What are the early symptoms of genital herpes? What are the symptoms of genital herpes?

Genital herpes is common in male friends aged 15 to 45 years old, and the affected parts of the male genitals are the foreskin, glans, coronal sulcus and penis. It is also easily transmitted to women during sexual intercourse, and can cause great harm to patients after the onset of the disease. So what are the early symptoms of genital herpes?

1. Initial infection

80% to 90% of initial infections are latent infections, and only a few (about 1% to 10%) are overt infections, whose symptoms and signs are much more severe than those of recurrent infections. The initial infections caused by type I and type II are equally serious and can be divided into primary infection and non-primary infection.

1. Primary infection: The incubation period of primary genital herpes is 2 to 7 days. Usually it takes 3 to 5 days, and the affected area first has a burning sensation. The primary lesion is one or several small, itchy red papules, which quickly turn into small blisters. After 3 to 5 days, the blisters turn into erosions or ulcers, form scabs, and become painful. Systemic symptoms may occur during and before the onset of the disease, including fever, general malaise, neck stiffness, headache, and paresthesias in the sacral 2-4 segments. The lesions may be solitary or fused and in men they may be located on the glans penis, coronal sulcus and scrotum, urethral orifice or penis body. In women, the infection occurs in the genitals, perianal area, thighs or buttocks, and about 90% of cases also invade the cervix. Some primary herpes only affects the cervix and is easily overlooked. Vaginal HSV lesions are uncommon. HSV can be isolated not only from the urethra of male patients, but also cultured from prostatic fluid or seminal vesicle fluid. Direct anal injury may cause no symptoms or may cause itching, pus discharge, and a feeling of tenesmus. Generally, all primary genital herpes may be accompanied by swollen and tender lymph nodes, which slowly subside after 1 to 2 months.

Neurologic complications are also common in patients with primary genital herpes. In primary genital herpes, 13% to 36% of patients have mild meningitis and cerebrospinal fluid leukocytosis; 1% of patients have severe sacral nerve or autonomic nervous system damage, manifested as urinary retention, constipation, fatigue, erectile dysfunction, and sensory abnormalities. HSV encephalitis is caused by HSV type 1 and has a mortality rate of 70%. Among gay men, HSV is second only to gonorrhea in the likelihood of causing proctitis.

2. Non-primary infection: refers to oral infection before the onset of the disease and anti-HSV antibodies in the serum. Symptoms are milder than the primary infection and healing is faster.

(II) Recurrent infection

Recurrent genital herpes occurs within 1 to 4 months after the initial onset. Nearly 60% of patients will relapse within one year after the first herpes simplex virus infection, and the disease may relapse 4 to 6 times or more, with the number of relapses decreasing thereafter. Whether in men or women, the symptoms of recurrent genital herpes are often milder than those of the initial outbreak. Each outbreak is shorter in duration, the skin lesions disappear quickly, and are not accompanied by lymphadenopathy, and there are rarely systemic symptoms. Among recurrent cases, 99% are caused by HSV type II. Initial infection is usually bilateral, while recurrent infection is usually unilateral. HSV can be isolated from the urethra in less than 2% of patients with recurrent infection. Primary genital herpes causes extragenital lesions in 1% of men and 26% of women, usually due to autoinoculation.

Recurrent infection has a great impact on patients' psychology, because there is currently no effective way to prevent recurrence, and recurrent infection can lead to genital malignancy. Therefore, patients often have psychological disorders such as depression and fear, which in turn can lead to recurrence of HSV.

HSV-2 infection in male homosexuals is second only to male anorectal inflammation caused by gonococci. The clinical manifestations are severe anorectal pain. Other symptoms include constipation, anal discharge, tenesmus and fever. Some patients have blisters or ulcers around the anus. The risk of female patients developing cervical cancer is 5 to 10 times greater than that of ordinary women.

(III) HSV infection in pregnant women

Infection with type 2 HSV during the first three months of pregnancy often causes viremia, which can lead to miscarriage, fetal malformation or stillbirth. During the delivery process of pregnant women with primary herpes, when the fetus passes through the cervix, vagina and vulva infected with HSV, 40% to 60% of newborns may be infected with HSV. The chance of pregnant women with recurrent herpes transmitting the virus to the fetus is less than 8%.

(IV) Neonatal HSV infection

The fetus can be infected with HSV through the birth canal during delivery, and the disease usually occurs 4 to 6 days after birth. Mild cases manifest as oral, skin and eye herpes. Severe cases may develop hematogenous dissemination of the central nervous system and internal organs throughout the body, manifested by feeding difficulties, high fever, hepatosplenomegaly, jaundice, bleeding and central nervous system symptoms. The mortality rate can be as high as 60%. Survivors often suffer from sequelae.

5. HSV and HIV infection

HSV can co-infect with HIV-I and can promote the progression of the disease, causing severe local and disseminated infections. HSV is currently believed to be a regulatory factor that can activate HIV replication. Some researchers performed skin biopsies on the lesions of patients with AIDS and genital HSV infection and found that both keratinocytes and macrophages contained HIV-I and HSV-I. After hybridization, HIV-I retained its infectivity and was able to enter the cell without binding to the CD4 molecule. In addition, HSV-I can stimulate latent HIV-I, thereby increasing HIV-I/HSV-I co-infection and replication in tissues.