Herpetic urethritis

Herpetic urethritis is a viral disease characterized by a variety of clinical symptoms. In the past few years, there has been a trend towards widespread distribution. According to modern literature, the number of new cases increased by more than 10%.

[1], [2], [3], [4]

Causes of the herpetic urethritis

The causative agent of herpetic urethritis is the herpes simplex virus type 2, which is secreted with a primary lesion of the genital organs. Herpetic urethritis is very contagious, infection occurs when intimate, intimate contacts.

In this case, infection can occur from an infected patient both having symptoms of the disease, and in their absence. Primary infection is often accompanied by severe symptoms, after which the virus goes into a latent state. A repeated exacerbation of the disease is observed in approximately 75% of patients.

[5], [6], [7], [8]

Symptoms of the herpetic urethritis

Symptoms of herpetic urethritis in men appear 3-7 days after contact: on the penis, the inner surface of the prepuce, in the urethra, local erythema, vesicles, erupt, form ulcers framed by a red inflammatory fringe. Herpetic eruptions are usually localized in the scaphoid fossa and do not extend beyond the hanging portion of the urethra. When urethroskopii they look like multiple small erosion, sometimes merging into a larger focus, which is accompanied by pain and fever, inguinal lymphadenitis, dysuria.

Appear scanty mucous discharge from the urethra, usually in the form of a morning drop, accompanied by a slight tingling or burning. As a rule, the symptoms of herpetic urethritis disappear after 1-2 weeks. But most patients have relapses with an interval of several weeks to several years. As a rule, the recurrence of viral urethritis proceeds more easily than the primary infection. In case of bacterial infection, the discharge becomes purulent, more abundant, and the duration of the disease increases to 3 weeks or more. In sexual partners of patients with herpetic urethritis, long-term endocervicitis, which is also very resistant to treatment, is often found.

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Diagnostics of the herpetic urethritis

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

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

At present, specific and sensitive methods for the detection of the antigen of the herpes simplex virus are being successfully applied - the direct immunofluorescence reaction, in which rounded formations with a bright green glow appear in the nuclei of the affected epithelial cells.

[12], [13], [14], [15], [16]

Treatment of the herpetic urethritis

Treatment of herpetic urethritis is extremely difficult task, as the disease can proceed latently. Principles of treatment of genital herpes:

• treatment of the first clinical episode of herpes;
• treatment of relapses;
• prolonged suppressive therapy.

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

• Acyclovir 400 mg orally 3 times a day 7-10 days or 200 mg orally 5 times a day 7-10 days;
• or famciclovir 250 mg orally 5 times a day for 7-10 days;
• or Valaciclovir 1 g inside twice a day for 7-10 days.

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

With insufficient effectiveness of treatment after a 10-day course, further administration of the drug is possible.

Acyclovir is the drug of choice and usually provides a fairly successful treatment. Clinical observations confirmed the effectiveness of this drug: when it is used in patients with a primary lesion of the genital tract, both the spread of the virus and the severity of clinical symptoms decrease. The drug is used inside, intravenously, topically (3-5% acyclovir ointment).

Existing methods of treatment of herpetic urethritis allow only 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 face recurrence of the disease. This is less common in patients initially infected with the herpes simplex virus type 1. Anti-herpetic therapy for relapses is prescribed occasionally during clinical manifestations of genital herpes to improve the condition of patients and reduce the duration of relapse. She 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 are data on the efficacy and safety of acyclovir for more than 6 years and the drugs valaciclovir and famciclovir for more than a year.

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

Recommended regimens for the pharmacotherapy of recurrences of genital herpes are as follows:

• Acyclovir 400 mg 3 times a day for 5 days, or 800 mg twice a day for 5 days, or 800 mg 3 times a day for 2 days; .
• or famciclovir 125 mg 3 times daily for 5 days or 100 "m 2 times a day 1 day;
• or valaciclovir 1 g 2 times a day for 5 days or 500 mg 2 times a day for 3 days.

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

• Acyclovir 400 mg twice a day;
• or famciclovir 250 mg twice a day;
• or valaciclovir 500 mg once a day or 1 g once a day.

It is recommended that the drug be stopped periodically (every 12 months) to assess possible changes in the course of the disease.

Valacyclovir 500 mg once a day may be less effective than other dosage regimens, as well as acyclovir in patients with very frequent relapses (more than 10 times a year). This dictates the need to search for more effective methods of chemotherapy and specific prevention of this infection.

Etiotropic treatment of herpetic urethritis may also include bromuridin, ribovirin, bonofon, epigen, gossypol, megasil.

With recurrent forms of herpetic infection, antiviral therapy is supplemented with the appointment of immunomodulators (interleukins, cycloferon, roferon, interferon inducers).

For complete remission vaccine prophylaxis is required for herpes vaccine and antioxidant protection.

It should be noted that in the treatment of children, elderly and senile patients suffering from herpetic urethritis, patients with chronic renal and hepatic insufficiency, including those on hemodialysis, a corresponding dose adjustment is necessary.