Herpes igm positive during pregnancy. Herpes in pregnant women

Herpes simplex virus infection is one of the most common sexually transmitted infections. Because the infection is common in women of reproductive age, it can be transmitted to the fetus during pregnancy and childbirth. Herpes simplex virus is an important cause of neonatal infection that can lead to fetal death or developmental problems. The greatest risk of transmission to the fetus and newborn occurs in the case of a primary infection of the mother, concluded in the second half of pregnancy. The risk of herpes transmission to mother\u003e fetus\u003e newborn can be reduced by antiviral treatment or caesarean section in some specific cases.

Herpes simplex virus (HSV, HSV) is a ubiquitous DNA virus belonging to the herpesvirus family, transmitted through mucous membranes and damaged skin, which migrate to nerve tissues, where they remain latent. HSV-1 is predominant in orofacial (mouth-to-face) lesions, usually dormant in the trigeminal ganglia, while HSV-2 is most often hidden in the lumbosacral ganglia. However, these viruses can infect both the orofacial areas and the genital tract. In some developed countries, type 1 has recently become an important pathogen in genital lesions, which has been associated with sexual behavior in young people.

• The first primary infection develops when a sensitive person ( previously devoid of HSV-1 and HSV-2 antibodies) gets sick with herpes.
• P the first non-primary episode is when a person with preexisting antibodies against HSV (either type 1 or 2) develops the opposite type of HSV for the first time.
• Recurrent infection occurs in a person with pre-existing antibodies against the same type of HSV.

Infection during pregnancy can be transmitted to newborns: HSV-1 and HSV-2 can cause eye or skin lesions, meningoencephalitis, disseminated infections, or malformations.yes.

The clinical manifestations of herpes in a pregnant woman can be erased, she consulted a doctor during the healing of skin and mucous membrane lesions, the danger of herpes for the fetus and newborn, antiviral therapy - require laboratory confirmation.

Microscopy

Microscopic examination of damaged skin or mucous membranes using Romanovsky stains is used by a number of laboratories in Eastern Europe.This method, however, as well as cytological examination using Tzank smears, has been found to have low sensitivity and specificity and therefore should not be relied on for diagnosis.

Antigen detection

Viral antigen in sample swabs can be detected using either direct immunofluorescence (DIF) or enzyme-linked immunosorbent assay (ELISA).

Direct immunofluorescence

PIF is a quick diagnostic test that allows you to differentiate the type of genital herpes viruses.The test is useful when testing women with a pronounced clinic, but when testing asymptomatic patients, the sensitivity can be reduced to less than 50% compared to cultureThe disadvantages of a mutual fund are that it is time consuming, laborious and has suboptimal sensitivity.

Linked immunosorbent assay

Method sensitivityELISAcompared to virus isolation greater than or equal to 95% and with specific rates of 62% to 100% for symptomatic individuals. The sensitivity of ELISA for antigen detection may be higher than that of the virus culture for typical manifestations of herpes, but lower for smears from the cervix and urethra. However, most commercially available assays do not detect the serotype of the antigen.

Insulation virus in cell culture

Performed by the virological laboratory.Isolation of viruses in cell culture has been a cornerstone of HSV diagnosis over the past two decades in laboratories in Western Europe and the United States.Although HSV can be isolated from over 90% of vesicular or pustular lesions, the rate of recovery from ulcerative lesions is only 70% and falls by 27% on stages of crust formation. Delayed transport of samples to the laboratory and lack of refrigeration during transport significantly affect test results.

PCR

PCR allows you to identify the DNA of the virus. PCR is a more sensitive test for virus detection than virus culture.Diagnosis of HSV using polymerase chain reaction (PCR) is the criterion of choice in women with genital herpes sores.

Serological tests

Serologic tests detect antibodies to HSV in the blood, which indicate an ongoing latent infection. Antibodies to HSV develop during the first few weeks after infection and persist indefinitely. However, immediately after infection, there is a “window” in which antibody testing will be negative. Serodiagnosis is useful for diagnosis in individuals who are intact or with atypical lesions. Testing for HSV-specific antibodies can also be used to diagnose HSV-2 infection in asymptomatic individuals and others with undiagnosed HSV-2. Whether genital herpes is caused by HSV-1 or HSV-2 affects prognosis and counseling. Up to 50% of cases of the first episode of genital herpes are caused by HSV-1.

Although detection of HSV-specific IgM is theoretically useful for detecting recent herpes infection in the absence of an IgG response, approximately one third of patients with recurrent HSV-2 genital herpes have IgM responses. Thus, IgM detection is a poor indicator of recent infection.

* All women with genital ulcers should have serologic tests for syphilis and chancre.

