Herpes genitale
Herpes genitale: cause
L’herpes genitale è una malattia causata dal virus chiamato HSV-2 e meno frequentemente da HVS-1 a seguito di rapporti sessuali oro-genitali; le forme ricorrenti sono esclusivamente provocate da HSV-2. Nella maggior parte dei casi nell’herpes genitale si riscontra l’ HSV-2 a trasmissione genitale ma, negli ultimi anni, sì e assistito ad una crescita importante di casi sostenuti da HSV-1 attraverso i rapporti oro-genitali. L’herpes genitale nell’uomo colpisce soprattutto il prepuzio e l’uretra; nella donna si estende a vulva, vagina e cervice coinvolgendo talvolta anche le regioni cutanee perivulvari e perineali.
Trasmissione
La trasmissione dell’herpes genitale avviene sempre per un contatto sessuale (genitale e oro-genitale), per contatto diretto delle mucose genitali, anali e del cavo orale, ma non è necessariamente seguita da manifestazioni cliniche. La latenza tra il contagio e i sintomi può seguire il rapporto di alcune settimane o anche di anni. Il virus può essere trasmesso dalla madre al neonato (via transplacentare) durante il parto con conseguenze gravi. L’infezione dura tutta la vita ma la frequenza delle recidive, in genere, si riduce con il passare degli anni.
Sintomi
Il primo episodio di herpes genitale è caratterizzata dalla presenza di:
- febbre
- cefalea
- mialgie
- malessere generale
- vescicole diffuse intensamente dolorose, localizzate nell’area genitale
- linfoadenite inguinale bilaterale dolente in un paziente visibilmente sofferente
Nelle recidive l’herpes primario si presenta con un quadro clinico che si caratterizza per alcuni punti fermi:
- vescicole urenti con sintomi molto variabili (bruciore, prurito, parestesia, stranguria e dispareunia)
- localizzazione fissa delle vescicole sempre nella stessa sede in un’area di 1-3 cm di diametro
- risoluzione spontanea entro 10 giorni
- intervallo di almeno 30 giorni tra i due episodi.
Se l’episodio dura più di 30 giorni non si tratta di herpes oppure è un herpes cronico dell’immunodepresso e costituisce un criterio diagnostico di AIDS.
Diagnosi
la diagnosi si basa sull’osservazione e l’unico criterio clinico attendibile è l’elevata dolorabilità riferita dal paziente. Si può giungere alla diagnosi anche attraverso i seguenti test:
- esame citodiagnostico classico con striscio (abbastanza aspecifico)
- immunofluorescenza su materiale prelevato o sulle colture (assai specifico)
- microscopia elettronica (poco praticata)
- sierologia (ricerca degli anticorpi neutralizzanti anti herpes).
Terapia
Non esiste una cura che debelli definitivamente il virus, l’obiettivo della terapia non è la guarigione dell’infezione che persiste a vita ma la riduzione e un controllo dei sintomi e una riduzione della contagiosità. Sarà compito del medico decidere se usare i farmaci antivirali. L’efficacia delle creme locali (acyclovir) non è stata mai provata scientificamente.
Prevenzione
- Evitare di toccare la parte infetta durante la manifestazione clinica e lavarsi accuratamente le mani se si è venuti a contatto con la parte infetta.
- Evitare rapporti sessuali (anali, vaginali, orali) durante questo periodo e fino alla scomparsa dei sintomi. La protezione durante i rapporti sessuali riduce del 50% il rischio di contagio (meglio astenersi).
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