Author of the article - an obstetrician Grigorieva Xenia S.
Herpes - a viral disease that is characterized by specific rashes on the lips and genitals, as well as in other areas of the skin and mucous membranes.
Upon infection, the virus remains in the body forever, it can not be completely cured, but the symptoms can be eliminated and symptoms. Pronounced signs of herpes manifested in a decrease in immunity.
There are 2 types of this virus:
- HSV-1 (herpes simplex virus). It affects the lips of the patient, so it is called the lip.
- HSV-2 (genital). It affects the genitals.
HSV-1 is not dangerous, it is one of the most common infections. And the virus type 2 has a negative impact during the childbearing. It is important to be tested for infection at the stage of planning of pregnancy. If early detection and adequate treatment of the disease is likely to avoid adverse consequences.
Causes
The herpes virus is transmitted from an infected person. Infection may occur from both the patient symptomatic and latent (asymptomatic) stage. The virus may be present in all biological patient secretions (saliva, semen, the contents of rashes and so on.).
The infection can occur in the following ways:
- airborne (by kiss);
- contact-household (tableware, medical instruments, toys, etc...);
- sexual;
- transplacental (from mother to fetus during pregnancy);
- vertical (during labor);
- parenterally (via the blood, such as transplant of infected organs, blood transfusion, ECO).
Genital herpes can be primary and secondary (recurrent symptoms, recurrence).
The disease is normal (lesions in certain areas) and heavy (spread throughout the body).
Symptoms of herpes virus infection
HSV-1 and HSV-2 have similar symptomatology:
- burning and itching at the site of injury;
- the appearance of vesicles (bubbles) with transparent liquid content after the burning and itching. After a few days these rashes are opened and their contents follows, forming ulcers;
- increase in body temperature (38-39 degrees);
- general weakness, malaise.
A significant feature of herpes - a transition to a state of latency (in "hibernation") with subsequent activation of the weakening of the immune system. Once once in the body, the virus lives in it for a lifetime. The latent period of the virus is not dangerous.
In the primary infection period if symptoms 15-16 days on average. And the duration of relapses - 8-10 days.
There is also asymptomatic disease (rarely). This is when there are no signs of the disease, but the isolation of the virus in the environment occurs. That is probably infected another person.
Genital herpes (HSV-2)
When genital infection vesicles may appear on the labia, vagina, anus and cervix.
Secondary herpes is different from the primary fact that the symptoms are less pronounced. Relapse during pregnancy occurs due to lower immunity women.
herpes zoster
It is difficult and dangerous form of the disease during pregnancy. Characterized by unilateral enanthesises (located on one side of the body). With herpes zoster virus is localized in the nerve cells of the patient, which causes pain in the site of the lesion.
Encircling the mold can be of different types:
- motor (affecting the muscles);
- ophthalmic (eye disease);
- Ramsay-Hunt syndrome (lesion of the facial nerve, facial paralysis occurs);
- hemorrhagic (in vials stored content instead of hemorrhagic serous transparent);
- abortifacient (instead of bubbles produced erythema and edema);
- cystic (formed larger rash);
- gangrenous (develop deeper ulcers and leave a scar).
Depending on the type of shingles symptoms may vary. But always similar in that rashes appear on one side (along the nerve trunks). Also there is a general malaise, fever, weakness, pain in the areas of rash.
The vesicles do not appear immediately, their occurrence is preceded by pink spots. After opening the bubbles are formed in their place sores with crusts, which subsequently disappear.
Diagnostics
Diagnostic measures:
- Anamnesis. If earlier the woman suffered herpes, this should be reported to a gynecologist, who is pregnant. This will prevent the development of complications.
- Examination of the skin and mucous membranes, including vaginal examination using a mirror. The doctor will be able to detect the presence of vesicles or ulcers.
- Laboratory tests (PCR, serological method). As the biological material is blood or vesicle contents.
- When pregnancy is determined by the presence of specific serum IgG (avidity index). If the index is less than 30%, it says acute primary form, more than 40% - chronic (secondary).
differential diagnosis
Herpes must be differentiated from:
- primary syphilis (formed mainly erosion unit with clear boundaries);
- dermatitis (skin inflammation, irritation);
- chicken pox.
Treatment of herpes in pregnancy
The goal of treatment is to eliminate the symptoms persist and reduce relapses. When pregnancy is therapeutic measures aimed at child transmission prevention.
In the primary infection and recurrent doctor prescribes Acyclovir. The duration of treatment is 5-7 days. Hospitalization be pregnant with herpes zoster.
For the treatment of newborn Acyclovir is also used, but intravenously.
Delivery in the presence of herpes
Severe symptoms of genital herpes after 36 weeks of pregnancy and during childbirth are an indication for cesarean section.
Possible consequences for mother and child
Primary infection with genital herpes during pregnancy increases the risk of fetal infection.
Possible complications include:
- intrauterine infection of the fetus;
- miscarriage, miscarriage (1 trimester);
- preterm labor, premature birth;
- fetal malformation (encephalitis, hydrocephalus and so forth.).
Herpes of the first type (lip) causes no complications and concerns. But local therapy is still needed.
Neonatal herpes newborn
Infection of the child in primary herpes occurs in about 50 cases out of 100, while the secondary - much less. Neonatal herpes is dangerous for the health of the newborn. Therefore it is necessary to remind once again, how important it is to be surveyed at the stage of planning of pregnancy and undergo timely treatment when the first symptoms of the disease.
Features newborn herpes:
- infection in the womb occurs less frequently, mainly at the time of delivery, passing through the birth mother's ways;
- development of primary herpes in the mother, especially closer to delivery, increases the risk of disease in the child;
- Symptoms of neonatal herpes may occur immediately after birth, and sometimes after 5 weeks from the date of birth.
Forms of neonatal herpes:
- generalized. Affected skin (sometimes mucous membranes) of the child, as well as the liver, nervous system and other organs;
- damage to the central nervous system (CNS). Rashes on the skin are absent;
- encephalitis or hydrocephalus (Brain damage);
- lesion oral and conjunctival without involvement of internal organs and the CNS.
Child transmission can also occur after birth, through contact with an infected mother.
The disease often starts suddenly and without obvious symptoms of herpes. The newborn does not eat, there is increased tearfulness and irritability. After that the body temperature rises and appear respiratory disorders. The skin can be marked jaundice and hemorrhagic diathesis (petechiae). Eruptions in most infants do not appear.
Important! It is important to recognize the newborn herpes, because if left untreated it can cause irreversible consequences. Contact your pediatrician immediately necessary for any deviation from the norm and change the child's behavior and be sure to report the presence of herpes in the mother.
prevention
Preventive actions:
- Analysis on the herpes virus at the stage of planning of pregnancy;
- strengthening the immune system;
- caesarean section is the primary measure to prevent infection of the newborn.
If the time to notice the symptoms of herpes, and immediately inform your doctor, it is possible to avoid dangerous consequences. As obstetrician-gynecologist should advise us early adjourned herpes.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
