Treatment Of Genital Herpes Infections Research Articles

Suchasni zasady likuvannia henitalnoho herpesu u zhinok (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. Recently, much attention has been paid to the problem of new approaches in the treatment of genital herpes in women. The problem is extremely important, because this genital infection is very common in the world. The main types of genital infection are herpes simplex virus (HSV-1) and (HSV-2). Worldwide, more than 400 million people have genital herpes caused by HSV-2. In the United States of America (USA), nearly one in five adults (approximately 40 million people) have HSV-2 infection, with approximately one million new infections occurring each year. The aim of the study. To analyze the modern principles of treatment of genital herpes in women, using literary sources and the results of own research. Materials and methods. In total, twelve publications by foreign authors were selected and processed based on their relevance to the chosen topic, and information on the effectiveness of the use of the antiviral agent “Virostat” in one’s own practice was provided. Results. To date, there are several strategies for the use of antiherpetic drugs (acyclovir, virostat (famciclovir), valacyclovir), which have been studied and tested in cases of first infection with genital herpes, episodic and suppressive cure. There are two important priorities for the treatment of genital herpes: the first is to prevent clinical manifestations and relapses, and the second is to prevent transmission to sexual partners. Our clinical experience allows us to recommend the use of the Ukrainian medicine “Virostat” (producer “Kyiv Vitamin Plant”) for the treatment of HSV infection in women with various clinical manifestations. Conclusions. To date, it should be noted that genital herpes remains a very common sexually transmitted disease. The increasing frequency of HSV-1 and HSV-2 is associated with recurrences of genital ulcer disease. HSV-2 plays a key role in the spread of HIV and, although rare, HSV-1 and HSV-2 lead to severe complications if contracted during pregnancy, both among mothers and newborns. A review of the literature on the treatment of sexually transmitted diseases as of 2021 found few significant advances in the treatment of genital herpes infections. The greater availability of nucleic acid amplification tests for the diagnosis of HSV in the presence of genital ulcers improves diagnosis in the acute phase, but serological tests lack diagnostic accuracy, so advances in the diagnostic algorithm as well as new diagnostic tools are needed. Although the symptoms of genital herpes can be controlled and transmission to sexual partners can be prevented with antiviral therapy, new treatments with new mechanisms of action will improve the well-being of patients. Considering our clinical experience of using the Ukrainian medicine “Virostat” for various clinical manifestations, we recommend its wide implementation and use.

Применение адоптивной иммунотерапии для лечения герпесвирусной инфекции

Given the ability of the herpes simplex virus to persist for a long time, leading to a decrease in the specific immune response, the treatment of cancer patients with concomitant herpesvirus infection (HVI) is a difficult task. In the 1980s, progress was made in the study of HVI related to the development of the first drug from the group of acyclic nucleosides. Usually, the treatment of HVI includes antiviral agents, analgesics, antipyretics, local drugs with antiviral components and anesthetics. However, wellknown treatment for the disease does not provide complete elimination of the virus, and often after drug withdrawal, the symptoms occur, which causes problems in providing the medical care. Thus, the search for new ways to treat HVI, including in patients with a cancer, is relevant and necessary. The article describes the method for treating patients with HVI using in vitro activated autologous lymphocytes. Six clinical cases of successful treatment of genital herpes infection in patients were considered. Two patients had cancer, in the first case – cervical cancer, in the second – anal cancer. The conducted study allows to conclude that the uing of the method of adoptive immunotherapy for the treatment of patients with HVI improves the quality of life of the patient, induces the high immune response, which manifests itself in the duration of the relapse-free period from 8 to 45 months. Key words: adoptive immunotherapy, autologous lymphocytes, herpes virus infection, cancer patient

Efficiency of a low-intensity laser in the treatment of genital herpes infections

90 women at the age of 30,9±0,4 years with clinical laboratory signs of herpetic defeat of urogenital system took part in research lasting 12 months. Therapy included a preparation Valaciclovir on 500 mg, complex therapy was carried out with use of intra vascular laser radiation of blood (wavelength of 365 nm, power of the radiation of 2 mW, an influence exposition the laser of 8 min, the number of sessions 15) along with application of a preparation Valaciclovir. Results of the study indicate a positive clinical dynamics and immunomodulatory action of intravascular laser irradiation of blood that can be recommended as a method of complex treatment of herpetic lesions of the reproductive system.

Иммунологические аспекты патогенетической терапии генитального герпеса с использованием внутривенного лазерного освечивания крови

Chronic recurrent herpes virus infection of the genitals caused by the herpes virus type 2 is an
 inflammatory polyetiological disease, in the pathogenesis of which the reduction of non-specific resistance of the
 organism, an imbalance of immune factors plays an important role. Treatment of genital herpes infection should
 cover all the links of pathogenesis, including immunological. Clinical and immunological assessment of the effectiveness
 of intravenous laser light of blood in the UV spectral range (wavelength 365 nm, the device "Lasmik-
 VLOK") was carried out. This study involved 79 women at the age of 29,9±0,2 years with clinical signs of
 chronic recurrent genital herpes.
 Etiotropic therapy was conducted with the use of the Aciclovir in a dose of 500 mg once a day for 6
 months. The complex therapy included the use of laser ultrasonic irradiation of blood simultaneously with the
 application of standard methods of treatment. The results of the study indicate the presence of positive clinical
 dynamics and immune-modulating activity of laser ultrasonic spectrum, that allows to recommend this method
 in complex therapy of chronic recurrent genital herpes.

Antiviral treatment of genital herpes.

