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Herpes genitalis

Herpes genitalis

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Weltweit haben in den letzten Jahren Infektionen mit Herpes genitalis zugenommen, die überwiegend durch das Herpesvirus Typ 2, vermehrt auch durch Typ 1 hervorgerufen werden. Die Viren sind sexuell übertragbar.

Klinik

Die Herpesviren rufen zunächst erythematöse Papeln, im weiteren Verlauf feuchte und schmerzhafte Ulzerationen hervor. Bakterielle Superinfektionen sind möglich. Ein rekurrierender Herpes genitalis resultiert aus einer Reaktivierung des Virus mit einer klinischen Symptomatik. Die Symptome der Rezidive können denen einer Primärinfektion ähneln, wobei diese Patienten eine geringere Symptomatik und eine verkürzte Symptomdauer aufweisen als nach einer ersten Krankheitsepisode.

Diagnostik, Therapie und Prophylaxe

Die Diagnosestellung erfolgt entweder über die klinische Symptomatik oder über den Nachweis von Virusantigen aus der Vesikelflüssigkeit durch Virusanzucht oder häufiger Polymerasekettenreaktion (PCR). Aciclovir, Famciclovir und Valaciclovir werden zur Therapie des Herpes genitalis sowohl bei der Primärinfektion und bei Rezidiverkrankungen als auch als Suppressionstherapie eingesetzt. Eine prophylaktische Herpes-simplex-Virus (HSV)-Impfung ist die beste Möglichkeit, um einer Infektion vorzubeugen, wobei in den nächsten Jahren ein effizienter und klinisch geprüfter Impfstoff sehr unwahrscheinlich ist.

Schlussfolgerung

Die steigende Inzidenz des genitalen Herpes, die veränderten epidemiologischen Gegebenheiten, die psychische und körperliche Belastung dieser rekurrierenden sexuell übertragenen Infektion sowie die häufig ungenügenden antiviralen Therapiestrategien, um eine rezidivierende Infektion einzudämmen, führen zu einer hohen körperlichen, psychischen und sozioökonomischen Belastung, die globale Präventionsmaßnahmen und neue therapeutische Strategien für die Behandlung eines Herpes genitalis dringend erforderlich macht.

Abstract

Background

In recent years infections with herpes genitalis have increased worldwide, which are predominantly caused by herpesvirus type 2 but increasingly more by herpesvirus type 1. Herpesviruses are sexually transmitted.

Clinical aspects

Herpesvirus initially induces erythematous papules which are followed later by moist and painful ulcerations. Bacterial superinfections are possible. Recurrent herpes genitalis results from a reactivation of the virus with clinical symptoms. The symptoms of recurrences can resemble those of a primary infection, whereby these patients show less severe symptoms and a shorter duration than a primary disease episode.

Diagnostics, therapy and prophylaxis

The diagnosis is made either by the clinical symptoms or by the detection of viral antigens in vesicular fluid by virus cultivation or more commonly by the polymerase chain reaction (PCR). Aciclovir, famciclovir and valaciclovir are administered for therapy of herpes genitalis for primary infections, for recurrent diseases and also as suppression therapy. A prophylactic vaccination with herpes simplex virus (HSV) is the best possibility to prevent infection but an efficient and clinically tested vaccine is very unlikely in the coming years.

Conclusion

The increasing incidence of genital herpes, the altered epidemiological circumstances, the mental and physical stress of this recurrent sexually transmitted infection and the often insufficient antiviral therapeutic strategies to contain recurrent infections, lead to a high physical, mental and socioeconomic burden. This urgently necessitates global preventive measures and novel therapeutic strategies for the treatment of herpes genitalis

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  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe – Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Maistraße 11, 80337, München, Deutschland

    I. Mylonas

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K. Friese, Oberaudorf

W. Mendling, Wuppertal

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Mylonas, I. Herpes genitalis. Gynäkologe 48, 795–800 (2015). https://doi.org/10.1007/s00129-015-3769-x

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