Genital herpes, chronic sexually transmitted infection
Genital herpes is a chronic sexually transmitted infection, caused by herpes simple herpes virus (VHS), this can be known two types: type 1 HSV-1 and type 2 HSV-2, both types can spread through genital contact-Genital or oral-genital;This disease can occur symptomatic and asymptomatic in the host and is currently the main responsible for genital ulcers.
Regardless of the viral type, HSV mainly affects the skin and mucous membranes. Primary herpetic gingivoestomatitis (PHGS) is the most common orofacial manifestation of HSV1 infection and is characterized by oral and / or perioral vesicululcerative lesions . It usually develops after the first time exposure of seronegative individuals or those who have not produced an adequate antibody response during a previous infection with either HSV.
Primary herpetic gingivoestomatitis
Labial herpes is another of the very common clinical manifestations, it is characterized by recurrent vesicular eruptions mainly on the lips and perioral skin. The condition is contagious, it can cause significant discomfort / pain and can have an adverse effect on the quality of life.
Herpes labialis
Most primary genital infections are asymptomatic, male patients with genital herpes may complain of quite intense pain, dysuria or urethral secretion. The first genital herpes clinical episode is generally presented as acute red papules, vesicles or erosions in the glans, foreskin or penis axis. A sensation of burning or stinging can precede the appearance of papulo-vesicles or erosions.
Genital herpes
In addition to the primary and recurring genital and orolabial herpes, there is a growing variety of rare and atypical manifestations attributed to the VHS-1 and VHS-2.
The herpetic eczema is a dissemination of oral or perioral VHS infection can complicate a cutaneous burn, pre -existing atopic dermatitis or cosmetic procedures in the region of the head and neck, which gives rise to a serious and progressive condition. It has an acute start of nodules and vesicululorerative plates extensive, antistnetics, clinically similar to the Impetigo. Monomorphic vesicles and pustules bind in large superficial erosions that are susceptible to overy by skin bacteria . Herptic lesions spread directly to an irritated or sick skin region, without going through nerve endings and ganglion.
Herpetic ecchema
The herpetic panadell refers to the cutaneous herpetic infection of the distal phalanx pulp of the hand that often affects health workers, children with primary oral herpes and adults with genital infection by VHS. Results from the direct inoculation of the finger involved through the skin worn by VHS1 or VHS2.
Primary herpetic panador on the middle finger
HSV’s ocular inoculation can lead to unilateral or bilateral keratoconjunctivitis, recurrent ocular ulcerations and visual disability that require immediate antiviral therapy.
Ocular inoculation by VHS
Neonatal herpes is a devastating and often fatal consequence of HSV’s vertical transmission to newborns. Neonatal infections may arise from the baby’s direct exposure to infected maternal lesions or secretion. Neonatal HSV can be manifested in several ways:
- to skin, eye, mouth disease (sem);
- Central Nervous System (CNS),
- disseminated disease. Most neonatal HSV infections occur within the first 6 weeks of life;However, almost all children develop manifestations of the disease in the first month.
In immunocompromised patients recurring VHS infection is an important cause of morbidity and mortality, who experiences frequent, persistent and serious recurrences of HSV1 and HSV2. Mucocutaneous recurrences are often prolonged, more symptomatic, little receptive to therapy, associated with a longer detachment, involving multiple sites and at risk of virmic dissemination.
In immunocompromised patients, annogenital infections due to evident VHS as atypical lesions, particularly as painful warty nodules and persistent ulcers. HSV types 1 and 2 can cause wart. Papules and confluent warty nodules may appear in the penis, the scrotum, the vulva, the intergluteal cleft and other leather and mucous sites.
Herpes Anagenital
According to recent studies, an indirect bond between pyogen granuloma and chronic HSV-1 infection in an immunocompromised patient has been described. In chronic infections, keratinocytes do not experience a rapid cytopathic effect, but suffer from low-productivity HSV-1 infection, probably without altering the main cytokine synthesis capabilities. A greater expression of the epidermal growth factor (EGF) and the vascular endothelial growth factor (VEGF) in the keratinocytes infected with HSV-I, which are necessary for the formation of piogen granuloma were evidenced. The rapid regression of piogen granuloma after several months of existence after antiviral treatment with Valacyclovir constitutes another support argument for this link.
Piogen granuloma by VHS 1
VHS -related folliculitis is another little recognized entity, with a clinical spectrum that goes from asymptomatic follicular lesions, more or less pustulous, to severe herpetic sycosis of the beard area. According to the depth of follicular infection, the clinical picture varies from erythematous folliculitis in the case of deep infundibular lesions to vesicular and pustular folliculitis when the infection is relatively superficial.
The HSV-I and HSV-II wart. The genital area is affected more frequently. The lesions tend to be warty, sometimes erosive in the center, simple or multiple, and isolated or merging into large plates. The injuries vary from small conileged masses to giants.
Chronic genital warty herpes of the perineal area
Another manifestations recently recognized by recurring VHS-1 infection is the pathogenesis of Boca Boca Syndrome (BMS). The infection of the periareolar area is another rare manifestation of VHS-1 and VHS-2. Injuries are usually particularly painful. They can be uni or bilateral, but they do not tend to reappear. The transmission of these injuries is by sexual contact (symptomatic or asymptomatic) or occurs during breastfeeding.
HSV zosteriform infections are found more frequently in facial and anogenite areas.
The ‘Cuño Cutting Sign’ is a particular manifestation of HSV-I or HSV-II infection found in the immunocompromised host. It is characterized by one or more, more or less linear elongations of ulcerative and erosive erosion located in large folds, such as inguinal, axillary, vulvar or abdominal folds, under the breasts or behind the ear.
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