For quotation: Gomberg M.A. Clinical analysis of a case of genital herpes in a young woman // RMJ. 2010. No. 12. P. 782

Patient Zh., 24 years old, consulted a dermatovenerologist.
Complaints. At the time of the examination, she had no complaints, but a week before the visit the patient had vaginal discharge, frequent urination and a burning sensation at the end of urination, pain in the sacral area.
History of the disease. Similar symptoms have been bothering me for the last 3 years. Repeatedly contacted gynecologists and urologists. In urine tests - leukocytosis, however, during bacteriological examination of urine, no growth of flora was detected. Based on the clinical picture, Zh. was diagnosed with cystitis and prescribed various antibiotics, most often ciprofloxacin. After a course of antibiotic therapy, relief occurred each time, but 3-4 times a year the symptoms returned again. The appearance of these symptoms, as a rule, was preceded by the following factors: hypothermia, climate change during vacation, or active and prolonged sexual intercourse. In addition, over the past 4 years, the patient experienced vaginal discharge three times, also accompanied by a burning sensation. She did not contact gynecologists, but on the advice of a friend, who, according to her, had similar symptoms, used suppositories with clotrimazole. Within 5-6 days, the discharge and discomfort stopped. The latest exacerbation was much more severe than before, and coincided with the husband’s return from a business trip (a week before the onset of symptoms). Without turning to doctors, the patient again used the usual tactics, which had helped her previously in similar situations (suppositories with clotrimazole, 1 at night in the vagina for 6 days). If this tactic did not help, the patient took the antibiotic ciprofloxacin 250 mg 2 times a day. 5 days. There were no cases where one or another treatment used did not lead to the disappearance of symptoms by the end of the course. This time, only clotrimazole was sufficient. By the 6th day of its use, all clinical manifestations subsided. Nevertheless, frightened by the latest exacerbation that arose after her husband’s return, the patient decided to undergo examination.
The patient took the latest exacerbation very seriously, as she began to suspect her husband of infidelity. She became irritable, and thoughts of divorce arose. Sex life went wrong. I consulted with my friends and began looking for an explanation of my symptoms on the Internet. Because of the suspicions that had arisen, this time I decided to go not to a gynecologist or urologist, which I had previously done when similar symptoms appeared, but to a dermatovenerologist in order to be thoroughly examined for sexually transmitted infections (STIs).
Life history and gynecological history. Menstruation began at the age of 14 and began immediately. Married for 4 years. The husband is 5 years older than Zh. and is the patient’s first and only sexual partner. J. had no pregnancies. Until now, spouses protected themselves during sexual intercourse with a condom in order to prevent unwanted pregnancy. Sometimes the husband noted the presence of small abrasions on the head of the penis, then the wife did not use a condom, and in order to prevent unwanted pregnancy, they practiced interrupted sexual intercourse.
Inspection data. A physical examination of the patient did not reveal the presence of anogenital warts, molluscum contagiosum, scabies or pubic lice.
Examination of the vulva revealed slight hyperemia in the area of ​​the vaginal vestibule and urethral sponges. Milky vaginal discharge was noted, somewhat more abundant than normal, without an unusual odor. The cervix was unremarkable on examination. Slight hyperemia around the opening of the cervical canal. The pH value of vaginal discharge was 4.5. Aminotest of vaginal contents with 10% KOH gave a negative result. Bimanual examination revealed no pathology.
The tasks facing the doctor could be divided into 2 groups.
1. Related directly to the disease, for which it was necessary to establish the cause of the patient’s symptoms.
2. Prevent possible incorrect conclusions regarding the husband’s adultery and try to find reasons to lift the patient out of a depressive state.
Obviously, both of these tasks had to be solved in parallel, since the patient’s psychological state could affect her desire to cooperate with the doctor and trust him.
Let's consider the doctor's actions taking into account the assigned tasks.
Since it became clear from the conversation with the patient that her main concern was related to the suspicion of contracting a sexually transmitted infection, there were reasons for this, the possible cause of the symptoms should be established as quickly as possible and it was necessary to determine whether the STI infection had recently occurred.
The doctor explained to Zh. that although she did not have convincing evidence for the presence of a recent STI, but, understanding that this issue worried the patient most of all, he suggested, in the process of searching for the causes of her periodic symptoms, to conduct an examination for all major STIs.
This decision reassured J., because allowed her to solve both problems that were troubling her and also strengthened her confidence in the doctor.
Examinations to identify possible causes of the disease.
