Features Treatment of Chronic Nonbacterial Prostatitis/chronic Pelvic Pain Syndrome (Category IIIB) due to Herpetic Infection

Abstract

The objective: to evaluate the effectiveness of the improved treatment of chronic nonbacterial prostatitis CNP/CPPS (category IIIB) of herpetic etiology, by including antiviral and immunomodulating therapy in standard therapy.Materials and methods. 71 people with chronic nonbacterial prostatitis (category IIIB) were examined. The comparison group (group I) consisted of 46 men aged 35,2±4,6 with CNP/CPPS of herpetic etiology, whose patients were divided into two subgroups, 23 people each, who subsequently underwent various types of treatment: traditional treatment of CNP/CPPS according according to the protocol and, accordingly, traditional treatment and additionally 500 mg valaciclovir 2 times a day for 10 days with the transition to maintenance therapy 500 mg 1 time per day for another 20 days and in parallel sodium oxodihydroacridinyl acetate (intramuscular 2,0 ml (250 mg) once a day every 48 hours 10 injections. The control group (group II) consisted of 25 men aged 35,5±2,8 CNP/CPPS without viral infection. The state of local and systemic immunity before and after treatment was assessed by the level of indicators: IFN-γ in blood serum and the content of secretory immunoglobulin A (sIgA) in the ejaculate of patients, the level of pro-inflammatory interleukin 6 (IL-6) and anti-inflammatory interleukin 10 (IL-10) in ejaculate. To assess the symptoms of prostatitis, the NIH-CPSI Chronic Prostatitis Symptom Index Scale was used, with an assessment of the quality of life, an assessment of the general condition by the total score (S+L).Results. According to the study, a positive dynamics of prostatitis symptoms was recorded in both subgroups (p<0,05). However, when comparing the results between the subgroups, a significant difference was found in favor of improved treatment (p<0,05). The levels of IFN-γ in the blood serum of patients after both types of treatment significantly improved (р<0,05). When comparing between subgroups, the level of IFN-γ is higher after improved treatment (p<0,001). The results of both types of treatment compared with the control group: after the traditional one, the level of IFN- γ is lower (p<0,05). After improved treatment, the level of IFN-γ in serum did not statistically differ (p>0,05). Dynamics of secretory immunoglobulin A (sІgА) in the ejaculate of patients: in the subgroup of patients after traditional treatment – 20,90±2,09 (p<0,001). In the subgroup of patients after improved treatment, it increased by 20% (p<0,001). Between comparison subgroups, the level of immunoglobulin became significantly higher precisely after improved treatment. The results of both types of treatment compared with the control group: after the traditional level of sІgA – no significant difference was recorded (p>0,05). After improved treatment, sIgA levels are higher than in the comparison group (p<0,05). When assessing the level of IL-6 in the ejaculate, there was a significant decrease after improved treatment, compared with traditional (p<0,05). After the traditional one, the level was high compared with the control group, in patients of the subgroup after advanced treatment, lower than in patients of the control group (p<0,05), which shows the effectiveness of the proposed treatment and the presence of the viral etiology of chronic prostatitis. The level of anti inflammatory interleukin 10 (IL-10) after treatment was: after traditional treatment, 11,36±1,31 (p<0,001), in patients after advanced treatment, according to 12,45±1,24 (p<0,001). When comparing with each other, significantly higher levels of IL-10 were in patients after improved treatment. It should be noted that in patients of both subgroups, the indices after treatment (both traditional and advanced) were significantly higher than the indicators of IL-10 in the ejaculate in patients of the control group.Conclusion. The proposed therapy with the inclusion in treatment, along with the traditional, chronic nonbacterial prostatitis of the herpetic etiology of valaciclovir and sodium oxodihydroacridinyl acetate is significantly more effective than traditional monotherapy according to the protocol.