Genital herpes in practice of gynecologist: complicated questions - simple answers

• Tamara N. Bebneva
• Marina B. Khamoshina
• Marina S. Tulupova
• Agamurad A. Orazmuradov
• Mekan R. Orazov
• Marianna Z. Abitova

Abstract

Among specific genital infections, genital herpes (GH) takes a special place. For a gynecologist, aspects of timely diagnosis and therapy are of prime importance, including possibility of an atypical course of the disease and virus transmission through sexual encounter from asymptomatic carriers, since GH creates opportunities for viral invasion into tissues of endometrium, increases risks of miscarriage and failure to become pregnant after in vitro fertilization. Algorithms for management of patient or married couples shall comply with current clinical practice guidelines. At a fundamental level of GH therapy there is nucleoside analogues usage, which can reduce the period of clinical implications (episodic therapy), as well as reduce number of disease recurrences and viral transmission probability (suppressive therapy). Evidence-based data suggests that valaciclovir usage (second generation' acyclic nucleoside) allow to reduce effective daily dose, reverse HG symptoms faster, prolong delaying time to relapse, increase compliance and safety of therapy. All of this makes valaciclovir the drug of choice if suppressive therapy, including long-term therapy is necessary. When managing patients with GH, especially with an atypical or asymptomatic disease, it is necessary to inform them about features of the infection course and importance for examination and treatment of sex partners, as well as about therapy which is aimed at primary prevention of viral transmission and reducing number of disease recurrences.

Keywords:genital herpes, treatment, suppressive therapy, specific genital infections

References

1. Krasnopolsky V.I., Serova O.F., Tumanova V.A., et al. The effect of infections on the reproductive system of women. Rossiyskiy vestnik akushera-ginekologa [Russian Bulletin of Obstetrician-Gynecologist]. 2004; 4 (5): 26-9. (in Russian)

2. Tulupova M.S., Khamoshina M.B. Male reproductive health in couples suffering from miscarriage. Vestnik RUDN. Seriya Meditsina. [Bulletin of Russian Peoples’ Friendship University. Series Medicine]. 2011; 5: 274-9. (in Russian)

3. Radzinsky V.E., Khamoshina M.B., Shelenina L.A., Klimova O.I., Lebedeva M.G., Zamotina I.V. Vaginal infection treatment: different aspects of the problem (international reality and local experience). Doctor.Ru. Gynecology. Endocrinology. 2013; 7: 13-7. (in Russian)

4. Ashley R.L., Wald A. Genital herpes: review of the epidemic and potential use of type-specific serology. Clin Microbiol Rev. 1999; 12: 1-8.

5. Khamoshina M.B. Pathology of the cervix and genital infections in adolescent girls of the Primorsky Territory // Collection of materials of the 1st Russian Congress “Genital infections and pathology of the cervix”. Мoscow, 2004: 26. (in Russian)

6. Goryachkina M.V., Belousova T.A. Dermatocosmetological aspects of herpes virus infection Eksperimental’naya i klinicheskaya dermatokosmetologiya kosmetologiya [Experimental and clinical dermatocosmetology]. 2006; 12: 56-60. (in Russian)

7. Kuzmin V.N. A modern view of the clinical course, diagnosis and therapy of genital herpes in women.Lechashchiy vrach [Attending doctor]. 2009; 3: 42-7. (in Russian)

8. Uuskula A., Raukas E. Atypical genital herpes: report of five cases. Scand J Infect Dis. 2004; 36 (1): 37-9.

9. Clinical recommendations of the Ministry of Health of the Russian Federation. Herpes simplex (PG) in adults. M., 2016.

10. Posiseeva L.V., Tulupova M.S., Khamoshina M.B. Male contribution to miscarriage: insight into problem. Doctor.Ru. Gynecology. Endocrinology. 2013; 7 (85): 56-60. (in Russian)

11. Tronstein E., Johnston C., Huang M.L., Selke S., et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. 2011; 305 (14): 1441-9. doi: 10.1001/ jama.2011.420.

