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Основные принципы ведения пациенток с генитальным герпесом
DOI: 10.26442/20795696.2019.1.190236
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Pestrikova T.Yu., Yurasova E.A., Yurasov I.V., Kotelnikova A.V. Basic principles of management of patients with genital herpes (literature review). Gynecology. 2019; 21 (1): 80–85. DOI: 10.26442/20795696.2019.1.190236
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Цель. Поиск адекватных схем этиотропной противовирусной терапии, направленной на снижение частоты рецидивов при генитальном герпесе.
Материалы и методы. Для написания данного обзора был осуществлен поиск отечественных и зарубежных публикаций в российских и международных системах поиска (PubMed, eLIBRARY и пр.) за последние 2–10 лет. В обзор были включены статьи из рецензируемой литературы.
Результаты. В обзоре изложены особенности клинического течения генитального герпеса, его диагностики, дифференциальной диагностики, осложнений. Представлены различные схемы лечения. Проведена оценка эффективности этиотропной терапии различными препаратами.
Выводы. Эпизодическое использование при рецидивирующем генитальном герпесе валацикловира позволяет статистически значимо снизить тяжесть и продолжительность текущего рецидива, оказать психологическую поддержку пациенткам.
Ключевые слова: генитальный герпес, хроническое рецидивирующее заболевание, этиотропная противовирусная терапия, валацикловир.
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Background. Genital herpes is a chronic recurrent sexually transmitted viral disease. Recurrent genital herpes is a serious medical and psychosocial issue which significantly worsens patients’ quality of life. Such a course of the disease is a stressful and psycho-traumatic factor limiting patients’ social life. In addition, in about 10% of cases, relapses of genital herpes cause depression, acute psychosis and suicidal tendencies. Herpesvirus infection occupies a leading position among perinatal TORCH infections. Herpes infection exerts an unfavorable and often fatal effects on pregnancy and childbirth and it is of a relevant issue up today since its role in causing fetal and newborn disorders does not tend to decrease. Current an increase in genital herpes relapse rate dictates need for further research. Study of various etiotropic antiviral therapy regimens effectiveness is necessary for the further elaboration of optimal treatment regimens and preparation for pregnancy.
Aim. To search for adequate etiotropic antiviral therapy regimens aimed at reducing genital herpes relapse rate.
Materials and methods. To write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2–10 years. The review includes articles from peer-reviewed literature.
Results. The review describes features of genital herpes clinical course, its diagnosis, differentiated diagnosis and complications. Various treatment regimens are presented. The effectiveness of etiotropic therapy with various drugs was estimated.
Conclusions. Episodic use of valaciclovir for recurrent genital herpes allows to reduce significantly a current relapse severity and duration as well as to provide psychological support to patients.
Key words: genital herpes, chronic recurrent disease, etiotropic antiviral therapy, valaciclovir.
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23. Инструкция по применению Валвира. https://yandex.ru/health/pills/product/valvir-35633
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24. Инструкция по применению Ацикловира. https://yandex.ru/health/pills/product/aciklovir-47837
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27. Sauerbrei A. Herpes genitalis: diagnosis, treatment and prevention. Geburtshilfe Frauenheilkd 2016; 76 (12): 1310–7.
28. Handel S, Klinger EJ, Washburn K et al. Population-based surveillance for neonatal herpes in New York City, April 2006–September 2010. Sex Transmit Dis 2011; 38 (8): 705–11.
29. Robinson JL, Vaudry WL, Forgie SE, Lee BE. Prevention, recognition and management of neonatal HSV infections. Expert Rev Antiinfect Ther 2012; 10 (6): 675–85.
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127–31.
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1. Zhenskoe zdorov'e. Rukovodstvo dlia vrachei pervichnogo zvena. Pod red. A.Konnoli, A.Britton. Per. s angl. pod obshch. red. V.N.Prilepskoi. Moscow: MEDpress-inform, 2018 (in Russian).
2. Matstsa D. Spravochnik po ginekologii. Pod red. G.T.Sukhikh, I.A.Apolikhinoi. Per. s angl. Moscow: Prakticheskaia meditsina, 2017 (in Russian).
3. Federal'nye klinicheskie rekomendatsii po vedeniiu bol'nykh s genital'nym gerpesom. Moscow, 2015 (in Russian).
4. Ginekologiia. Natsional'noe rukovodstvo. Pod red. G.M.Savel'evoi, G.T.Sukhikh, V.N.Serova et al. 2-e izd., pererab. i dop. Moscow:
GEOTAR-Media, 2017 (in Russian).
5. Pestrikova T.Iu., Iurasov I.V., Iurasova E.A. Vospalitel'nye zabolevaniia v ginekologii. Moscow: Litterra, 2009 (in Russian).
6. Petersen E.E. Infektsii v akusherstve i ginekologii. Per. s angl. pod obshch. red. V.N.Prilepskoi. Moscow: MEDpress-inform, 2007 (in Russian).
7. Bollen L, Whitehead S, Mock P et al. Maternal herpes simplex virus type 2 coinfection increases the risk of perinatal HIV transmission: possibility to further decrease transmission? AIDS 2008; 22: 1169–76.
