HSV-1 are detected in the blood serum of 60% of children under 6 years of age).

The incubation period for primary herpes infection is 5-10 days (varies from 1 to 30 days).

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Herpetic infection of the mucous membranes and skin

Viral pharyngitis and stomatitis are observed more often in children and young people. The disease is accompanied by fever, chills, malaise, irritability, myalgia, difficulty in eating, hypersalization. Submandibular and cervical lymph nodes enlarge and become painful. Grouped vesicles appear on the mucous membrane of the cheeks, gums, inner surface of the lips, less often on the tongue, soft and hard palate, palatine arches and tonsils, after opening which painful erosions are formed. The duration of the disease is from several days to two weeks.

Herpetic pharyngeal lesions usually result in exudative or ulcerative changes in the posterior wall and/or tonsils. In 30% of cases, the tongue, mucous membrane of the cheeks and gums may be affected simultaneously. The duration of fever and cervical lymphadenopathy ranges from 2 to 7 days. In people with immune deficiency, the virus can spread deep into the mucous membrane and into the underlying tissues, causing them to loosen, necrosis, bleeding, and ulceration, which is accompanied by severe pain, especially when chewing.

With herpetic lesions of the skin, there is a local burning sensation, itching of the skin, then swelling and hyperemia appear, against the background of which round grouped vesicles with transparent contents are formed, which then become cloudy. The vesicles can open with the formation of erosions covered with a crust, or dry up, also covered with a crust, after the crust falls off, an epithelialized surface is found. The duration of the disease is 7-14 days. Favorite localization is the lips, nose, cheeks. Disseminated forms with localization of rashes on distant areas of the skin are possible.

Acute respiratory diseases

The herpes simplex virus can cause diseases resembling acute respiratory viral infections, the so-called herpetic fever, which is characterized by an acute onset, pronounced temperature reaction, chills and other symptoms of intoxication. Catarrhal phenomena in the nasopharynx are weakly expressed. Coughing is possible due to dry mucous membranes, moderate hyperemia of the arches and soft palate. Such symptoms persist for several days. Typical symptoms of simple herpes (herpetic infection), namely, rashes are not always observed in the first days of the disease, but can join on the 3-5th day from the onset of the febrile period or be absent.

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Herpetic eye infection

Herpetic eye lesions may be primary or recurrent. They most often develop in men under 40 years of age. This is one of the most common causes of corneal blindness. Clinically, superficial and deep lesions are distinguished. Superficial lesions include herpetic keratoconjunctivitis, dendritic keratitis, and herpetic marginal corneal ulcer; deep lesions include discoid keratitis, deep keratoiritis, parenchymatous uveitis, and parenchymatous keratitis.

Herpetic infection of the nervous system

In the etiological structure of viral encephalitis (meningoencephalitis), about 20% is due to herpes infection. Mostly people aged 5-30 and over 50 are affected. The incidence is 2-3 per 1,000,000 (US data), the incidence is uniform throughout the year. Herpetic meningoencephalitis is caused by HSV-1 in 95% of cases.

The pathogenesis of herpes encephalitis varies. In children and young people, primary infection may manifest as encephalomyelitis. It is assumed that the exogenously introduced virus penetrates the CNS, spreading from the periphery through the olfactory bulb. In most adults, clinical signs of generalized infection first appear, in some cases, damage to the mucous membranes and skin, and then damage to the CNS, i.e. the virus can penetrate the CNS hematogenously.

The onset of the disease is always acute, with a rise in body temperature to high values. Patients complain of malaise, persistent headache. A third of patients may have a moderate respiratory catarrhal syndrome in the first days of the disease. Herpetic exanthema and stomatitis are rare. After 2-3 days, the condition of patients sharply and progressively worsens due to the development of neurological symptoms. Consciousness is depressed, meningeal syndrome develops, generalized or focal tonic-clonic seizures appear, repeated many times during the day. General cerebral symptoms of simple herpes (herpes infection) are combined with focal manifestations (impaired cortical functions, damage to the cranial nerves, hemiparesis, paralysis). The further course of the disease is unfavorable, coma develops after a few days. Throughout the disease, body temperature remains high, the fever is irregular. In the absence of antiviral therapy, mortality reaches 50-80%.

A characteristic feature of herpes encephalitis is damage to the temporal lobe on one or both sides, which is manifested by personality changes with a decrease in intellectual functions and mental disorders.

Cerebrospinal fluid examination reveals lymphocytic or mixed pleocytosis, increased protein levels, xanthochromia, and the appearance of red blood cell admixture. Changes in EEG are possible. MRI of the brain reveals lesions with a predominance of changes in the anterior temporal lobes with predominant involvement of the cortex. MRI in herpes encephalitis has a significant advantage over CT, as it allows visualization of brain damage already in the first week of the disease.