The main question was: What infections should the patient be screened for, given her medical history and suspicion of a recent STI infection?
The patient's complaints suggested the presence of infection in the vagina (discharge) and in the urinary tract (pain when urinating). In addition, important information provided by the patient for identifying a possible infection was that the complaints appeared approximately a week after her husband returned from a business trip. Those. it was necessary to take into account the incubation period, which for various STIs varies from 2 days to six months.
According to the chart below (Figure 1), there are three main infectious causes of vaginal discharge: bacterial vaginosis (BV), urogenital trichomoniasis (UT), and urogenital candidiasis (UC). That. The differential diagnosis in the case of pathological vaginal discharge is carried out mainly between these three nosologies. In addition, vaginal discharge may also be associated with inflammatory processes in the cervical canal, which may be caused by C. trachomatis, N. gonorrhoeae or M. genitalium.
UT is considered the most common sexually transmitted infection. Incubation period with UT no more than a week. The detection of this infection could indicate an STI infection from the husband. Topical use of clotrimazole for trichomoniasis would not lead to complete disappearance of symptoms.
BV, although not an STI, is considered the most common cause pathological vaginal discharge and is considered as vaginal dysbiosis. Its occurrence could have no connection with receiving the infection from the husband.
UK is also widespread, accounting for about 1/3 of cases in the structure of infectious lesions of the vagina, but, like BV, it is not an STI. Clotrimazole could indeed lead to the disappearance of symptoms if candidiasis was the cause.
Thus, of the three main reasons for the appearance of vaginal discharge, only UT could indicate that our patient was infected with an STI.
As for C. trachomatis, N. gonorrhoeae or M. genitalium, it was impossible to exclude their presence in the patient without special testing, but the likelihood of vaginal discharge occurring just a week after potential infection with these infections seemed unlikely. The fact is that only very severe inflammation in the cervical canal can manifest itself as vaginal discharge, and even so soon - just a week after possible infection. The incubation period for chlamydial infection is 10-14 days. The role of M. genitalium in cervicitis has not yet been proven, although there are reports of the possible role of this infection in this nosology. But with gonorrhea, the incubation period is quite short (3-5 days). For any of these infections, no effect from the use of clotrimazole can be expected. In any case, it was necessary to examine the patient for all these infections.
Causes of symptoms urinary tract
Frequent urination and a burning sensation are the main signs of urethritis or cystitis. What could be the cause of these diseases? The most common cause of urethritis and cystitis is bacteria, in particular E. coli. In addition, pathogens that cause diseases related to STIs that cause cervicitis in women, namely C. trachomatis, N.gonorrhoeae or M. genitalium, can also enter the urethra. True, in the case of our patient, it would be unlikely to expect that intravaginal use of clotrimazole would have an effect in this case. Cystitis and urethritis can also be caused by yeast-like fungi of the genus Candida, but again in these cases the symptoms would not go away after intravaginal use of clotrimazole suppositories.
What about viruses? Specifically, the herpes simplex virus (HSV)? Could HSV be the cause of the urinary tract symptoms that our patient described?
It has long been known that HSV can cause urethritis. According to foreign studies, the frequency of detection of HSV-1, 2 in urethritis ranges from 6 to 25%.
It is generally accepted that the clinical picture of classic herpetic urethritis, in addition to discharge and symptoms of dysuria, includes the presence of vesicular or erosive elements in the genital area. Meanwhile, it is known that the clinical course of herpetic urethritis is often not accompanied by the classic symptoms of genital herpes.
Is there any reason to assume that the problems troubling our patient are of a viral nature?
Let's compare the characteristics of urethritis of bacterial or fungal etiology with viral ones caused by HSV.
How to distinguish urethritis of bacterial origin from herpetic urethritis?
.. With a bacterial genitourinary infection it is always possible to obtain bacterial growth in culture, but with herpetic urethritis it is not possible.
.. With herpetic urethritis, as a rule, there is no frequent and imperative urge to urinate, since, unlike cystitis, there are no spastic contractions of the bladder.
.. When examining scrapings from the urethra, HSV can be detected, although the result is often false negative.
How to distinguish candidiasis of the genitals from HSV infection?
What common?
.. Itching in the genital area is one of the leading symptoms of HSV and genital candidiasis in women.
.. In this regard, in the presence of periodic itching in the genital area, a diagnosis of candidiasis is made, while in fact this may be a manifestation of a herpetic infection.
What are the differences?
