Герпес-вирусная инфекция: эпидемиология, диагностика, терапия

Доброхотова Ю.Э., Боровкова Е.И. Герпес-вирусная инфекция: эпидемиология, диагностика, терапия. Гинекология. 2017; 19 (5): 20–25.
DOI: 10.26442/2079-5696_19.5.20-25

________________________________________________

Dobrokhotova Yu.E., Borovkova E.I. Herpes-viral infection: epidemiology, diagnosis, therapy. Gynecology. 2017; 19 (5): 20–25. DOI: 10.26442/2079-5696_19.5.20-25

Читать PDF

Аннотация

Генитальный герпес является распространенным заболеванием, диагностируемым у 90% людей, и характеризуется рецидивирующим пожизненным течением. Клинические проявления разнообразны и обнаруживаются у 20% инфицированных. «Золотым стандартом» диагностики остаются выявление культуры вируса и метод полимеразной цепной реакции в режиме реального времени. Проведение пероральной противовирусной терапии значительно снижает продолжительность, тяжесть заболевания и риск инфицирования полового партнера. При первичном эпизоде генитального герпеса необходимо проводить системную противовирусную терапию с максимально ранним ее стартом. Эффективность применения ацикловира, валацикловира и фамцикловира сопоставима, но только у валацикловира доказана эффективность двухкратного ежедневного дозирования. Для пациентов с шестью и более эпизодами обострений в год показано проведение супрессивной терапии, препаратом выбора является валацикловир. При частоте рецидивов менее 6 в год достаточно проведение эпизодической противовирусной терапии. Клинические испытания продемонстрировали сопоставимую эффективность ацикловира, фамцикловира и валацикловира. Трехдневный курс валацикловира (500 мг 2 раза в день) наиболее приемлем в связи с высокой биодоступностью и быстрым купированием виремии.

Ключевые слова: генитальный герпес, вирус простого герпеса, беременность, противовирусная терапия, валацикловир, внутриутробное инфицирование.

________________________________________________

Genital herpes is a common disease diagnosed in 90% of people and is characterized by a recurring lifelong course. Clinical manifestations are diverse and manifest in 20% of infected people. The gold standard for diagnosis is the detection of virus culture and polymerase chain reaction in real time. Conducting oral antiviral therapy significantly reduces the duration, severity of the disease and the risk of infection of the sexual partner. At the initial episode of genital herpes it is necessary to carry out system antiviral therapy with its earliest start. The effectiveness of the use of acyclovir, valaciclovir and famciclovir is comparable, but only with valaciclovir the efficacy of two-fold daily dosing is proved. For patients with 6 or more episodes of exacerbations per year, suppressive therapy is indicated, the drug of choice is valaciclovir. With a relapse rate of less than 6 per year, it is sufficient to conduct episodic antiviral therapy. Clinical trials have demonstrated comparable efficacy of acyclovir, famciclovir and valaciclovir. The three-day course of valaciclovir (500 mg 2 times a day) is most suitable in view of the high bioavailability and rapid relief of viremia.

Key words: genital herpes, herpes simplex virus, pregnancy, antiviral therapy, valaciclovir, intrauterine infection.