Interpretation of laboratory results

Primary HSV infection during pregnancy

• The risk of infection in newborns appears to be higher when the first infection occurs in the third trimester of pregnancy. In this case, there may not be enough time for the development of maternal IgG and their transfer to the fetus, and the risk of neonatal infection is 30-50%.
• If infection occurs in the first trimester of pregnancy, it is associated with an increase in spontaneous abortions and incidence of intrauterine growth restriction. Only in rare cases is transmission of the virus transplacental, resulting in a very serious congenital infection that can cause microcephaly, hepatosplenomegaly, intrauterine fetal death, and intrauterine growth restriction. The use of antiviral drugs is permitted in the first trimester of pregnancy if the mother's injuries are particularly severe. At the moment, there is enough data for the safe use of cyclovir during pregnancy.
• If seroconversion is completed during labor, a caesarean section is not required because the risk of transmitting HSV to the fetus is low and the newborn must be protected by maternal antibodies.
• If the primary genital infection is acquired during the third trimester of pregnancy, the optimal treatment has not been determined. Most recommendations suggest a cesarean section for women who have a primary clinical infection during the last 4-6 weeks of pregnancy because they cannot complete seroconversion (antibody production) before delivery and so they can infect the newborn. When vaginal delivery is predetermined, because the risk of vertical transmission is high (41%), therapy with intravenous acyclovir for the mother and newborn is recommended.

The herpes virus is not just an annoying rash on the lip, but also a pathogen that can cause many health problems. In medical practice, there are many types of this virus, but if herpes type 1 and 2 are diagnosed as IgG positive, what does this mean for the patient and what danger does it pose to the patient? What tests are prescribed by doctors and how do they interpret the results obtained?

What are types 1 and 2 herpes?

Herpes simplex virus types 1 and 2 are the most common and common type of infection in the human body. In practice, doctors count 8 types of herpes - of which type 1 and 2 are the most common. They are referred to as simple virus type 1 and 2 and have been abbreviated as HSV-1 and HSV-2.

The level of human infection with the 1st type of virus is up to 85%, but the production of antibodies to the herpes simplex virus 2 HSV is in 20% of the world's population.

Ways of infection and manifestations of herpes

Before prescribing treatment, it is worth knowing how herpes is transmitted. HSV-1 will be transmitted both by airborne droplets and by tactile contact between a healthy and infected patient. With regard to HSV-2, you can become infected with this type of herpes through sexual contact, or at the time of birth, when the child passes through the birth canal.

Herpes, classified as HSV-1, most often manifests itself externally, in the area around the mouth and on the lips, in the nasal cavity and oral cavity. In an adult patient, herpes will manifest itself as a numerical rash over the body.

Herpes, classified as HSV-2, is mostly localized in the genital area. Its rash is similar to the first type of virus and, taking into account its localization, it is called genital.

In the body, after infection, the herpes virus may not manifest itself. Being in a latent, latent form, it does not show itself as a negative symptomatology, therefore, treatment is not required. Stressful situations and weakening of the immune system, hypothermia and other negative factors - all of them can provoke the activation of the herpes virus.

To herpes simplex virus types 1 and 2, the body itself develops immunity and the disease is not dangerous. However, if treatment is not carried out in a timely manner, when the virus manifests itself in an active form, it can provoke the development of a serious illness, for example, viral encephalitis. In men, the HSV-2 virus can provoke the development of pathologies such as prostatitis, herpes urethritis, and in women, vulvovaginitis.

Diagnostic methods

Treatment of herpes types 1 and 2 is carried out in a complex, but, first of all, the doctor directs the patient to conduct laboratory tests. Doctors take blood as biological material for research.

A blood test is carried out to determine IgG to the herpes virus by two methods:

1. ELISA - an analysis that allows you to study immunity for enzyme compounds.
2. PCR is a polymerase type of chain reaction.

The difference between these methods is that ELISA allows you to establish the level of antibodies to the herpes virus type 1 and 2, PCR - the herpes virus itself in the blood, or rather its DNA. Most often, doctors prescribe an ELISA. It helps to identify the virus throughout the body, but PCR - only in the tissues taken for analysis.

When conducting a laboratory study using the ELISA method, if the indicators give "positive", this will indicate the presence of IgG, IgA or IgM antibodies in the patient's body. It is the latter that are immunoglobulins - antibodies produced by the immune system in the fight against infection.

In particular, the production of antibodies and the result for IgM is positive - this indicates the initial stage of the course of herpes infection. If IgA or IgG is diagnosed, such proteins are detected in the body after a month after infection with the herpes virus.