The differences are microbiological: in the presence of recurrent genital itching and a negative result of a native test for the presence of a yeast infection, an examination for HSV should be performed.
Table 1 shows differential diagnosis, based on our own clinical experience, various pathological conditions, which in women may be accompanied by a burning sensation in the urogenital area.
Based on the data in the table presented, the most likely cause of the various symptoms described by the patient is HSV. Such an assumption, of course, requires confirmation and does not in any way replace a thorough examination in order to determine other possible causes.
So, let's return to one of the main tasks formulated at the very beginning of working with the patient: what infections should she be examined for in order to establish the cause of her symptoms, as well as to determine the possibility of her having an STI.
Examination plan for Zh. for STIs
.. Microscopy of smears from the vagina and urethra with Gram staining.
.. Native preparations for testing for bacterial vaginosis, candidal infection and trichomoniasis.
.. PCR for the detection of N. gonorrhoeae, C. trachomatis, M. genitalium.
.. Culture for T. vaginalis.
Serological diagnosis to exclude STIs:
. diagnosis of HIV infection;
. RPR test to detect syphilis;
. determination of HBsAg and antibodies to HH-C;
. determination of type-specific IgG to HSV-1 and HSV-2.
Why you should not test IgM for HSV-1 and 2 during routine STI testing
. Current IgM tests have serious shortcomings:
. Cross-activity between IgM to HSV-1 and 2 is possible.
. With herpetic HSV-1 infection on the lips, positive tests for HSV-2 are possible ⇒ false diagnosis of genital herpetic infection ⇒ inadequate treatment and unwanted emotional problems when it comes to starting a family or long-term relationship.
. A cross-reaction with other herpesviruses is possible: CMV, Epstein-Barr and others.
.. In 35% of people with HSV-2 reactivation, IgM may be present ⇒ the test cannot distinguish a new infection from an existing one.
. This test may be justified in newborns because IgM does not cross the placenta.
. ⇒ detection of IgM in newborns may mean that these immunoglobulins appeared in response to their own infection, and did not penetrate transplacentally from the mother.
The results of the examination of J.
In patient Zh., all tests for STIs were negative, except for a positive type-specific test for HSV-1 and HSV-2.
Consulting J.
After analyzing the results, the doctor explained to the patient that she was a carrier of HSV infection, which, obviously, periodically caused all the symptoms that had been bothering her in recent years, which was completely consistent with the natural course of HSV infection, and the “effect” of the used The use of drugs actually coincided in time with the end of the next exacerbation of herpetic infection.
The patient was very surprised because, in her opinion, neither she nor her husband had ever had symptoms of this disease. She imagined that a herpes infection would appear as a blistering rash, for example, on the lips. This is always a very important moment for the doctor, because when making the initial diagnosis of HSV infection, it is very important to conduct competent counseling, answering all possible questions of the patient who first heard about his diagnosis.
The main questions that interested J. were the following:
.. How long has she been infected and where did the infection come from?
.. Why did the doctors she visited earlier never examine her for herpes?
.. Can a herpes infection be classified as an STI if it is localized in the genital area?
The European guidelines for the management of patients with genital herpes provide a list of questions for discussion with the patient during a primary episode of genital herpes:
1) possible source of infection;
2) course of the disease - the risk of developing a subclinical infection;
3) various treatment options;
4) the risk of transmission of infection through sexual or other means;
5) the risk of transmission of infection from mother to fetus during pregnancy;
6) the need to notify the obstetrician-gynecologist about the presence of the disease;
7) consequences of an infected man infecting an uninfected partner during pregnancy;
8) the ability to notify partners.
As can be seen from this list of questions recommended for discussion, this list is even broader than those topics that interested J. Of all the points presented here, only the consequences of an infected man infecting an uninfected partner during pregnancy were not relevant to our case, since J. was already infected.
In the process of counseling our patient, the opportunity finally arose to begin a reasoned consideration of the second important topic in order to prevent possible incorrect conclusions regarding the husband’s adultery and try to find arguments that would improve the patient’s state of mind.
In principle, the tasks of medical consultation do not include conducting “an investigation to convict one of the partners of adultery.” On the contrary, a great success for a doctor can be considered a situation where, despite diagnosing the spouses with an STI, which clearly indicates the fact of infidelity, counseling is carried out so that the fact of infection, in any case, is not used as a negative argument when the spouses decide on the issue of preserving the family .
Let us consider from this point of view the situation of patient Zh., in whom it was possible to establish the presence of HSV infection.
