Herpetic urethritis

Herpetic urethritis is a viral disease characterized by a variety of clinical symptoms. In recent years, a tendency towards their widespread distribution has been noted. According to modern literature, the number of newly infected people has increased by more than 10%.

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Causes herpetic urethritis

The causative agent of herpetic urethritis is the herpes simplex virus type 2, which is isolated with predominant damage to the genitals. Herpetic urethritis is highly contagious, infection occurs during close, intimate contacts.

In this case, infection can occur from an infected patient both with and without symptoms of the disease. Primary infection is often accompanied by pronounced symptoms, after which the virus goes into a latent state. Repeated exacerbation of the disease is observed in approximately 75% of patients.

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Symptoms herpetic urethritis

Symptoms of herpetic urethritis in men appear 3-7 days after contact: local erythema and vesicles appear on the penis, the inner surface of the foreskin, and in the urethra, which, when broken through, form ulcers framed by a red inflammatory border. Herpetic eruptions are usually localized in the scaphoid fossa and do not extend beyond the hanging part of the urethra. During urethroscopy, they look like multiple small erosions, sometimes merging into a larger lesion, which is accompanied by pain and fever, inguinal lymphadenitis, and dysuria.

There is scanty mucous discharge from the urethra, usually in the form of a morning drop, accompanied by a slight tingling or burning sensation. As a rule, the symptoms of herpetic urethritis disappear after 1-2 weeks, but most patients experience relapses at intervals from several weeks to several years. As a rule, relapses of viral urethritis are milder than the primary infection. In the case of a bacterial infection, the discharge becomes purulent, more abundant, and the duration of the disease increases to 3 weeks or more. Sexual partners of patients with herpetic urethritis often have long-term endocervicitis, which is also very resistant to the treatment.

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Diagnostics herpetic urethritis

Diagnosis of herpetic urethritis is based on the detection of multidimensional giant cells and intracellular inclusions in scrapings or smears taken from the bases of fresh herpetic lesions of the skin or mucous membrane of the urethra.

PCR diagnostics and indirect agglutination reaction are also carried out: the herpes virus is fixed in tannin-sensitized erythrocytes. The result is obtained in a few hours.

Currently, specific and sensitive methods for detecting the herpes simplex virus antigen are successfully used - the direct immunofluorescence reaction, in which rounded formations with a bright green glow are visible in the nuclei of affected epithelial cells.

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Treatment herpetic urethritis

Treatment of herpetic urethritis is an extremely difficult task, since the disease can be latent. Principles of treatment of genital herpes:

• treatment of the first clinical episode of herpes;
• treatment of relapses;
• long-term suppressive therapy.

Recommendations for the treatment of the first clinical episode of genital herpes:

• acyclovir 400 mg orally 3 times a day for 7-10 days or 200 mg orally 5 times a day for 7-10 days;
• or famciclovir 250 mg orally 5 times a day for 7-10 days;
• or valacyclovir 1 g orally 2 times a day for 7-10 days.

Treatment of herpetic urethritis should be started as early as possible, immediately after the first symptoms of the disease appear.

If the treatment is not effective enough after a 10-day course, further use of the drug is possible.

Acyclovir is the drug of choice and usually provides quite successful treatment. Clinical observations have confirmed the effectiveness of this drug: when used in patients with primary genital tract infection, both the spread of the virus and the severity of clinical symptoms are reduced. The drug is used orally, intravenously, and locally (3-5% acyclovir ointment).

Existing methods of treating herpetic urethritis only allow to stop relapses of the disease, but not to eliminate relapses of the disease. Most patients with the first clinical episode of infection with the herpes simplex virus type 2 then experience relapses of the disease. This is less common in patients initially infected with the herpes simplex virus type 1. Antiherpetic therapy for relapses is prescribed episodically during clinical manifestations of genital herpes to improve the condition of patients and reduce the duration of the relapse. It is prescribed for a long time as a suppressive therapy, which reduces the number of relapses in patients with frequent exacerbations of the disease (more than 6 times a year) by 70-80%. With such treatment, many patients note the absence of clinical episodes. There is data on the effectiveness and safety of taking acyclovir for more than 6 years and valacyclovir and famciclovir for more than a year.

Episodic treatment of recurrent genital herpes should be started on the first day of clinical manifestations or during the prodromal period.

The recommended drug therapy regimens for recurrent genital herpes are as follows:

• acyclovir 400 mg 3 times a day for 5 days, or 800 mg 2 times a day for 5 days, or 800 mg 3 times a day for 2 days;
• or famciclovir 125 mg 3 times a day for 5 days or 100 mg 2 times a day for 1 day;
• or valacyclovir 1 g 2 times a day for 5 days or 500 mg 2 times a day for 3 days.

In order to prevent relapses of herpes infection, suppressive therapy regimens have been developed:

• acyclovir 400 mg 2 times a day;
• or famciclovir 250 mg 2 times a day;
• or valacyclovir 500 mg once a day or 1 g once a day.

It is recommended to periodically discontinue taking the drug (once every 12 months) to assess possible changes in the course of the disease.

Valaciclovir 500 mg once daily may be less effective than other dosing regimens, as well as aciclovir in patients with very frequent relapses of the disease (more than 10 times a year). This dictates the need to find more effective methods of chemotherapy and specific prevention of this infection.

Etiotropic treatment of herpetic urethritis may also include bromuridine, ribovirin, bonofton, epigen, gossypol, megasil.

In recurrent forms of herpes infection, antiviral therapy is supplemented by the administration of immunomodulators (interleukins, cycloferon, roferon, interferon inducers).

For complete remission, herpes vaccine prophylaxis and antioxidant protection are mandatory.

It should be noted that when treating children, elderly and senile people suffering from herpetic urethritis, patients with chronic renal and hepatic insufficiency, including those on hemodialysis, an appropriate adjustment of the drug dosage is necessary.