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

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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

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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.

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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.

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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

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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

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