This is how the doctor answered the questions posed by the patient.
. How long has she been infected and where did the infection come from?
Based on the medical history, it can be assumed that the infection occurred after marriage and the source of infection, apparently, was the spouse. But it cannot be ruled out that the spouse could have had HSV before marriage and the infection remains in a latent or possibly asymptomatic state. To clarify this issue, it was necessary to talk with Zh.’s husband and examine him.
. Why had neither gynecologists nor urologists ever examined her for herpes before?
The rules of deontology suggest that one should not accuse colleagues of mismanaging a patient. We must try to find an explanation for a complete diagnostic error that would not make the patient want to sue the doctors - naturally, if such errors were not so gross that they led to serious consequences for the patient. In our case, insufficient examination of the patient did not lead to just such consequences. The explanation, which quite satisfied the patient, was this: most likely, doctors had previously relied too much on clinical manifestations, which were quite typical for both candidiasis and bacterial cystitis, and therefore did not consider it necessary to conduct additional research. Perhaps the doctors were misled by the fact that the prescribed therapy was always accompanied by the disappearance of symptoms.
. Can a herpes infection be classified as an STI if it is localized in the genital area?
Can. But once again it should be emphasized that from this fact alone it does not at all follow that the husband contracted this infection while being married. It is quite possible that he acquired it before marriage. It can also be said with absolute certainty that the coincidence of Zh.’s latest exacerbation has nothing to do with her husband’s return from a business trip, where, in Zh’s opinion, he could have contracted an STI. Rather, the cause of the latest exacerbation could have been prolonged active sex, after which J. had experienced exacerbations before. By the way, relapses after trauma, even minor ones, which is quite likely during active sex, are very characteristic of a herpetic infection.
After discussing the situation, it was decided to invite Zh.’s husband for a conversation and examination.
The results of the examination of the patient’s husband Zh.
K., husband Zh., came for examination. In a conversation with a doctor, he stated that before marriage he had sexual intercourse and among his partners there may have been those who had a herpes infection. He never had any symptoms of herpetic infection, and he believed that he did not have this disease.
However, based on the data obtained, it could be assumed that K. could also be a carrier of HSV.
A type-specific serological diagnosis was carried out, the results of which confirmed this assumption: Zh.’s husband turned out to be seropositive for HSV-1 and 2.
This greatly surprised our patient’s husband, because, as he claimed, he never had symptoms of the disease. The doctor had to provide counseling to the spouse as well.
First of all, the doctor explained to him that, according to modern ideas Regarding herpes infection, individuals with positive type-specific serological tests for HSV-2 are almost always infected with the virus and can transmit it to others even if they have never had symptoms of this infection.
The doctor referred to American data, according to which 22% of people over 14 years of age in the United States are carriers of HSV-2 infection and only 10% of these people knew that they were infected.
The fact that Zh.’s husband never developed herpetic infection meant that it was subclinical in him. Moreover, it is during this course of infection that the partner is most often infected. So it’s not surprising that, despite the lack clinical manifestations herpes infection, husband Z. transmitted HSV to his wife.
Now the time has come to discuss the current situation with both spouses and outline an action plan to control the herpetic infection, especially since before the last visit to the doctor they were planning to have a child.
Couple counseling
This is a necessary part of counseling when it comes to permanent sexual partners, since we are talking about an infection that they will have to live with for the rest of their lives, and only professionally competent consultation and therapy will allow this couple to properly control it and not become depressed due to persistence in the body of an infection caused by HSV, because elimination of the latter is impossible. So, the doctor invited both spouses for a final conversation.
This is how this final conversation was structured.
1. First of all, the doctor summed up the results of the examination of the spouses and informed them that the only infection that could be detected in them was HSV, both HSV-1 and HSV-2.
2. The symptoms that periodically bothered J. can be explained by the presence of this particular infection.
3. The source of infection is Zh.’s husband, whose HSV infection was subclinical.
4. Based on the anamnesis and the data obtained during the examination of Zh’s husband, we can come to the conclusion that he acquired HSV infection before his marriage to Zh.
5. Finally, the doctor discussed the issue of existing therapeutic options.

