What are the symptoms of herpes simplex (herpetic infection)?
Symptoms of herpes simplex (herpetic infection) and the course of the disease depend on the localization of the process, the age of the patient, the immune status and the antigenic variant of the virus.
The most common are skin and mucous membranes. Lesions of the eyes (herpetic keratitis), CNS infections, herpes of newborns are rare, but they have a very serious clinic. HSV in the absence of skin manifestations rarely causes fulminant hepatitis. Especially strong herpes infection occurs in patients with HIV infection. There may be progressive and persistent esophagitis, colitis, perianal ulcers, pneumonia, encephalitis, meningitis. The onset of HSV can occur with erythema multiforme, possibly as a result of an immune response to the virus. Herpetic eczema is a complication of HSV infection in patients with eczema when affected with herpes eczematous areas.
Lesions of the skin and mucous membranes. Rashes may appear anywhere on the skin and mucous membranes, but most often around the mouth, on the lips, conjunctiva and the cornea, on the genitals. After a short prodromal period (typically less than 6 hours with relapse of HSV-1), when tingling and itching are felt, small strained vesicles appear on the erythematous base. Single clusters of bubbles vary from 0.5 to 1.5 cm in diameter, sometimes their groups merge. Dermal lesions, firmly fused with the underlying tissues (for example, on the nose, ears, fingers), are painful. After a few days the vesicles begin to dry out to form a thin yellowish crust. Healing occurs in 8-12 days from the onset of the disease. Individual herpetic lesions usually heal completely, but as a result of recurrence of rashes on the same sites, atrophy and scarring are possible. Sometimes a secondary bacterial infection may join. In patients with decreased cellular immunity due to HIV infection or other causes, skin lesions may persist for weeks or more. Localized infection can disseminate frequently and dramatically in immunocompromised patients.
Acute herpetic gingivostomatitis often develops as a result of primary infection of HSV-1 and is typical for children. Incidentally, with oral-genital contact, the disease can cause HSV-2. Bubbles inside the mouth and on the gums are opened for several hours or days, forming ulcers. Often there is fever and pain. Difficulties in eating and drinking can lead to dehydration. After resolution, the virus remains asleep in the semilunar ganglia.
Herpes labialis is usually a recurrence of the herpes simplex virus. It develops like ulcers on the red border of the lips or less often as ulceration of the mucosa on the hard palate.
Herpetic panaritium - swelling, tenderness, erythematous lesion of the distal phalanx as a result of the penetration of the herpes simplex virus through the skin and is most common in medical workers.
Genital herpes is the most common ulcer disease in developed countries transmitted through sexual contacts. Usually called HSV-2, although 10-30% of HSV-1. Primary lesion develops 4-7 days after contact. Vesicles usually open with the formation of ulcers, which can merge. In men, the bridle, head and body of the penis are affected, in women - the labia, clitoris, vagina, cervix, pyreneum. They can be localized around the anus and in the rectum during anal sex. Genital herpes can cause urinary disorders, dysuria, urinary retention, constipation. Severe sacral neuralgia may occur. After recovery, scars can form, relapse occurs in 80% of HSV-2 and 50% of HSV-1. Primary genital lesions are usually more painful (compared to relapse), prolonged and prevalent. It is usually bilateral, involves regional lymph nodes with the development of common symptoms. Relapses can have pronounced prodromal symptoms and may involve the buttocks, groin and thigh.
Herpetic keratitis. HSV infection of the corneal epithelium causes pain, lacrimation, photophobia, corneal ulcers, which often have a branching pattern (dendritic keratitis).
Herpes newborns. Infection develops in newborns, including those of them whose mothers did not know about the previous herpetic infection. Infection often occurs in childbirth, a type 2 virus. The disease usually develops at the 1-4 th week of life, resulting in the appearance of mucosal vesicles on the skin or involvement of the CNS. Disease is a serious cause of morbidity and mortality.
Herpes infection of the central nervous system. Sporadically there is a herpetic encephalitis and can be severe. Characteristic of multiple convulsive seizures. Asp infection of HSV-2 can occur aseptic meningitis. They usually self-resolve, with the development of lumbosacral radiculitis, which can lead to a delay in urine and severe constipation.