Decoding of the obtained results

1. A negative and negative titer was diagnosed - there is no infection with the virus, and there is no immunity.
2. Negative and positive titer result - herpes is present in its open form, immunity is formed, but when it weakens, the disease will manifest itself as a negative symptomatology.
3. Positive / negative titer - there is a primary infection, therefore urgent treatment is indicated. This is especially important if the analysis was taken by a woman planning a pregnancy - the moment of conception should be postponed for the period of the course of treatment.
4. The titer result is positive / positive - in this variant of the results obtained, herpes develops not in the chronic stage of its course, but during an exacerbation. Both antiviral and immunostimulating drugs are prescribed.

Important to remember! When all 3 types of herpes infection are detected in the laboratory - IgG, IgM or IgA, or the first two, this indicates a serious danger.

If viruses of the pathogenic microorganism of herpes 1 IgG are detected, the infection is primary, therefore additional studies are prescribed to detect IgM. With a positive type of titer, the infection proceeds in its acute or chronic stage of the course.

With negative indicators, studies are carried out after some time. When IgG antibodies are detected in the blood, according to positive dynamics, the indicators indicate the following:

• the infection proceeds in its chronic form, with a positive dynamics of the course of the disease, herpes will manifest itself as clinical signs in an acute form.
• intrauterine infection is also possible.

If the results of laboratory tests are negative for the detection of IgG antibodies, the course of the acute form of injection is unlikely, the patient does not have a chronic form of herpes types 1 and 2.

Herpes and pregnancy

When IgM antibodies and PCR are detected in the 1st trimester, you should immediately take action and thereby prevent infection of the baby.

If there is a relapse, the likelihood of infection of the fetus is minimal, but it is still worth taking a course of medical therapy. When the disease is diagnosed in the 2nd and 3rd trimester, the fetus becomes infected during childbirth.

What is the danger of the herpes virus during the period of gestation? The virus itself for an adult does not always pose a threat to the body, exacerbating with a confluence of negative external and internal factors. But for an unborn baby in the early stages, it can provoke fading and miscarriage.

If the child survives in utero infection, herpes can provoke the following consequences:

• Skin rashes over the body of a newborn.
• Damage to the eyes and underdevelopment of the gray matter of the brain, respectively, and the mental retardation of the baby.
• Seizures and retardation.

If the fetus is infected with herpes infection during the passage of the birth canal, the child may experience the following complications:

• Characteristic eruptions on the body, in the mouth and eye damage.
• The development of encephalitis in a child - brain damage.
• Disseminated herpes infection. In 8 out of 10 cases, this can provoke death in a child.

Additional indicators

Each patient should remember: the diagnosis is not limited only to data on the amount of antibodies in the blood, it is important to take into account the existing avidity index. If this indicator varies within 50-60%, after 2-3 weeks, repeated, additional diagnostics and laboratory tests will be required. When the indicators are below the level of 50%, this indicates that the virus entered the body for the first time, if more than 60, the course of the disease proceeds in its chronic form, or the person is a carrier of a viral infection.

Analysis

ELISA as a laboratory analysis is carried out in 2 stages:

1. The collected biomaterial is combined with the antigen. It is after this that the immune complex is monitored.
2. A chromogen is added to the starting material, and by the intensity of staining, we can talk about the level of pathogenic microflora in the patient's body.

Preparation for analysis

For the analysis results to be accurate and reliable, follow a number of simple rules:

1. They donate blood in the laboratory exclusively on an empty stomach.
2. Minimize any physical activity one hour before the test.
3. During the day, it is worth excluding fatty and fried foods, alcohol, and no smoking from the diet.
4. Also, exclude taking any drugs or medicines per day.
5. Children under 5 years old are given a glass of warm water half an hour before the test.

Principles of treating viral manifestations

Treatment of viral herpes infection involves an integrated approach, but before starting any course, it is worth remembering a few basic rules:

• It is impossible to achieve complete destruction and remove the virus naturally.
• With regard to prevention, there are no specially designed drugs, so you cannot protect yourself from infection.
• If type 1 herpes is weak, prescribing medication will be unjustified.

In terms of the immunity produced in an infected patient, it is temporary and sometimes incomplete, when, after a weakening of the immune system, a relapse most often occurs. Acyclovir is most often included in the course of treatment for herpes, as prescribed by a doctor. Due to the similarity of its structure with the main elements of the amino acid of a viral infection, its active components enter its DNA, the synthesis of new chains and a pathogenic effect on the entire body will be blocked.