Choosing a strategy to combat HSV infection
1. Treatment of each episode of infection;
2. Prevention of its relapses.

The doctor explained to the couple that, according to modern ideas, the final decision on how to control HSV infection should be made jointly by the patient and the doctor, after explaining to the patient the meaning of each of these approaches.

1. Treatment of each episode of genital herpes infection (GG) is called episodic therapy.
It refers to the ingestion of antiviral drugs at the time of exacerbation of infection. This tactic is recommended for patients with rare, clinically unexpressed exacerbations and in the presence of a clearly defined prodromal syndrome, during which medication should be started. As a rule, such therapy is recommended for people who have no more than 6 exacerbations of HH per year.
According to the European recommendations for the management of adult immunocompetent (with normal immune status) patients with genital herpes, the recommendations of the International Forum for the Treatment of Herpes, as well as clinical recommendations for the treatment of genital herpes RODV, which is also reflected in the instructions for the use of antiherpetic drugs in the Russian Federation, for primary infection or relapse of a previously untreated herpetic infection, the following treatment regimens with etiotropic (antiherpetic) drugs should be prescribed: on average
. Acyclovir 200 mg x 5 times a day. 5 days
400 mg x 3 times/day. 5 days
. Valacyclovir 500 mg x 2 times a day. 5 days
. Famciclovir 250 mg x 3 times a day. 5 days
For all subsequent relapses of chronic herpetic infection in adult immunocompetent patients, acyclovir and valacyclovir are recommended to be prescribed in the same dosages, and famciclovir - 125 mg x 2 times / day. Treatment should begin already in the prodromal period or immediately after the onset of symptoms of the disease. The duration of treatment for relapse is 3-5 days.
2. Prevention of relapses of HSV infection or suppressive (preventive) therapy for HH.
This approach involves daily intake of etiotropic antiviral drugs in a continuous mode for a long time (4-12 months).
Indications for suppressive therapy are:
1. severe course with frequent exacerbations;
2. absence of prodrome;
3. special circumstances (vacation, wedding, etc.);
4. while taking immunosuppressive therapy;
5. for psychosexual disorders;
6. to avoid the risk of transmission of infection.
According to the above international and Russian clinical recommendations, which is also reflected in the instructions for the use of antiherpetic drugs in the Russian Federation, the following long-term regimens are prescribed for suppressive therapy of HH (4-12 months) with periodic assessment of the course of the disease:
. Acyclovir 400 mg x 2 times/day.
. Valaciclovir 500 mg x 1 time / day.
. Famciclovir 250 mg x 2 times a day.
As follows from the description of the indications and principles of episodic and suppressive therapy, patient Zh. could be recommended episodic therapy, because the number of relapses of the disease, according to her medical history, did not exceed 6 per year. Nevertheless, among the indications for suppressive therapy there were those that were related to it. Thus, relapses in Zh. always occurred in the absence of a prodrome, often occurred when the climate changed during vacation and were accompanied by psycho-sexual disorders.
The doctor explained that the choice of antiherpetic therapy tactics may change depending on the circumstances, and invited Zh. to decide for herself which treatment option she prefers at the present time.
Having received so much new information, Zh. decided to think it over in a calm atmosphere and visit the doctor again to make a final decision regarding the choice of one or another approach to controlling herpetic infection.
Appearing for the next appointment, the patient reported that, having weighed various circumstances, she was inclined to believe that suppressive therapy was preferable in her situation, since it would help her not only cope with exacerbations, but also find peace after suffering stress and improve marital relationships. relationship.
After discussing the available therapeutic options with the doctor, a decision was made on suppressive therapy with valacyclovir (Valtrex) daily, 1 tablet of 500 mg. The jointly made decision in favor of Valtrex was based both on existing recommendations for the treatment of HH, and on the fact that since the patient was to take the drug for a long time, it was preferable for her to take the drug no more than once a day, and Valtrex also seemed to her the most acceptable in terms of cost.
Z. was prescribed Valtrex and asked to come for a consultation with a doctor 3 months after its use according to the suppressive therapy regimen: 1 tablet (500 mg) once a day, regardless of food and liquid intake.
Final consultation. Planning a pregnancy
J. came for an appointment after 3 months. During this time, while taking Valtrex, 1 tablet (500 mg) 1 time/day. she did not have a single relapse. The patient was in a good mood. The relationship with my husband has finally improved. They vacationed together in the Italian Alps, skiing. Despite hypothermia, there were no exacerbations of herpetic infection during suppressive therapy with Valtrex. The patient decided to continue therapy and asked whether she could plan a pregnancy.
The doctor explained to Zh. that according to European recommendations for the management of patients with genital herpes, when pregnancy occurs, the obstetrician-gynecologist should be informed about the presence of HSV infection.
As for continuing suppressive therapy, it should be discontinued when planning pregnancy. If an exacerbation of a herpetic infection occurs during pregnancy, you should visit a doctor to decide whether treatment is necessary.
Although there is a risk of transmission of HSV infection from mother to fetus during pregnancy, in the case of Z. this risk is minimal, because she already has antibodies to this virus and a serious danger to the fetus can only occur if HSV infection worsens at the time of birth. At this point treatment should be prescribed. Taking into account the presence of HSV in the spouse, the situation during J.’s pregnancy would be much more difficult, since a serious threat would arise for the fetus if a seronegative mother became infected during pregnancy.
J. was completely satisfied with the consultation and grateful that, with the help of the doctor, she finally learned to fully control her disease and found peace of mind.