12. Corey L., Wald A. Genital herpes. In: K.K. Holmes, P.F. Sparling, P.A. Mardh et al. (eds). Sexually Transmitted Diseases. 3rd ed. New York: McGraw-Hill, 1999: 285-312.

13. Wald A., Zeh J., Selke S., et al. Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med. 1995; 333: 770-5.

14. Mertz G.J., Benedetti J., Ashley R., Selke S.A., et al. Risk factors for the sexual transmission of genital herpes. Ann Intern Med. 1992; 116: 197-202.

15. Wald A., et al. N Engl J Med. 2000; 342: 845-50.

16. WHO Guidelines for the Treatment of Genital Herpes Simplex Virus. Department of Reproductive Health and Research. Geneva: World Health Organization, 2016: 47 p. URL: http://apps.who.int/

17. Genital herpes. Clinical recommendations. RODVK, 2016. (in Russian)

18. Patel R. et al. European Guideline for the Management of Herpes. 2010.

19. Esber A.L., Miguel R.D.V., Cherpes T.L., Klebanoff M.A., et al. Risk of bacterial vaginosis among women with herpes simplex virus type 2 infection: a systematic review and meta-analysis. J Infect Dis. 2015; 212 (1): 8-17.

20. Fayzullina D.I. The effectiveness of complex therapy of chronic endometritis after a history of IVF failure.Autoabstract of Diss. Moscow, 2019. 24 p. (in Russian)

21. Marchenko L.A., Lushkova I.P. Genital herpes and its effect on the reproductive health of women. Kachestvo zhizni. Meditsina. [The Quality of Life. The medicine]. 2004; 3 (6): 39. (in Russian)

22. Federal clinical guidelines. Dermatovenerology 2015: Diseases of the skin. Sexually transmitted infections. 5^thed. Moscow: Delovoy ekspress, 2016. 768 p. (in Russian)

23. CDC Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep. 2015; 64: 1-137.

24. Instructions for the medical use of the drug famciclovir. Registration number: LP-001740. (in Russian)

25. Instructions for the medical use of the drug Valvir. Registration number: LP-001723. (in Russian)

26. Spruance S.L., Tyring S.K., DeGregorio B., et al. A Large-scale, placebo-controlled, dose-ranging trial of peroral valaciclovir for episodic treatment of recurrent herpes genitalis. Valaciclovir HSV Study Group. Arch Intern Med. 1996; 156 (15): 1729-35.

27. Goryachkina M.V., Belousova T.A. Episodic and suppressive therapy of herpes simplex using acyclic nucleosides. Klinicheskaya derma-tologiya i venerologiya [Russian Journal of Clinical Dermatology and Venereology]. 2014; 4: 68-74. (in Russian)

28. Patel R., Bodsworth N.J., Woolley P., et al. Valaciclovir for the suppression of recurrent genital HSV infection: a placebo controlled study of once daily therapy. Genitourin Med. 1997; 73: 105-9.

29. Bodsworth N.J., Crooks R.J., Borelli S., et al. Valaciclovir versus aciclovir in patient initiated treatment of recurrent genital herpes: a randomised , double blind clinical trial. Genitourin Med. 1997; 73: 110-6.

30. Халдин А.А. Воспроизведенные ациклическиесинтетические нуклеозиды. Klinicheskaya dermatologiya i venerologiya [Russian Journal of Clinical Dermatology and Venereology]. 2014; 2: 75-8. (in Russian)

31. Warren T., Harris J., Brennan C.A. Efficacy and safety of valacy-clovir for the suppression and episodic treatment of herpes simplex virus in patients with HIV. Clin Infect Dis. 2004; 39 (5): 258-66.

32. Posiseeva L.V., Peretiatko L.P., Kulida L.V., Khamoshina M.B. Placental factors of mortinatality: Possibilities of prevention. Rossiyskiy vestnik akushera-ginekologa [Russian Bulletin of Obstetrician-Gynecologist]. 2014; 14 (5): 83-6. (in Russian)

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