The drug itself has a selective effect against the herpes virus, its active components do not destructively affect the structure of human DNA. Its use in accordance with the instructions helps to speed up recovery, but the existing restrictions on its intake should be taken into account. Such restrictions are the following points:

1. Pregnancy and lactation.
2. Excessive sensitivity to the active ingredients of the drug.
3. For children under 3 years of age, this drug is not prescribed.
4. In case of kidney problems, you should first consult with a doctor when a specialist selects their analogue or reduces the dosage.
5. In old age, take this drug, combining it with plenty of drinking.
6. Do not allow the drug to get on the mucous membrane of the eyes, in order to avoid irritation and the development of a burn.

With regard to the treatment of herpes during gestation, most often doctors prescribe drugs such as:

• Acyclover.
• Valacyclovir.

Of course, these drugs have not been shown to be safe for the fetus, but animal clinical trials have shown no side effects on the fetus in laboratory rats. In any case, you should not practice self-treatment, when each drug, taking into account its composition and characteristics, must be prescribed by a doctor.

Herpes (herpes) was first described in ancient Greece. The name of this virus is translated from the Greek language "creeping". Since then, the prevalence of this disease has not decreased - now this infection occurs in more than 90% of the world's population. Presumably, on the territory of Russia and the CIS, about 20 million people are infected with various forms of herpes infection annually, and mortality among viral diseases ranks second after influenza.

The disease is caused herpes simplex virus (HSV, herpes simplex)... Of the 80 types of herpes in humans, only 9 can cause diseases, while the first (HSV1) and second (HSV2) type is most often recorded. The main difference between the two viruses is that infection with the first type virus manifests itself as herpes of the lips, eyes and mouth, while the herpes virus type 2 causes genital, or genital, herpes and herpes in newborns. Recently, however, this statement has been questioned. So, in 20-40% (according to various sources) of cases with genital herpes, the first type of pathogen is detected.

In almost all cases of herpetic lesions of the genital tract in women, infection occurs during sexual intercourse, infection is also possible with a kiss, the use of common utensils, towels, and linen. A patient with herpes infection is contagious, as a rule, only during an exacerbation, i.e. when rashes appear or there are other signs, which will be discussed below. Upon contact with a sick person during an exacerbation, the likelihood of infection is very high. Self-infection is also possible, when the patient himself transfers the herpes virus from the focus of infection to uninfected parts of the body: the face, hands, eyes, mouth or genitals.

Through the mucous membranes, the virus enters the nervous system (paravertebral ganglia in genital herpes and the trigeminal ganglion in facial herpes), where it can be in a "dormant" state for a long time. When favorable conditions arise for it, for example, when the body's defenses are weakened during stress or a cold, it is activated, migrates from nerve cells to the skin and mucous membranes.

Herpes Symptoms

The incubation period - the period from infection until the first symptoms appear - with herpes infection is 3-14 days.

Then comes the period of the harbingers of the disease. General weakness, an increase in body temperature up to 38 ° C, painful enlargement of the inguinal lymph nodes, increased urination, muscle pain are noted. In the genital area, itching, pain, burning are felt. Sometimes nausea, vomiting, numbness of the occiput, headache occur, but all these symptoms go away on their own with the appearance of rashes. On the mucous membranes of the genitals (labia majora, labia majora, vulva, clitoris, vagina, cervix) and adjacent areas of the skin appear grouped, prone to fusion, small bubbles filled with liquid, with redness around them. After 2-4 days, the contents of the bubbles become cloudy, and they burst, forming weeping sores, which then become crusted. With a favorable course of the disease, the crust disappears after 5-7 days, a stain remains in its place. Even if untreated, symptoms usually resolve on their own after 2-3 weeks.

Subsequently, in many, the disease recurs, and the time until the next relapse can range from several weeks to several years. When infected with the first type of virus, relapses occur within a year in 50%, with the second - in 90% of patients. Various factors contribute to the exacerbation of the disease: ultraviolet irradiation with prolonged exposure to the sun, pregnancy, menstruation, medical manipulations, including abortion and the introduction of an intrauterine device, excessive cooling, stress factors, etc.

The clinical picture of recurrence of chronic genital herpes infection is diverse. Diagnosis of relapses is often difficult because the precursor period is very short and there may be no signs of discomfort. However, some patients, 6-12 hours before the appearance of the rash at the site of the primary lesion, note tingling. As a rule, relapses are easy, the duration of the rash does not exceed 3-5 days. In some cases, with a relapse, no visible rashes are found at all, but swelling, itching, and a feeling of discomfort in the genital area appear. Patients with a good immune system tolerate herpes infection more easily, and it often goes away in a latent form. Patients with reduced immunity are more likely to have severe and prolonged herpetic lesions.

