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"code": "A60",
"name": "Аногенитальная герпетическая вирусная инфекция [herpes simplex]",
"icd_name": "Аногенитальная герпетическая вирусная инфекция [herpes simplex]",
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"cause": [
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"slug": "a60_anogenitalnaya_gerpeticheskaya_virusnaya_infekciya_herpes_simplex",
"lead": "Нарушение здоровья, относящееся к группе инфекции, передающиеся преимущественно половым путем",
"description": "Аногенитальная герпетическая инфекция представляет собой хроническое рецидивирующее вирусное заболевание, передаваемое преимущественно половым путем, характеризующееся поражением кожи и слизистых оболочек половых органов и мочеполового тракта.",
"etiology": "<p>Возбудитель генитального герпеса является разновидностью вируса простого герпеса (ВПГ 2 типа). Генитальный герпес имеет половой путь передачи, при различных формах половых контактов легко проникает через поврежденную кожу и эпителий слизистой оболочки от больного генитальным герпесом. </p>\r\n<p>Также передача ВПГ возможна:</p>\r\n<ul>\r\n<li>воздушно – капельным путем;</li>\r\n<li>вертикальным путем от больной матери плоду (во время родов при контакте с родовыми путями матери, трансплацентарно, восходящим путем с наружных половых органов матери через цервикальный канал в полость матки);</li>\r\n<li>при самозаражении - аутоинокуляции (больной человек сам переносит инфекцию с зараженных участков тела на незараженные – с лица на половые органы);</li>\r\n<li>бытовым путем - редко (через влажные предметы гигиены).</li>\r\n</ul>\r\n<p>Факторами, способствующими проявлению и/или рецидивированию генитального герпеса, являются: снижение иммунологической реактивности, переохлаждение и перегрев организма, интеркуррентные заболевания, медицинские манипуляции, в том числе аборты и введение внутриматочной спирали, а также некоторые психические и физиологические состояния.</p>",
"pathogenesis": "<p>ВПГ передается при тесном контакте с больным или вирусоносителем. Вирус проникает через слизистые оболочки половых органов, уретры, прямой кишки или микротрещины кожи.</p>\r\n<p>После проникновения в организм через слизистую или кожные покровы, вирус сразу же взаимодействует с сенсорными нервными окончаниями, используя особые рецепторы. После попадания в нервный аксон, вирус оказывается в нервных ганглиях, в которых он может оставаться в пассивном состоянии, зачастую, навсегда.</p>",
"diagnostics": "<p>Диагностика типичных случаев генитального герпеса, как правило, не затруднена и основана на клинических проявлениях.</p>\r\n<p>Лабораторные методы диагностики генитального герпеса включают:</p>\r\n<p> </p>\r\n<ul>\r\n<li>Методы обнаружения ВПГ в материале пораженных органов (соскобахиз влагалища и шейки матки, мазке из уретры, гистологическом материале маточных труб и т. д.). С этой целью применяется метод выращивания ВПГ на культуре тканей и последующего изучения его свойств, используется метод распознавания вируса под электронным микроскопом;</li>\r\n<li>Методы обнаружения антител к ВПГ в сыворотке крови (иммуноглобулины М и G). Позволяют выявить генитальный герпес даже при бессимптомном течении и определить антитела к ВПГ 1 или 2 типа. К ним относится ИФА- метод иммуноферментного анализа.</li>\r\n</ul>\r\n<p>Обнаружение генетического материала вируса методом ПЦР.</p>",
"treatment": "<p>Существуют три основных подхода в лечении генитального герпеса: противовирусная химиотерапия, иммунотерапия и комбинация этих методов.</p>\r\n<p>Этиопатогенетическая противовирусная терапия с использованием аналогов нуклеозидов (препараты ацикловира) основана на способности последних угнетать ВПГ на стадиях синтеза вирусной ДНК и сборки вирусных частиц, торможении их размножения. Именно поэтому всем больным с диагнозом генитальный герпес следует назначать эпизодическую или превентивную (супрессивную) терапию.</p>\r\n<p>Эпизодическую терапию используют в момент обострения у пациентов с редкими симптоматическими высыпаниями, во время которого необходимо начать приём препарата.</p>\r\n<p>Превентивная (супрессивная) терапия направлена на подавление возможной реактивации латентного ВПГ. Её назначают в следующих случаях:</p>\r\n<ul>\r\n<li>пациентам с тяжёлыми и частыми рецидивами генитального герпеса (более 6 обострений в год);</li>\r\n<li>с целью профилактики передачи ВПГ в парах, где один из партнёров не инфицирован генитального герпеса (не имеет АТ к нему в крови);</li>\r\n<li>при наличии выраженных психосексуальных реакций на рецидивы герпеса;</li>\r\n<li>при значительном влиянии инфекции на качество жизни пациента.</li>\r\n</ul>\r\n<p>Противовирусные препараты при супрессивной терапии назначают ежедневно, в непрерывном режиме, длительное время.</p>\r\n<p>Возможно использование супрессивной терапии короткими курсами для предотвращения развития клинических симптомов на определённый период (экзамены, отпуск и т.п.). Супрессивная терапия приводит к снижению частоты рецидивов, уменьшению асимптоматического выделения вируса, снижая риск его передачи.</p>\r\n<p>У больных с генитального герпеса в стадии ремиссии возможна стимуляция неспецифической резистентности иммуномодуляторами под контролем иммунограммы. </p>",