Полный текст

Материалы доступны только для специалистов сферы здравоохранения.
Чтобы посмотреть материал полностью Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Bernstein DI, Bellamy AR, Hook EW et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis 2013; 56: 344.
2. Schillinger JA, McKinney CM, Garg R et al. Seroprevalence of herpes simplex virus type 2 and characteristics associated with undiagnosed infection: New York City, 2004. Sex Transm Dis 2008; 35: 599.
3. Xu F, Sternberg MR, Kottiri BJ et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006; 296: 964.
4. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1.
5. Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of herpes simplex virus types 1 and 2. United States, 1999–2010. J Infect Dis 2014; 209: 325.
6. Centers for Disease Control and Prevention (CDC). Seroprevalence of herpes simplex virus type 2 among persons aged 14–49 years. United States, 2005–2008. MMWR Morb Mortal Wkly Rep 2010; 59: 456.
7. Sizemore JM Jr, Lakeman F, Whitley R et al. The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic. J Infect Dis 2006; 193: 905.
8. Langenberg AG, Corey L, Ashley RL et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. N Engl J Med 1999; 341: 1432.
9. Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 2003; 30: 797.
10. Jin F, Prestage GP, Mao L et al. Transmission of herpes simplex virus types 1 and 2 in a prospective cohort of HIV-negative gay men: the health in men study. J Infect Dis 2006; 194: 561.
11. Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med 2004; 350: 1970.
12. Gupta R, Warren T, Wald A. Genital herpes. Lancet 2007; 370: 2127.
13. Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med 1983; 98: 958.
14. Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med 1999; 131: 14.
15. Mertz GJ, Critchlow CW, Benedetti J et al. Double-blind placebo-controlled trial of oral acyclovir in first-episode genital herpes simplex virus infection. JAMA 1984; 252: 1147.
16. Johnston C, Magaret A, Selke S et al. Herpes simplex virus viremia during primary genital infection. J Infect Dis 2008; 198: 31.
17. Gupta R, Warren T, Wald A. Genital herpes. Lancet 2007; 370: 2127.
18. Gupta R, Wald A, Krantz E et al. Valacyclovir and acyclovir for suppression of shedding of herpes simplex virus in the genital tract. J Infect Dis 2004; 190: 1374.
19. Fife KH, Almekinder J, Ofner S. A comparison of one year of episodic or suppressive treatment of recurrent genital herpes with valacyclovir. Sex Transm Dis 2007; 34: 297.
20. Mills J, Mindel A. Genital herpes simplex infections: some therapeutic dilemmas. Sex Transm Dis 2003; 30: 232.
21. Lebrun-Vignes B, Bouzamondo A, Dupuy A et al. A meta-analysis to assess the efficacy of oral antiviral treatment to prevent genital herpes outbreaks. J Am Acad Dermatol 2007; 57: 238.
22. Fife KH, Crumpacker CS, Mertz GJ et al. Recurrence and resistance patterns of herpes simplex virus following cessation of > or = 6 years of chronic suppression with acyclovir. Acyclovir Study Group. J Infect Dis 1994; 169: 1338.
23. Reitano M, Tyring S, Lang W et al. Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. International Valaciclovir HSV Study Group. J Infect Dis 1998; 178: 603.
24. Wald A, Selke S, Warren T et al. Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis 2006; 33: 529.
25. Cernik C, Gallina K, Brodell RT. The treatment of herpes simplex infections: an evidence-based review. Arch Intern Med 2008; 168: 1137.
26. Corey L, Fife KH, Benedetti JK et al. Intravenous acyclovir for the treatment of primary genital herpes. Ann Intern Med 1983; 98: 914.
27. Corey L, Benedetti J, Critchlow C et al. Treatment of primary first-episode genital herpes simplex virus infections with acyclovir: results of topical, intravenous and oral therapy. J Antimicrob Chemother 1983; 12 (Suppl. B): 79.
28. Perry CM, Wagstaff AJ. Famciclovir. A review of its pharmacological properties and therapeutic efficacy in herpesvirus infections. Drugs 1995; 50: 396.
29. Perry CM, Faulds D. Valaciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in herpesvirus infections. Drugs 1996; 52: 754.
30. Bryson YJ, Dillon M, Lovett M et al. Treatment of first episodes of genital herpes simplex virus infection with oral acyclovir. A randomized double-blind controlled trial in normal subjects. N Engl J Med 1983; 308: 916.
31. Loveless M, Sacks SL, Harris JRW. Famciclovir in the management of first episode genital herpes. Infect Dis Clin Pract 1997; 6: S12.
32. Fife KH, Barbarash RA, Rudolph T et al. Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Study Group. Sex Transm Dis 1997; 24: 481.
33. Wald A, Benedetti J, Davis G et al. A randomized, double-blind, comparative trial comparing high- and standard-dose oral acyclovir for first-episode genital herpes infections. Antimicrob Agents Chemother 1994; 38: 174.

________________________________________________

Авторы

Ю.Э.Доброхотова, Е.И.Боровкова*

ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*katyanikitina@mail.ru

________________________________________________

Yu.E.Dobrokhotova, E.I.Borovkova*

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*katyanikitina@mail.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.