How herpes infection occurs, how herpes is diagnosed and treated, is illustrated by the video:

The course of pregnancy with herpes

HSV ranks second after rubella in teratogenicity (the ability to form malformations in the fetus). It has been established that intrauterine infection with HSV can occur:
... transplacentally - through the vessels of the placenta;
... ascending from the infected genital tract, especially with premature rupture of the membranes, prolonged anhydrous period;
... from the pelvic cavity through the fallopian tubes.

If the expectant mother first becomes infected with genital herpes during pregnancy, the fetus may suffer. As a rule, when infected before the 10th week of pregnancy, fetal death and miscarriage occur. Possible damage to the developing organs of the fetus, the occurrence of congenital deformities.

Infection in the second - third trimester, and especially after 36 weeks of pregnancy, is fraught with damage to the nervous system of the fetus, skin, liver, spleen. Despite the treatment prescribed after childbirth, up to 80% of newborns with a primary episode of genital herpes in the mother die or become severely disabled.

The initial episode of genital herpes and the associated loss of the desired pregnancy is a severe psychological trauma for both potential parents. But the next pregnancy will proceed against the background of recurrent genital herpes, and antibodies will circulate in the mother's blood for life, which will preserve and protect the unborn child, penetrating the placenta into his body. During pregnancy from a mother with recurrent genital herpes, the virus is transmitted to the fetus only in 0.02% of cases. Therefore, recurrent genital herpes is not so dangerous during pregnancy, does not cause deformities and lesions of internal organs. However, with recurrent herpes, the incidence of abnormalities in the function of the placenta, intrauterine growth retardation, and miscarriage increases. These complications are most often associated with autoimmune processes in the mother's body against the background of herpes infection, when the immune system “does not recognize” its own tissues and cells and develops antibodies to them as to foreign proteins. Such processes affect, in particular, the process of blood coagulation, while the fetus suffers a second time as a result of damage to the vessels of the developing placenta.

Therefore, if you have a recurrent herpetic infection, you need to carefully follow the schedule of all studies carried out during pregnancy in order to eliminate possible complications in a timely manner.

Congenital herpes

If a woman has active rashes during childbirth, newborn babies do not always manage to avoid infection when passing through the mother's infected genital tract. The incidence of infection in newborns whose mothers are diagnosed with the herpes virus at the end of pregnancy is 40-60%. According to WHO experts, 0.03% of all newborns were infected with HSV during childbirth. In addition to the above ways of transmission of infection, during childbirth, infection is possible through direct contact during passage through the birth canal, as well as after childbirth from the mother if she has active rashes. In newborns, rashes on the skin are detected, in severe cases, damage to the brain and other organs (liver, lungs, adrenal glands) is possible. The mortality rate of newborns with primary herpes infection is about 50%, and half of the survivors have ocular or neurological complications.

Diagnosis of herpes

Diagnosis of genital herpes is currently carried out in three areas:

. Cultural method... Its essence lies in the fact that from a herpetic rash or vesicles from a sick person, the contents are taken and placed on a growing chicken embryo. Then, the presence of HSV is determined by characteristic lesions. The advantages of the method include its high sensitivity, the disadvantages are the duration of the study (the result is prepared up to 2 weeks). Thus, we can say for sure that these rashes are of a herpetic nature.

. DNA diagnostics, which is carried out using the polymerase chain reaction (PCR), i.e. isolation of the pathogen itself. PCR can detect a virus in a patient only at the time of relapse. The material for PCR is taken with a special brush from the lesions. The reaction allows you to find out whether or not there is a particular type of herpes virus in the body.

. Serodiagnostics (detection of specific antibodies to the herpes virus in the blood serum). Antibodies to the herpes virus appear in the blood serum by 4-7 days after the initial infection, reach a peak in 2-3 weeks and can persist throughout life. Since the growth of antibodies is very important for establishing a diagnosis, their presence in a single serum sample does not mean anything. Most adults always have antibodies in their blood. In order to distinguish the primary episode of genital herpes from the first relapse with visible symptoms, the patient needs to donate blood from a vein for antibodies to the first and second types of herpes virus. If the blood contains IgG - protective antibodies - class G immunoglobulins, it means that herpes is recurrent and there is practically no threat to the fetus or embryo. If there is no IgG in the blood, but there is IgM, then this is the primary episode of genital herpes.

Signs of intrauterine infection by ultrasound can be a suspension in the amniotic fluid, a "thick" placenta, low and polyhydramnios, fetal brain cysts.

Pregnancy management and treatment of herpes

If the primary episode of the disease coincides with the first trimester of pregnancy, it is advisable to terminate the pregnancy.

When infected in the second or third trimester, the pregnancy is maintained, treated, the birth is planned through the natural birth canal. To prevent rashes, 2 weeks before delivery, the doctor may prescribe antiviral drugs by mouth acyclovir, famciclovir, or valacyclovir... You can use candles viferon, kipferon.