Literature
1. Reis A.J. Treatment of vaginal infections. Candidiasis, bacterial vaginosis and trichomoniasis. J Am Pharm Assos. 1997:NS37:563-569.
2. Oni AA, Adu FD, Ekweozor CC et al. Herpetic urethritis in male patients in Ibadan. West Afr J Med 1997 Jan-Mar;16(1):27-29.
3. Sturm PD, Moodley P, Khan N. et al. Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence. Int J Antimicrob Agents 2004 Sep;24 Suppl 1:8-14.
4. Srugo I, Steinberg J, Madeb R et al. Agents of non-gonococcal urethritis in males attending an Israeli clinic for sexually transmitted diseases. Isr Med Assoc J 2003 Jan;5(1):24-27.
5. European guideline for the management of genital herpes. International Journal of STD & AIDS, 2001; 12(Suppl. 3):34-39.
6. Sacks SL. The Truth about Herpes. 4th ed. Vancouver, BC: Gordon Soules Book Publishers: 1997.
7. CDC Web site. Tracking the hidden epidemics: trends in STDs in the United States 2000.
8. UNAIDS/WHO. USA: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infection 2002 Update.
9. Armstrong GL et al. Am J Epidemiol. 2001;153:912-920.
10. International Herpes Management Forum. www.IHMF.org
11. Clinical recommendations of the Russian Society of Dermatovenerologists (RODV). Ed. A.A. Kubanova, Moscow, Dex-Press, 2008.

Antigen enters healthy body most often during sexual intercourse, less often - from the toilets of public toilets, from towels and when personal hygiene is not observed. It is insidious in that it may not manifest itself for some time. The virus settles in nerve cells and falls asleep for the time being.

Herpetic prostatitis in men is such a rare disease that it has been little studied and is difficult to diagnose. People aged 26 to 56 years are most often susceptible to infection.

Manifestations of the disease

Herpetic prostatitis, although it occurs very rarely, does occur. It never goes unnoticed. The only thing is that the infection may simply be misdiagnosed. And men themselves, for the most part, are in no hurry to seek medical help. The incubation period of the virus lasts about five days, but in a very weakened body it can appear within a few hours.

Many people mistake symptoms for manifestations common cold and are treated only for it. Herpetic prostatitis can be recognized by the following signs:

• nasal discharge, runny nose;
• possible cough;
• weakness throughout the body;
• apathy, loss of appetite;
• heat;
• headache is very bad;
• burning sensation in the perineum;
• severe pain in the pelvic and sometimes in the lumbar region;
• bowel movements may be disrupted (constipation, diarrhea);
• severe pain when urinating;
• temporary sexual dysfunction;
• loss of libido.

Judging by the latest symptoms of herpetic prostatitis, men generally think that age-related changes are beginning, for which they have already prepared in advance and tuned in to them, and many take the first manifestations for ARVI and treat them accordingly.

This is how the infection starts, and in severe cases complications appear. Still, the main reason for the appearance of the disease is a very weak immune system, which is unable to resist the invasion of enemy antigens.