A review of the randomized, controlled trials in the literature on the treatment of genital herpes infection with aciclovir, famciclovir and valaciclovir. Common clinical questions encountered by physicians, such as the effect of antivirals on symptoms, healing, aborting attacks and subsequent recurrences, are addressed. There is very little comparative data between the three licensed drugs but the little data that there is shows no difference in efficacy, tolerability and toxicity between aciclovir, valaciclovir or famciclovir when taken orally. Choice of therapy would then depend on convenience of dosing and cost.

Pharmacokinetics of novel dipeptide ester prodrugs of acyclovir after oral administration: intestinal absorption and liver metabolism.

The amino acid prodrug of acyclovir (ACV), valacyclovir (VACV), is an effective antiherpetic drug. Systemic availability of ACV in humans is 3 to 5 times higher after oral administration of VACV. Enhanced bioavailability of VACV has been attributed to its carrier-mediated intestinal absorption via hPEPT1 peptide transporter followed by rapid and complete conversion to ACV. An earlier report suggested that the dipeptide ester prodrugs of ACV possess high affinity toward the intestinal oligopeptide transporter hPEPT1 and therefore seem to be promising candidates in the treatment of oral herpes virus infections. In the present study, we have examined the bioavailability of a series of dipeptide prodrugs of ACV after oral administration in Sprague-Dawley rats with cannulated jugular and portal veins. The area under plasma-concentration time curves expressed as minutes microgram milliliter(-1) for total concentration of VACV (208.4 +/- 41.2), and the dipeptide prodrugs Gly-Val-ACV (GVACV) (416.1 +/- 140.9), Val-Val-ACV (VVACV) (147.7 +/- 89.3), and Val-Tyr-ACV (VYACV) (180.7 +/- 81.2) were significantly higher than that of ACV (21.2 +/- 5.2) upon intestinal absorption. Interestingly, the bioavailability of ACV after administration of GVACV was approximately 2-fold higher than VACV. There was significant metabolism by hepatic first pass effect of the dipeptide prodrugs as evident by the higher levels of ACV obtained after systemic absorption compared with intestinal absorption of GVACV and VVACV. The dipeptide prodrugs of ACV exhibited higher systemic availability of regenerated ACV upon oral administration and thus seem to be promising drug candidates in treatment of genital herpes infections.

Genital Herpes Simplex Virus Infections

There has been a dramatic increase in patient visits to physicians for evaluation and treatment of genital herpes infections. This has resulted in part from an increase in genital herpes infections, particularly severe, first-episode genital herpes infections in adults without prior HSV-1 infection. Virus culture remains the most sensitive and specific method for diagnosis, and use of viral cultures is encouraged. Type-specific antibody tests have been employed in studies documenting the role of asymptomatic shedding of HSV in transmission of genital infections, the role of genital HSV in transmission of HIV, the predominance of asymptomatic and unrecognized infections in those infected with HSV-2, and the presence of past asymptomatic or unrecognized acquisition of HSV-2 in 25% of persons presenting with first-episode genital herpes. Unfortunately, commercially available serologic tests do not reliably differentiate between antibody to HSV-1 and HSV-2. Recent studies suggest that the annual risk of transmission from a sexual partner with genital herpes is about 10% in heterosexual couples. Currently, promotion of "safe sex" is the only available approach for prevention of transmission. However, ongoing research is focused on the development of an effective vaccine. Acyclovir should be used routinely in persons with first-episode genital herpes, but careful evaluation is needed in persons with recurrent genital herpes to determine whether episodic or suppressive treatment is indicated. Acyclovir should also be used routinely for episodic or suppressive treatment of HSV infections in persons with AIDS. Additional antiviral agents are needed for more effective suppressive therapy and for treatment of ACV-resistant HSV infections in the immunocompromised host.

Diagnosis and Treatment of Genital Herpes Infections

Oral acyclovir is the treatment of choice for most patients with first episode genital herpes (Table 2). Therapy of first episode herpes may not be indicated in patients whose symptoms and lesions are clearly resolving at the time of presentation, and intravenous acyclovir therapy should be considered in patients with first episode herpes who require hospitalization. A viral culture should be obtained prior to initiating treatment in persons with first episode genital herpes, and typing should be performed to predict the risk and frequency of subsequent recurrences. Serologic differentiation of primary and nonprimary first episode disease is generally not performed outside the research setting. Suppression of recurrent genital herpes infections with daily oral acyclovir therapy has been shown to be safe and effective when continued for periods for up to 2 years. Oral acyclovir suppression should be considered in patients with frequent recurrences who complain of significant morbidity in association with their genital herpes infections (Table 2). The clinical benefit from episodic treatment of recurrent genital herpes infections is less dramatic. Patient-initiated therapy with oral acyclovir at the first sign of prodome or lesions should be considered in patients with relatively severe recurrences who are not candidates for suppressive treatment. Virologic confirmation of infection is encouraged. Oral acyclovir is the treatment of choice for short-term or long-term suppression in immunocompromised hosts, although short-term suppression with intravenous acyclovir may be indicated for persons who cannot take oral medications. Episodic treatment with topical, oral, and intravenous acyclovir is effective in immunocompromised patients, but topical treatment should be limited to persons with external lesions only.

Neutral red with photoinactivation in the treatment of herpes genitalis.

A clinical trial was undertaken to compare the efficacy of neutral red photodynamic inactivation treatment of genital herpes infections with that of a non-photoactive dye, phenol red, as a control. In a series of nineteen patients with virologically proven herpes genitalis who were adequately followed, eleven were treated with neutral red, and eight with phenol red; no difference in response to therapy was found between the two groups, and it is concluded that under the conditions of this trial neutral red with photoinactivation was not effective in the treatment of acute genital herpes infections. Approximately 75 per cent. of those with vulval lesions also had concurrent cervical infection, so that an effective topical treatment would need to be applicable to both anatomical sites.