In the event that the first episode of genital herpes in life occurs 30 days before childbirth, delivery by caesarean section is recommended. If such a woman has a rupture of the membranes earlier than 4-6 hours before childbirth, then the woman gives birth through the natural birth canal, which is treated with IODONAT or other antiseptics - this is a common measure, it is used for all women in childbirth without exception. If a woman has herpes not on the genitals, then a cesarean section is not performed.

In women with recurrent genital herpes, pregnancy management has some peculiarities. During pregnancy, in order to avoid exacerbation of herpes, it is advisable to avoid stress, be more outdoors, and take vitamins for pregnant women. But if an exacerbation does happen, it is necessary to undergo complex treatment. Outwardly, for rashes, you can use an ointment based on acyclovir... Ointments and creams do not work on the fetus, because they are not absorbed into the blood.

Two weeks before childbirth, drug prevention of exacerbation is carried out, material for PCR diagnostics is taken from the cervical canal, the birth canal, perineum and vulva are carefully examined to identify possible herpetic lesions. If mothers who have had recurrences of genital herpes during childbirth find rashes on the skin and mucous membranes or a herpes virus in a smear, then delivery is carried out using a cesarean section or the birth canal is carried out through the natural birth canal with the treatment of the birth canal and the baby's skin with antiseptics.

Herpes Prevention

Once in the body, the virus periodically causes exacerbations. It is impossible to achieve the removal of the virus from the body with the current methods, therefore, no treatment can be foreseen before pregnancy. Specific methods for preventing the transmission of genital herpes during pregnancy have also not been developed. It is necessary to plan the onset of pregnancy (or rather, to be examined in advance), exclude bad habits from your life, undergo a course of general strengthening treatment (vitamin therapy, hardening, etc. - everything that will increase the body's defenses), do a serological test for HSV. If there are immunoglobulins G or M in the blood (regardless of their amount), it means that the initial episode of meeting with this virus has already been and you can become pregnant. When planning pregnancy in women with frequent relapses, the prophylactic administration of ACYCLOVIR, immunomodulatory drugs, multivitamins is recommended. A good effect before pregnancy is provided by a course of intravascular laser blood irradiation, carried out in specialized clinics. This treatment allows you to at least partially get rid of the virus.

If antibodies to HSV are not detected in the blood, then, on the one hand, this situation is most favorable for the fetus. However, such women need to take special precautions. In particular, you need to make sure that your partner does not have genital herpes. If your partner is found to have antibodies to HSV, sexual intercourse should be avoided (even using a condom or oral sex).

Herpes infection (HSV) includes eight types of viruses that can cause various clinical manifestations of the disease. The most famous and often found are sexual (type II) and labial (type I). A rash in the form of bubbles filled with liquid appears during a period of weakened immunity, especially during pregnancy. Is the virus dangerous for a baby? When and how to be treated?

It is believed that the herpes simplex virus type I occurs only on the mucous membrane of the lips and oral cavity, and the genital area - in the genital area. However, sexual liberation has long removed these boundaries - both types of pathogens can appear anywhere on the body.

Views

It is a common virus that, according to generally accepted statistics, is found in 90% of people. This concept most often means the herpes simplex virus (HSV types I and II). In fact, there are many more representatives of the Herpesviridae family.

• I type. The most common type of disease, manifested by a rash of blisters on the face. Particularly on the lips. Often referred to as "the common cold."
• II type. The next most common type of virus that affects mainly the genitals.
• III type. Varicella zoster virus. At the first contact with the pathogen, chickenpox occurs, with a recurrence of a chronic infection, shingles.
• IV type. Epstein-Barr virus. It provokes Filatov's disease - acute mononucleosis.
• V type. Cytomegalovirus, which has not been fully studied, since it was discovered only in 1956. Infection during pregnancy can lead to intrauterine infection, fetal death, and premature outpouring of water.
• VI type. It provokes the development of lymphoma, lymphosarcoma.
• VII type. A poorly understood form of herpes. It is manifested by constant fatigue, drowsiness and lethargy, which do not go away after rest.
• VIII type. There is also little information about such a virus. But it is known to attack white blood cells and is often diagnosed in HIV carriers.

Features and pathogenesis of HSV types I and II

After the first contact with the virus, which occurs in the first three years of a child's life, the pathogen "lives" in the body of most people. Moreover, women are more susceptible to it than men. It can exist in the human body for years without showing any signs, since its activity is suppressed by the body's defenses. With a weakening of immunity, it comes out of suspended animation and makes itself felt with unpleasant symptoms. Often, the disease attacks pregnant women due to the peculiarities of the physiological processes during this period.