Atypical manifestations of herpes encephalitis with damage to the brainstem and subcortical structures, abortive course of the disease, chronic and recurrent course of herpes encephalitis as a slow infection of the central nervous system are possible.

Another form of CNS damage of herpetic nature is serous meningitis. Serous meningitis is most often caused by HSV-2. The disease usually develops in people suffering from genital herpes. The share of herpes simplex virus infection among viral meningitis does not exceed 3%.

Clinically, meningitis is characterized by an acute onset, headache, fever, photophobia, and meningeal symptoms. When examining the cerebrospinal fluid, pleocytosis of 10 to 1000 cells per µl (300-400 on average) of lymphocytic or mixed nature is observed. Clinical symptoms persist for about a week, then disappear on their own without neurological complications. Relapses are possible.

Another common form of nervous system damage by the herpes simplex virus-2 is radiculomyelopathy syndrome. Clinically, it manifests itself as numbness, paresthesia, pain in the buttocks, perineum or lower extremities, pelvic disorders. Pleocytosis, increased protein concentration and decreased glucose content in the cerebrospinal fluid may occur. There is evidence of the isolation of HSV-1 from the cerebrospinal fluid of patients with cervical and lumbar radiculitis. The assumption of the connection between HSV-1 and damage to the facial nerves (Bell's palsy) has been confirmed.

Herpetic infection of internal organs

Herpetic lesions of internal organs are the result of viremia. Several organs are involved in the process; isolated lesions of the liver, lungs, and esophagus develop less frequently. Herpetic esophagitis may result from direct spread of infection from the oropharynx to the esophagus or occur as a result of virus reactivation. In this case, the virus reaches the mucous membrane via the vagus nerve. The dominant symptoms of esophagitis are dysphagia, chest pain, and weight loss. Esophagoscopy reveals multiple oval ulcers on an erythematous base. The distal section is most often affected, but as the process spreads, diffuse loosening of the mucous membrane of the entire esophagus occurs.

In individuals who have undergone bone marrow transplantation, interstitial pneumonia may develop in 6-8% of cases, as proven by biopsy and autopsy results. Mortality from herpetic pneumonia in patients with an immunosuppressive state is high (80%).

Herpetic hepatitis often develops in people with immunodeficiency, with an increase in body temperature, jaundice, and an increase in the concentration of bilirubin and aminotransferase activity in the blood serum. Sometimes the signs of hepatitis are combined with manifestations of thrombohemorrhagic syndrome.

Genital herpes infection

Genital herpes is most often caused by HSV-2. It can be primary or recurrent. Typical rashes are localized in men on the skin and mucous membrane of the penis, in women - in the urethra, on the clitoris, in the vagina.

Rashes on the skin of the perineum and inner thighs are possible.

Vesicles, erosions, ulcers are formed. Hyperemia, swelling of soft tissues, local pain, dysuria are noted. Pain in the lower back, in the sacrum, lower abdomen, in the perineum may be disturbing. In some patients, especially with primary herpes infection, inguinal or femoral lymphadenitis is observed. There is a connection between the frequency of genital herpes and cervical cancer in women, prostate cancer in men. In women, relapses occur before the onset of menstruation.

Generalized herpes infection

Generalized herpes infection develops in newborns and in individuals with severe immune deficiency (in hematological diseases, long-term use of glucocorticoids, cytostatics, immunosuppressants, HIV infection). The disease begins acutely, is severe with damage to many organs and systems. Characterized by high fever, widespread lesions of the skin and mucous membranes, dyspeptic syndrome, damage to the central nervous system, hepatitis, pneumonia. Without the use of modern antiviral drugs, the disease in most cases ends fatally.

Generalized forms of the disease include Kaposi's sarcoma herpetiformis, which is observed in children suffering from exudative diathesis, neurodermatitis or eczema. It is characterized by severe intoxication, abundant rashes on the skin, especially in areas of previous damage. The rash spreads to the mucous membranes. The contents of the vesicles quickly become cloudy, they often merge with each other. A fatal outcome is possible.

Herpes infection in HIV-infected individuals

Herpes infection in HIV-infected patients usually develops as a result of activation of a latent infection, and the disease quickly becomes generalized. Signs of generalization are the spread of the virus from the oral mucosa to the esophageal mucosa, and the appearance of chorioretinitis. Skin lesions in HIV-infected patients are more extensive and deep, with the formation of not only erosions, but also ulcers. Reparative processes are extremely sluggish, and ulcers and erosions typically do not heal for a long time. The number of relapses increases significantly.

Complications of herpes simplex (herpes infection)

Simple herpes (herpes infection) is usually complicated by the addition of secondary microflora.

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