Herpes Simplex: Ukuhlukanisa Imininingwane Yezokwelapha Nokuqonda Komphakathi

I-virus ye-herpes simplex iza ngezinhlobo ezimbili: i-HSV-1 ne-HSV-2, bobabili bangamalungu omndeni we-herpesvirus ophinde uhlanganise i-varicella-zoster (umkhuhlane wezinyoni/izikhumba), i-Epstein-Barr virus, kanye ne-cytomegalovirus. I-HSV-1 ivame ukuhlotshaniswa ne-herpes yomlomo (izilonda ezibandayo) kanti i-HSV-2 ihlotshaniswa ne-herpes yezitho zangasese, kodwa le mihluko isiyashintsha. I-HSV-1 manje iyimbangela ehamba phambili yokuphuma kwe-herpes yezitho zangasese ezweni eliningi elithuthukile, idluliselwa ngokuxhumana komlomo nezitho zangasese.

7 billion abaphansi kweminyaka engu-50 emhlabeni jikelele, baphatha i-HSV-1 (cishe u-67% wabantu emhlabeni), kanti abantu abangu-491 million abaphakathi kweminyaka engu-15-49 baphatha i-HSV-2 (13% wabantu emhlabeni). Lezi zibalo ziveza iqiniso eliyisisekelo: i-herpes iyinfections ejwayelekile kakhulu emlandweni wabantu, hhayi isimo esiyinqaba noma esingajwayelekile. Bobabili i-HSV-1 ne-HSV-2 zakha ukutheleleka okungapheli emgudwini wezitho — i-HSV-1 ivame ukuhlala emgudwini we-trigeminal (okhonzile ubuso), kanti i-HSV-2 igxile emgudwini we-sacral (okhonzile indawo yezitho zangasese).

Ngemuva kokutheleleka kokuqala, i-virus ihamba ngezintambo zenuvile iye emgudwini lapho ingena esimweni sokulala. Ngokuvamile, i-virus ibuyisela emuva, ihamba phansi ngezintambo zokuqonda iye phezulu kwesikhumba, futhi ibangele ukuphuma okuphindaphindiwe — noma, kaningi, ikhipha ngaphandle kwezimpawu ezibonakalayo. Lokhu kukhishwa ngaphandle kwezimpawu kubangelwa iningi lokudluliswa kwe-herpes, okusho ukuthi abantu bangasabalalisa i-virus noma ngabe babonakala bephila kahle ngokuphelele futhi bengenazo izilonda ezisebenzayo.

Ukuphuma kokuqala (okuyinhloko) kwe-herpes kuvame ukuba kubuhlungu kakhulu, kwenzeka ezinsukwini ezi-2-12 ngemuva kokubhekana. Izimpawu zingabandakanya ama-blisters amaningi abuhlungu noma ama-ulcers endaweni yokutheleleka, ubuhlungu obukhulu nokuthinteka, izimpawu ezifana neflu (ukushisa, ubuhlungu bomzimba, ama-node omzimba aphakeme), kanye nobunzima emisebenzini yansuku zonke (ukudla uma kungokwemlomo, ukuhlala noma ukuhamba uma kungokwezitho zangasese). Nokho, kuze kube ngu-80% yokutheleleka kokuqala akubonakali noma kubuhlungu kangako ukuthi akuboniwe — abantu abaningi baphatha i-HSV eminyakeni noma ezizukulwaneni ngaphandle kokwazi.

Uma izimpawu zenzeka, i-herpes yomlomo ibonakala njengezixuku zama-blisters amancane, agcwele umswakama, ezikhaleni noma eduze kwemilomo, kwesinye isikhathi ziye emlonyeni noma emathanjeni. Ama-blisters aphuka, akha ama-ulcers abuhlungu aphansi, bese ehlanzeka ngaphandle kokushiya izilonda ezinzima ezinsukwini eziyi-7-14. Abaningi beziguli bachaza umuzwa wokuthinta, ukushisa, noma ukungakhululeki (prodrome) ezinsukwini eziyi-12-48 ngaphambi kokuthi ama-blisters avele.

I-herpes yezitho zangasese ibonakala ngendlela efanayo: izixuku zama-blisters abuhlungu noma ama-ulcers ezithweni zangasese, emaphethelweni, emathangeni, noma ezithombeni eziphezulu, kwesinye isikhathi nezimpawu zokuchama (ukuchama okubuhlungu, ukuhamba kwezitho) noma ubunzima bokuhlala. Ukuphuma okuphindaphindiwe kuvame ukuba mfushane futhi kungabuhlungu kakhulu kunezikhathi zokuqala, kuhlala ezinsukwini ezi-3-7. I-herpes yezitho zangasese ye-HSV-2 iphinda ivame kakhulu (average 4-6 ukuphuma konyaka wokuqala) kune-herpes yezitho zangasese ye-HSV-1 (average 1 ukuphuma konyaka wokuqala, kuncipha ngokushesha emva kwalokho).