8. Sarazitdinova V.F. Naibolee rasprostranennye virusnye infektsii, peredavaemye polovym putem (gerpeticheskaia, papillomavirusnaia, tsitomegalovirusnaia). Klin. dermatologiia i venerologiia. 2011; 3: 82–7 (in Russian).
9. Vergou T. Herpes Simplex Virus Infection (Orofacial). Eur Handbook Dermatol Treatments 2015; 373–7. doi.org/10.1007/978-3-662-45139-7_38
10. Patel R, Alderson S, Geretti A et al. European guideline for the management of genital herpes, 2010. Int J STD AIDS 2011; 22: 1–10.
11. Bentley J, Neubauer A., Sauerbrei A. Value of herpes simplex virus typespecific serology: a case report. J. Clin Virol 2012; 54: 269–71.
12. Rukovodstvo po ambulatorno-poliklinicheskoi pomoshchi v akusherstve i ginekologii. Pod red. V.N.Serova, G.T.Sukhikh, V.N.Prilepskoi, V.E.Radzinskogo. 3-e izd., pererab. i dop. Moscow: GEOTAR-Media; 2016 (in Russian).
13. Stanberry LR. Genital and Perinatal Herpes Simplex Virus Infections. Sex Transmit Dis 2013; 26: 273–313. doi.org/10.1016/b978-0-12-391059-2.00012-7
14. Shul'zhenko A.E., Zuikova I.N. Psikhosotsial'nye aspekty genital'noi gerpes-virusnoi infektsii. Ros. zhurn. kozhn. i ven. boleznei. Gerpes (Pril.). 2007; 1: 13–8 (in Russian).
15. Paladino P, Mossman KL. Mechanisms Employed by Herpes Simplex Virus 1 to Inhibit the Interferon Response. J Int Cytokine Res 2009; 29 (9): 599–608. doi.org/10.1089/jir.2009.0074
16. Cao S, Gan Y, Dong X, Lu Z. Herpes simplex virus type 2 and the risk of cervical cancer: a meta-analysis of observational studies. Arch Gynecol Obstet 2014; 290 (6): 1059–66. doi.org/10.1007/s00404-014-3365-7
17. Patel R, Alderson S, Geretti A et al. European guideline for the management of genital herpes, 2010. Int J STD AIDS 2011; 22: 1–10.
18. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1–137.
19. Wagenlehner FM, Brockmeyer NH, Discher T et al. The presentation, diagnosis and treatment of sexually transmitted infections. Dtsch Arztebl Int 2016; 113: 11–23.
20. Pestrikova T.Iu., Iurasova E.A., Iurasov I.V. Medikamentoznaia terapiia v praktike vracha akushera-ginekologa. Moscow: Litterra, 2011 (in Russian).
21. LeGoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J 2014; 11: 1–17.
22. Deutsche STI-Gesellschaft. Sl-Leitlinie STI/STD – Beratung, Diagnostik und Therapie. Online: http://www.awmf.org/uploads/tx_szleitlinien/
059-006 l_S1_STI_STD-Beratung_2015-07.pdf; last access: 22.06.2016.
23. Instruktsiia po primeneniiu Valvira. https://yandex.ru/health/pills/product/valvir-35633 (in Russian).
24. Instruktsiia po primeneniiu Atsiklovira. https://yandex.ru/health/pills/product/aciklovir-47837 (in Russian).
25. WHO. Herpes simplex virus. News bulletin. 2016; 400. http:// www.who.int/mediacentre/factsheets/fs400/ru
26. Jones CA. Vertical transmission of genital herpes: prevention and treatment options. Drugs 2009; 69 (4): 421–34.
27. Sauerbrei A. Herpes genitalis: diagnosis, treatment and prevention. Geburtshilfe Frauenheilkd 2016; 76 (12): 1310–7.
28. Handel S, Klinger EJ, Washburn K et al. Population-based surveillance for neonatal herpes in New York City, April 2006–September 2010. Sex Transmit Dis 2011; 38 (8): 705–11.
29. Robinson JL, Vaudry WL, Forgie SE, Lee BE. Prevention, recognition and management of neonatal HSV infections. Expert Rev Antiinfect Ther 2012; 10 (6): 675–85.
30. Corey L, Wald A. Maternal and neonatal HSV infections. N Engl J Med 2009; 361 (14): 1376–85.
31. Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database System Rev 2008; Is. 1.
32. Pestrikova T.Iu., Iurasova E.A., Kotel'nikova A.V. et al. Otsenka klinicheskoi effektivnosti protivovirusnoi terapii pri retsidiviruiushchem genital'nom gerpese. Akush. i ginekol. 2017; 9: 127–31 (in Russian).
ФГБОУ ВО «Дальневосточный государственный медицинский университет» Минздрава России. 680000, Россия, Хабаровск, ул. Муравьева-Амурского, д. 35
*typ50@rambler.ru
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Tatiana Yu. Pestrikova*, Elena A. Yurasova, Igor V. Yurasov, Anastasia V. Kotelnikova
Far Eastern State Medical University of the Ministry of Health of the Russian Federation. 35, Murav'eva-Amurskogo st., Khabarovsk, 680000, Russian Federation.
*typ50@rambler.ru