"prevention": "<p>Способом профилактики первичного заражения генитальным герпесом служит использование презервативов при случайных половых контактах. Однако, даже в этом случае вероятность инфицирования ВПГ через микротрещины и повреждения на слизистых оболочках и коже, не прикрываемых презервативом, остается высокой. Возможно применение антисептических средств (мирамистин и др.) для обработки участков, на которые может произойти попадание вируса.</p>\r\n<p>Рецидивирующее течение генитального герпеса отмечается при снижении защитных реакций организма: болезнях, перегревании, переохлаждении, приходе менструации, беременности, приеме гормональных препаратов, стрессах. Поэтому для предотвращения рецидивов генитального герпеса имеет значение здоровый образ жизни, полноценное питание и отдых, прием витаминных препаратов. Мерами профилактики генитального герпеса служат также соблюдение интимной гигиены и гигиены половой жизни, своевременное выявление и лечение венерических болезней.</p>\r\n<p>Для профилактики самозаражения, когда вирус генитального герпеса переносится грязными руками с губ на половые органы, необходимо выполнение элементарных гигиенических требований: тщательное и частое мытье рук (особенно при наличии лихорадки на губах), использование отдельных полотенец для рук, лица и тела, а также для каждого члена семьи.</p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период может составлять до недели после полового контакта с вирусоносителем. Характерным признаком является появление герпетических пузырьков в месте, где было соприкосновение с половым партнером - в области наружных и внутренних половых органов, половых губ. Пузырьки вскрываются и на их месте образуются болезненные язвочки, которые покрываются корками. Затем корки сходят. В течение десяти дней могут появляться новое высыпание. Более чем в половине случаев герпес протекает без клинических симптомов, но вирусоносители также могут инфицировать своих половых партнеров. Наибольшую опасность бессимптомные вирусоносители представляют для новорожденных, поскольку у них герпес может вызывать тяжелые неврологические изменения и слепоту.</p>",
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"description": "Аногенитальная герпетическая инфекция представляет собой хроническое рецидивирующее вирусное заболевание, передаваемое преимущественно половым путем, характеризующееся поражением кожи и слизистых оболочек половых органов и мочеполового тракта.",
"etiology": "<p>Возбудитель генитального герпеса является разновидностью вируса простого герпеса (ВПГ 2 типа). Генитальный герпес имеет половой путь передачи, при различных формах половых контактов легко проникает через поврежденную кожу и эпителий слизистой оболочки от больного генитальным герпесом. </p>\r\n<p>Также передача ВПГ возможна:</p>\r\n<ul>\r\n<li>воздушно – капельным путем;</li>\r\n<li>вертикальным путем от больной матери плоду (во время родов при контакте с родовыми путями матери, трансплацентарно, восходящим путем с наружных половых органов матери через цервикальный канал в полость матки);</li>\r\n<li>при самозаражении - аутоинокуляции (больной человек сам переносит инфекцию с зараженных участков тела на незараженные – с лица на половые органы);</li>\r\n<li>бытовым путем - редко (через влажные предметы гигиены).</li>\r\n</ul>\r\n<p>Факторами, способствующими проявлению и/или рецидивированию генитального герпеса, являются: снижение иммунологической реактивности, переохлаждение и перегрев организма, интеркуррентные заболевания, медицинские манипуляции, в том числе аборты и введение внутриматочной спирали, а также некоторые психические и физиологические состояния.</p>",
"pathogenesis": "<p>ВПГ передается при тесном контакте с больным или вирусоносителем. Вирус проникает через слизистые оболочки половых органов, уретры, прямой кишки или микротрещины кожи.</p>\r\n<p>После проникновения в организм через слизистую или кожные покровы, вирус сразу же взаимодействует с сенсорными нервными окончаниями, используя особые рецепторы. После попадания в нервный аксон, вирус оказывается в нервных ганглиях, в которых он может оставаться в пассивном состоянии, зачастую, навсегда.</p>",