Ngaphezu kwesikhathi, ukuvuselelwa kuvame ukuncipha kokubili izinhlobo. Abaningi beziguli bakha umkhuba wokuthinta owaziwayo ovumela ukuba babone ukuphuma futhi baqale ukwelashwa kusenesikhathi.

Ngenkathi i-virus ikhetha ukuthi ubamba i-herpes, izinto eziningi zithinta ukuthi kwenzekani futhi kangakanani ukuphindaphinda. Ukucindezeleka komzimba kuyisizathu esinamandla: ukugula, ukushisa, izinqubo zokuhlinzwa, kanye nokulimala komzimba (kuhlanganisa nomsebenzi wezokwelapha we-herpes yomlomo) kungadala ukuphuma. Ukukhanya kwelanga, ikakhulukazi i-UV radiation emilonyeni, kuyisizathu esaziwayo se-herpes yomlomo — lokhu kungukuthi, izilonda ezibandayo zivame ukuvela ngemuva kwezinsuku zokuphumula olwandle noma ezinsukwini zokushushuluza.

Ukucindezeleka kwemizwa nokukhathazeka kwengqondo kubalwa phakathi kwezizathu ezivame kakhulu ezibikwayo, mhlawumbe ngenxa yokuncipha kokuvikela okwenziwa yi-cortisol. Ukushintsha kwezinga le-hormone kuphakamisa ukuphuma kwabesifazane abaningi, lapho ukuphindaphinda kuvame ukwenzeka ngesikhathi sokukhulelwa. Ukukhathala, ukungaphumuli ngokwanele, kanye nokuncipha kokuvikela okuvela kunoma iyiphi imbangela kukhuphula ingozi yokuphindaphinda.

Ukulimala kwesikhumba sendawo yokutheleleka kungaphakamisa ukuphindaphinda — ukucindezela, ukuhuzuka, nokusebenza ngokocansi kungadala ukuphuma kwezitho zangasese. Ku-herpes yomlomo, ukulimala kwemilomo, imilomo ephukile ngenxa yesimo sezulu esibandayo, kanye nezinqubo zokubukeka ezikhaleni zomlomo kungadala ukuphuma. Imithi yokunciphisa ukuvuvukala kanye nezimo zikhuphula kakhulu kokubili ukuvuselelwa kanye nobuhlungu bokuphuma.

Abanye beziguli bahlonza izizathu zokudla, nakuba ubufakazi bezinhlobonhlobo zokudla buphakathi kokukhuluma. Ubudlelwano phakathi kwe-amino acids i-lysine ne-arginine buphikiswa — ubufakazi obuthile bukhombisa ukuthi ukudla okunamafutha aphezulu e-lysine nokuphansi e-arginine kunganciphisa ukuvuselelwa, kodwa imiphumela ayihambisani. Ukuqonda izizathu zakho zomuntu siqu ngokubheka ngokucophelela kukuvumela ukuba ubone izikhathi ezibucayi futhi uthathe imithi yokuvikela ye-antiviral noma wenze izindlela zokuvikela. I-diary yokuphuma — ukubhala izinsuku zokuphuma kanye nezizathu ezingenzeka ezifana nokucindezeleka, ukugula, ukukhanya kwelanga, isikhathi sokukhulelwa, kanye nekhwalithi yokulala — kusiza ukuveza umkhuba wakho oyingqayizivele ezinyangeni eziningi.

Imithi emithathu ye-antiviral ivunyelwe ukwelashwa kwe-herpes simplex: i-aciclovir, i-valacyclovir (Valtrex), kanye ne-famciclovir (Famvir). Zonke zisebenza ngokuvimbela ukuphindaphinda kwe-DNA ye-virus, zinciphisa ubuhlungu nobude bokuphuma futhi zinciphisa ukuncipha kwe-virus. Lezi zimithi ziphephile, zikhululekile, futhi zitholakala ngezinhlobo ezijwayelekile ngentengo ephansi.

Zingasetshenziswa ngezindlela ezimbili: ukwelashwa okuphindaphindiwe (okuthathwa ekuqaleni kokuphuma ukuze kuncishiswe ubude bayo) noma ukwelashwa kokunciphisa (okuthathwa nsuku zonke ukuvimbela ukuphuma nokunciphisa ukudluliswa). Ukwelashwa okuphindaphindiwe kusebenza kahle kakhulu uma kuqala ngesikhathi sokuqala sokuphuma — kahle kakhulu ngesikhathi sokuthinta noma sokushisa ngaphambi kokuthi ama-blisters avele. I-valacyclovir engu-2g ethathwa kabili ngosuku (amahora angu-12 aphakathi) ingavimbela noma inciphise kakhulu isikhathi sokuphuma kwe-herpes yomlomo.