The herpes virus enters the body in the following ways:

• acquired - by sexual, airborne, contact (through household items, handshakes, kisses) ways;
• congenital - during intrauterine development or during childbirth.

The virus is able to penetrate the mucous membranes of the mouth, upper respiratory tract, reproductive system and spread to various organs through the lymphatic and blood vessels. It is "implanted" into the genetic material of nerve cells and can be stored there for years.

It is impossible to completely get rid of the virus. In response to the process of its introduction, the immunity develops special antibodies (immunoglobulins of the M, G, A class), which suppress herpes and prevent it from progressing. When exposed to adverse factors, the virus is activated and multiplies in the epithelial cells of the skin and mucous membranes, affecting them and leading to death. Clinically, this is manifested by itching, burning, rashes, sores and then crusts that form in this place.

The virus lives in human blood, lymph, cerebrospinal fluid, urine, semen, saliva.

Aggravation provocateurs

The main factor that provokes the development of herpes is a weakening of the immune system. Concomitant reasons that affect the activation of HSV type I can be:

• hypothermia;
• colds, acute respiratory infections, flu;
• suffered stress or trauma;
• hypovitaminosis;
• unbalanced diet;
• passion for natural or artificial tanning.

The reasons for the appearance and subsequent relapse of HSV type II is unprotected sexual contact. Additional factors contributing to the activation and transmission of infection are:

• infections of the genitourinary system;
• hormonal disruptions;
• weakening of immunity;
• physical and emotional stress;
• hypothermia.

In patients with cancer, AIDS, the disease often progresses against the background of decreased immunity. It has a more vivid clinical picture, affects several areas and is difficult to treat.

The main manifestations of the disease

HSV can affect the skin and mucous membranes anywhere on the body. The classic manifestations of herpes infection types I and II are as follows.

Herpes type I:

• localization - the nasolabial part of the face, the mucous membrane of the nose, lips in the area of \u200b\u200bthe border with the skin, the mucous membrane of the oral cavity (stomatitis) and tonsils (tonsillitis);
• the nature of the rash- small bubbles with a light liquid, after their opening or injury, a crust forms;
• additionally - itching and burning in the area of \u200b\u200bthe affected areas.

HSV type II, when localized on the mucous membrane of the vagina and cervix, does not have typical manifestations. It is found in the study of smears, with targeted PCR examination. If the foci are located on the external genital organs, then it is possible:

• burning and itching;
• swelling and redness;
• painful sensations;
• enlarged lymph nodes in the groin area;
• eruptions in the form of bubbles with a colorless liquid;
• the appearance of small ulcers at the site of the bubbles.

Required examination

A comprehensive examination to establish the presence and type of HSV includes two stages:

• examination by a specialist;
• laboratory research.

The main methods that can reliably confirm the presence of an infection are the following.

• Polymerase chain reaction (PCR)... A simple way to identify a virus, even if it is in the body in low concentration. The essence of the method consists in multiple copying of a pathogen DNA section and further identification of its type. The material is taken from the alleged focus of infection - from the place of rashes on the lips, genitals, from the cervical canal. PCR allows you to indicate whether HSV is active at the moment. A negative result indicates no active infection, but not a complete cure.
• Enzyme-linked immunosorbent assay (ELISA). Allows you to identify antibodies such as IgM and IgG, set their number. Thus, the phase of the disease is determined.
• Immunofluorescence reaction (RIF)... The taken biological material is processed with a special substance, after which the antigens begin to glow. This allows them to be detected under a microscope. Used less often.

The interpretation of the test results for HSV types I and II is presented in the table.

Table - Correct assessment of test results for HSV types I and II

ELISA IgM	ELISA IgG	PCR	Result
Not performed	Not performed	Negative	- No active infection;
Not performed	Not performed	Positive	- Active infection; - immunity to the pathogen is unknown
Positive	Negative	Positive	- Active infection; - first contact with the pathogen
Positive	Positive	Positive	- Active infection; - exacerbation of a chronic form
Positive	Negative	Negative	- Acute infection, but there is no pathogen in the studied focus; - first contact with the pathogen
Positive	Positive	Negative	- Exacerbation of chronic infection; - there is no virus in the material for PCR
Negative	Positive	Negative	Suppressed infection
Negative	Positive	Positive	Subacute course

Additional research methods include the following.

• Cultural. The biomaterial is placed in a nutrient medium where viruses are expected to grow. If it is not there, there is no infection either.
• Immunogram. Blood test for the content of immune cells. Does not indicate the presence / absence of a virus.
• Vulvocolpocervicoscopy... Inspection of the mucous membrane of the vagina and cervix with a colposcope. Signs of herpes lesions can be found.