"diagnostics": "<p>Диагностика типичных случаев генитального герпеса, как правило, не затруднена и основана на клинических проявлениях.</p>\r\n<p>Лабораторные методы диагностики генитального герпеса включают:</p>\r\n<p> </p>\r\n<ul>\r\n<li>Методы обнаружения ВПГ в материале пораженных органов (соскобахиз влагалища и шейки матки, мазке из уретры, гистологическом материале маточных труб и т. д.). С этой целью применяется метод выращивания ВПГ на культуре тканей и последующего изучения его свойств, используется метод распознавания вируса под электронным микроскопом;</li>\r\n<li>Методы обнаружения антител к ВПГ в сыворотке крови (иммуноглобулины М и G). Позволяют выявить генитальный герпес даже при бессимптомном течении и определить антитела к ВПГ 1 или 2 типа. К ним относится ИФА- метод иммуноферментного анализа.</li>\r\n</ul>\r\n<p>Обнаружение генетического материала вируса методом ПЦР.</p>",
"treatment": "<p>Существуют три основных подхода в лечении генитального герпеса: противовирусная химиотерапия, иммунотерапия и комбинация этих методов.</p>\r\n<p>Этиопатогенетическая противовирусная терапия с использованием аналогов нуклеозидов (препараты ацикловира) основана на способности последних угнетать ВПГ на стадиях синтеза вирусной ДНК и сборки вирусных частиц, торможении их размножения. Именно поэтому всем больным с диагнозом генитальный герпес следует назначать эпизодическую или превентивную (супрессивную) терапию.</p>\r\n<p>Эпизодическую терапию используют в момент обострения у пациентов с редкими симптоматическими высыпаниями, во время которого необходимо начать приём препарата.</p>\r\n<p>Превентивная (супрессивная) терапия направлена на подавление возможной реактивации латентного ВПГ. Её назначают в следующих случаях:</p>\r\n<ul>\r\n<li>пациентам с тяжёлыми и частыми рецидивами генитального герпеса (более 6 обострений в год);</li>\r\n<li>с целью профилактики передачи ВПГ в парах, где один из партнёров не инфицирован генитального герпеса (не имеет АТ к нему в крови);</li>\r\n<li>при наличии выраженных психосексуальных реакций на рецидивы герпеса;</li>\r\n<li>при значительном влиянии инфекции на качество жизни пациента.</li>\r\n</ul>\r\n<p>Противовирусные препараты при супрессивной терапии назначают ежедневно, в непрерывном режиме, длительное время.</p>\r\n<p>Возможно использование супрессивной терапии короткими курсами для предотвращения развития клинических симптомов на определённый период (экзамены, отпуск и т.п.). Супрессивная терапия приводит к снижению частоты рецидивов, уменьшению асимптоматического выделения вируса, снижая риск его передачи.</p>\r\n<p>У больных с генитального герпеса в стадии ремиссии возможна стимуляция неспецифической резистентности иммуномодуляторами под контролем иммунограммы. </p>",
"prevention": "<p>Способом профилактики первичного заражения генитальным герпесом служит использование презервативов при случайных половых контактах. Однако, даже в этом случае вероятность инфицирования ВПГ через микротрещины и повреждения на слизистых оболочках и коже, не прикрываемых презервативом, остается высокой. Возможно применение антисептических средств (мирамистин и др.) для обработки участков, на которые может произойти попадание вируса.</p>\r\n<p>Рецидивирующее течение генитального герпеса отмечается при снижении защитных реакций организма: болезнях, перегревании, переохлаждении, приходе менструации, беременности, приеме гормональных препаратов, стрессах. Поэтому для предотвращения рецидивов генитального герпеса имеет значение здоровый образ жизни, полноценное питание и отдых, прием витаминных препаратов. Мерами профилактики генитального герпеса служат также соблюдение интимной гигиены и гигиены половой жизни, своевременное выявление и лечение венерических болезней.</p>\r\n<p>Для профилактики самозаражения, когда вирус генитального герпеса переносится грязными руками с губ на половые органы, необходимо выполнение элементарных гигиенических требований: тщательное и частое мытье рук (особенно при наличии лихорадки на губах), использование отдельных полотенец для рук, лица и тела, а также для каждого члена семьи.</p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период может составлять до недели после полового контакта с вирусоносителем. Характерным признаком является появление герпетических пузырьков в месте, где было соприкосновение с половым партнером - в области наружных и внутренних половых органов, половых губ. Пузырьки вскрываются и на их месте образуются болезненные язвочки, которые покрываются корками. Затем корки сходят. В течение десяти дней могут появляться новое высыпание. Более чем в половине случаев герпес протекает без клинических симптомов, но вирусоносители также могут инфицировать своих половых партнеров. Наибольшую опасность бессимптомные вирусоносители представляют для новорожденных, поскольку у них герпес может вызывать тяжелые неврологические изменения и слепоту.</p>",
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}
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}