Ku-herpes yezitho zangasese, uhlelo olujwayelekile lokwelashwa okuphindaphindiwe lungama-valacyclovir angu-500mg kabili ngosuku ezinsukwini ezi-3-5. Ukuqala ukwelashwa ngisho nangemva kokuthi ama-blisters avele kusenelisa ukunciphisa isikhathi ngamahora angu-1-2. Ukwelashwa kokunciphisa kubandakanya imithi ye-antiviral nsuku zonke, ngokuvamile i-valacyclovir engu-500mg-1g nsuku zonke ku-herpes yezitho zangasese.

Ukunciphisa kunciphisa ukuvuselelwa kwe-70-80%, kunciphisa ukuncipha kwe-virus okungabonakali ngama-50%, futhi kunciphisa ukudluliswa kwezocansi kubalingani abangathintekanga ngama-50% uma kuhlanganiswa nezinye izinyathelo zokuvikela. Ukwelashwa kokunciphisa kuyas rekomendwa kubantu abaneziqhamo ezivamile (6 noma ngaphezulu ngonyaka), kulabo abahlangabezana nokukhathazeka okukhulu kwengqondo ngenxa yokuphindaphinda, kanye nalabo abakwi-relationships ezihlukene (omunye umngane unokuthola, omunye ungenayo) ukuze kuncishiswe ingozi yokudluliswa. Ukwelashwa kokunciphisa kwesikhathi eside kuhlolwe isikhathi esingaphezu kweminyaka engu-20 futhi akukhombisi izinkinga ezinkulu zokuphepha — kungaqhubeka kuze kube phakade.

Ukumelana ne-antiviral kuyinto engajwayelekile kubantu abanezimfanelo ezinhle. Kubantu abanezimfanelo eziphansi, izilinganiso eziphezulu nezikhathi ezide zingadingeka, futhi ama-strains aphikisanayo angase adinge ama-antivirals ahlukile afana ne-foscarnet.

Ukuqonda komphakathi okukhuluma nge-herpes kuphakathi kokungafani kakhulu neqiniso lezokwelapha lesimo. Lokhu kuqonda kuyiqiniso elisha — kwenziwe kakhulu emakhulwini amakhulukhulu naphakathi kweminyaka yama-1980s ngokuphuma kwemidiya kanye nezimakethe zezimali ezakhayo ezabeka i-herpes njengokwehluleka kwezokuziphatha kunokuba kube yingozi ye-virus ejwayelekile. Ngaphambi kwalolu suku, izilonda ezibandayo ne-herpes yezitho zangasese zazibhekwa njengokungatheni, ukuphindaphinda okungatheni kwabantu abaphilayo.

Iqiniso lezokwelapha limi ngokuphikisana okuqinile nokuqonda: i-herpes simplex ibanjwa ngabaningi bezinhlaka zomhlaba; ayibangeli imiphumela emide kwezempilo kubantu abanezimfanelo ezinhle; ukuphuma kuvame ukuba kuncane futhi kuzinzile; ukwelashwa okusebenzayo kuyatholakala futhi kuyabiza; futhi i-virus ayilimazi phakathi kokuphuma. Kubantu abaningi, i-herpes ayinayo imiphumela emibi empilweni yomzimba futhi idinga ukungenelela okuncane kwezokwelapha. Ukuqhathaniswa nezinye izifo ezivamile kuyasiza: i-HPV (i-human papillomavirus) ithinta inani eliphezulu labantu abanezimfanelo zokuziphatha, ibangela ama-warts ezitho zangasese futhi ingabangela umdlavuza, kodwa ibanjwa ngempela kancane.

Umkhuhlane wezinyoni (owenziwa yi-herpesvirus ehlukile) uthinta abantu abaningi ebuncaneni ngezimpawu ezinzima, kodwa awunayo ukuqonda komphakathi. Ukuhlupheka kwemizwa okubangelwa ukuqonda kwe-herpes — ukuhluleka, ukwesaba ukuphikiswa, ukukhathazeka ngokuqhakambisa, ukugwema ubudlelwane — kuvame ukwedlula ubuhlungu bomzimba be-virus uqobo. Abantu abaningi babika ukuthi ukuthola ukuxilongwa kwe-herpes kubashiye bephukile ngokwengqondo, kuyilapho izimpawu zomzimba zivele zibe zincane noma zingekho.

Abahlinzeki bezempilo baye baqaphela ukuthi ukubhekana nomthelela wokwengqondo wokuxilongwa kwe-herpes kubalulekile njengokuphatha izimpawu zomzimba. Ukuhlola, ukufundisa, nokuxhumana nemiphakathi yokwesekwa kungasiza ukuhlela ukuxilongwa kusuka ekuphazamisekeni kube yisimo esijwayelekile, esilawulwayo.