When registering, a woman must undergo an analysis to detect TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes types I and II). And knowing the immune status before pregnancy, it is possible to timely identify the pathogen and prevent primary infection during gestation.

Treatment

The virus does not lend itself to radical therapy; it can only be stopped and immunity maintained, which suppresses the development and clinical manifestations of the pathogen. The task of the doctor and the pregnant woman is as follows:

• don't get sick the first time - if there were no episodes of the disease before;
• prevent rashes on the eve of childbirth - this is especially true for localization on the genitals, otherwise a cesarean section is indicated to prevent infection of the child;
• treat exacerbations - if there are few of them, local remedies are enough, with frequent episodes, medication is indicated by mouth.

The range of antiherpetic drugs is small.

• Outwardly. You can use "Panavir", "Acyclovir". When a bacterial infection is attached - tetracycline, erythromycin ointment. Also, oxolinic ointment and preparations based on interferons are prescribed topically. For quick healing of the affected integument, it may be recommended to treat them with vitamin E.
• Tablets inside. During gestation, only "Acyclovir" is allowed.
• Droppers. Solutions "Acyclovir", "Panavira".

"Ganciclovir" is one of the most effective antiherpetic drugs, which surpasses "Acyclovir" in its effect. However, its use is categorically contraindicated for expectant mothers.

Traditional methods

The most gentle are natural remedies. But even their use in pregnant women requires consultation with a specialist. The following alternative treatment options are popular:

• fir or castor oil - lubricate lesions several times a day;
• tea tree oil - helps to eliminate rashes with daily use;
• calendula ointment - softens crusts and heals wounds;
• infusion or cream based on chamomile - contribute to the softening of keratinized areas of the skin, their disinfection and regeneration;
• plentiful warm drink - teas and compotes with viburnum, cranberries or licorice root are needed for general strengthening of the immune system.

What is dangerous during gestation

At first glance, it might seem that herpes is not so terrible during gestation when it comes to types I or II. In a woman, it can manifest itself as rashes on the skin, lips, genitals. For maternal health, this, indeed, will not bring much harm, but the following situations are dangerous for the fetus:

• if mom got herpes for the first time;
• if exacerbation episodes are frequent;
• if the rash appeared on the eve of childbirth.

At the initial encounter with the virus during pregnancy, the female body does not yet have protective antibodies, so HSV also gets to the fetus, disrupting its development, and can cause defects. First of all, the nervous system suffers. The virus infects and provokes pathologies of the heart (myocarditis, organ failure), liver (hepatitis, underdevelopment of the bile ducts), the brain (increased intracranial pressure, hydrocephalus). In severe cases, it can provoke intrauterine fetal death. Similar consequences are also possible if the herpes infection flares up frequently - several times a month.

An analysis for herpes during pregnancy is taken when registering with a clinic or even at the planning stage, before conception. This is necessary because under certain unfavorable conditions, this virus can be dangerous to the fetus and cause mental retardation in the newborn or cerebral palsy. Therefore, it is much safer to be examined at the stage of family planning.

The presence of an infection in a woman's body is detected by IgG and IgM antibodies, and in order for a blood or urine sample, as well as a smear, to be indicative, it is necessary that at least 3 months have passed from infection. Otherwise, antibodies to herpes during pregnancy will not have time to form. When prescribing a study, it should be borne in mind that in some cases the patient may have a "menstrual" form of the virus, the aggravation of which occurs 4-5 days before the onset of bleeding.

Herpes in pregnant women in the blood can be detected using PCR and ELISA tests. Other blood tests such as the Herpeselect method and the Western Blot are popular abroad. Among the advantages of these foreign studies, their high accuracy in the determination of IgG and IgM antibodies from a blood sample is noted, and the disadvantage is the long processing time, which reaches two weeks.

Special preparation is not required before taking an analysis for detecting herpes during pregnancy in the blood. Everything is standard: the day before, they refrain from fatty foods and do not eat anything immediately before the test.

In order to decipher the results obtained, it is necessary to know what IgM and IgG are responsible for in the patient's body. A positive result for herpes IgG during pregnancy indicates that the disease was transferred by the woman earlier, but does not indicate its presence in the current oment. More revealing will be positive results of an IgM herpes test during pregnancy, since these antibodies are determined in the blood either during the acute course of the disease or within 60 days after recovery.

That is, if, as a result of a blood test, it is indicated that these antibodies are absent, then this indicates the absence of the disease and that it did not exist before. IgG is positive and IgM is negative - the disease has been transferred and the woman in labor is immune to it. The opposite result indicates an acute form of primary infection. In cases where both classes of antibodies are detected, they imply an exacerbation of the virus that the mother had in a latent form even before conception.