Ngenkathi ukuphuma kwe-herpes kuvame ukuba okungelula kwezokwelapha, izimo ezithile zidinga ukunakwa okuphuthumayo kwezokwelapha. Ukuphuma kokuqala okukhathazekile kufanele kuhlolwe njalo ngumdokotela ukuze kuqinisekiswe ukuxilongwa okufanele (ukuhlola kwezokwelapha nokuhlola i-virus noma ukuhlola i-PCR), ukuze kuqinisekiswe ezinye izimo ezingase zifane ne-herpes (i-syphilis, i-chancroid, ama-ulcers e-aphtous, i-contact dermatitis), kanye nokwakha uhlelo lokwelashwa. Ukuphuma okukhulu okunezimpawu eziningi, ubuhlungu obukhulu, ukugcina amanzi (ukungakwazi ukuhamba ngenxa yobuhlungu be-herpes yezitho zangasese), noma izimpawu ezijwayelekile ezifana nokushisa okuphezulu kudinga ukuhlolwa ngokuphuthumayo.

I-herpes eduze kweso (i-herpes keratitis) iyingozi yezokwelapha engase ibangele ukulimala kokuphuma kweso nokulahleka kokubona — izimpawu zifaka ubuhlungu beso, ububomvu, ukuhamba, ukukhathazeka kokukhanya, kanye nokubona okungacacile; funa ukuhlolwa kwe-ophthalmologic ngokuphuthumayo. Ukuphuma okwandayo okudlula endaweni ejwayelekile noma okuthinta izindawo ezinkulu zomzimba kungase kubonise ukuncipha kokuvikela futhi kudinge ukuhlolwa kwezokwelapha. I-herpes ngesikhathi sokukhulelwa idinga ukuphathwa ngokucophelela ukuvimbela i-herpes ye-neonatal, engase ibe yingozi kubantwana abasha — abesifazane abakhulelwe abane-herpes kufanele baxoxe ngokuqhubeka kokwelashwa ngesikhathi sokukhulelwa kwesithathu nodokotela wezokwelapha.

Uma ukuphuma kuqhubeka ngokuphindaphindiwe noma kube kubuhlungu kakhulu ngokuhamba kwesikhathi (umkhuba ojwayelekile unciphisa ukuvuselelwa), lokhu kungase kubonise izinguquko zokuvikela ezidinga ukuhlolwa. Abaguli abahlangabezana nokukhathazeka okukhulu, ukudangala, noma ubunzima bobudlelwane obuhlobene ne-herpes kufanele bafune kokubili ukunakekelwa kwezokwelapha ukuze kuqinisekiswe ukuphathwa kwe-virus nokwesekwa kwengqondo ukuze kuncishiswe umthwalo wokwengqondo.

Izilonda ze-herpes simplex zingase zixhunywe nezinye izimo — i-impetigo, i-contact dermatitis, ama-ulcers e-aphtous, isifo se-hand-foot-and-mouth, futhi ngisho ne-shingles yokuqala zingase zibonakale ngendlela efanayo. I-Skinscanner inikeza ukuhlolwa kokuqala okusheshayo okusize uqonde ukuthi ingabe izilonda zakho zinezakhiwo ezihambisana ne-herpes simplex. Ngokuthwebula isithombe sendawo ethintwe ngesikhathi sokuphuma kwe-blister noma kwe-ulcer, i-AI yethu ihlaziya umkhuba wezilonda, ukusabalala, nezici zomfanekiso ezijwayelekile ze-herpes uma kuqhathaniswa nezinye izimo.

Lokhu kubalulekile ikakhulukazi kubantu abahlangabezana nesikhathi sokuqala abangenandaba lokuthi baphatha ini, kanye nalabo abaneziqhamo eziphindaphindiwe abafuna ukuqinisekisa ukuthi izilonda ezintsha zihambisana nomkhuba wabo owaziwayo we-herpes kunokuthile okusha. Ukuze kuqondwe, ukubhaliswa kokuphuma njalo nezinga lokuphuma ngezithombe nezinsuku kusiza wena nodokotela wakho ukwenza izinqumo ezicacile mayelana nezindlela zokwelashwa — ukwelashwa okuphindaphindiwe noma ukwelashwa kokunciphisa — ngokusekelwe kudatha eqondile mayelana nomkhuba wakho wokuphuma. I-Skinscanner ayikwazi ukuqinisekisa ukuxilongwa kwe-herpes (lokhu kudinga ukuhlola i-virus noma ukuhlola i-PCR) kodwa inikeza isinyathelo sokuqala esitholakalayo ekuqondeni izimpawu zakho nasekuthatheni isinqumo sokuthi kufanele yini futhi kanjani ngokuphuthumayo ukufuna ukuhlolwa kwezokwelapha.