There are two forms of infection:

1. Chronic. These are periodic problems that cause a lot of problems. Not only does treatment for herpetic prostatitis last about a month, but the infection can reoccur up to five times. If recurrences of the disease occur six or more times a year, urgent assistance from a general practitioner and an immunologist is necessary. The symptoms of the chronic form of the disease are mild, but lead to irreversible disturbances in the functioning of the prostate: constant feeling burning sensation, severe discomfort when urinating, noticeable pain in the perineum and lower back during movement and sexual intercourse, severe sexual dysfunction. Unfortunately, if left untreated, protracted forms of herpetic prostatitis, which can last for years, lead to infertility and impotence.
2. Acute. It goes away with a pronounced clinical picture with burning, itching, temperature, retention and pain of urination, weakness and apathy. If treatment is not started during this period, there is a very high risk that the infection will develop. chronic form. The effect of the virus must be suppressed, although it cannot be destroyed or expelled from the body. - an incurable disease.

The main prevention and an important assistant to treatment is strengthening the immune system.

Viral urethritis in women and men

Herpetic urethritis is also caused by the herpes simplex virus type 2. Infection healthy person occurs through sexual intercourse, less often through the toilet and a shared towel, possibly through dirty hands. Symptoms during primary infection are very acute:

1. The appearance of a rash in men on the penis, in the glans area, in the urethra, on the inside of the foreskin.
2. In women, the rash is localized around urethra or inside.
3. Unbearable burning sensation when urinating.
4. Heat.
5. A sharp deterioration in health.
6. General decline in mood, apathy.
7. Periodic unbearable pain in the urethral area.
8. Constant urge to urinate.
9. Persistent feeling of always full bladder.

Herpetic urethritis is diagnosed using urethroscopy; it looks like a cluster of small erosive formations.

Another distinctive phenomenon with herpurethritis is mucous discharge from the urinary canal, especially in the morning. When the infection is advanced, bacteria attach, and then the discharge becomes purulent in nature.

Forms of infection

Depending on the symptoms, the course of the infection is divided into four main categories:

1. Lightweight. When the number of recurrent infections does not exceed four, the rash is minor and there are no other symptoms.
2. Moderate severity. The number of relapses does not exceed four per year, the rashes are profuse, and there are general ailments.
3. Heavy. Characterizes itself as repeating the infection more than five times a year, with a lot of rash and discharge.
4. Extremely severe form very dangerous. This is more than five relapses per year with severe symptoms of intoxication, malaise, pain, and acute inflammation.

Where is the immunity?

During periods of infection, many wonder why the immune system cannot cope with the disease. And the reasons for the lack of immunity in the person himself:

• lack of sleep;
• overwork;
• alcohol and smoking;
• frequent hypothermia;
• overheating;
• traveling to a country with a sharply different climate;
• avitaminosis.

It is very important to know that the herpes virus is so dangerous and omnipotent that it is not only capable of penetrating the nuclei of human cells, changing their structure and living there permanently, the herpes virus suppresses human immunity during periods of its activation.

Diagnosis of both diseases

Since these are diseases of the genitourinary system, their diagnosis can differ only in the type of biomaterial collected and a number of devices.

Both women and men must undergo a not very pleasant procedure - urethroscopy, in which a specialist accurately determines the presence of a rash, its prevalence and localization.

In addition to these procedures, biomaterial is collected for laboratory research:

• scrapings from the urethra of women and men;
• urine;
• blood from a vein;
• sperm;
• mucus discharge from the urethra;
• purulent discharge.

The main methods for determining the virus in the laboratory are as follows:

1. - this is a method in which blood is taken from a vein for analysis in the morning on an empty stomach, then by diluting its serum, the concentration of immunoglobulins is measured, the results are measured in titers.
2. PCR– polymerase chain reaction method; here the biomaterial can be all of the above; the presence of the virus is determined using chemical reactions.
3. Antigen illumination method– the blood is treated with a special solution, and then illuminated, viral formations are highlighted in a different color.

Effective therapy

Like any other disease, herpetic urethritis and prostatitis are treated depending on the form of the infection. In this case, only a doctor can make a diagnosis, so self-medication is strictly prohibited here.

Treatment for primary infection

If the infection first entered the body and immediately manifested itself, proceed as follows:

1. Prescribed three times a day, course seven days; or five to six times a day for 10 days; or Valaciclovir twice daily for 10 days. These are similar drugs, only the excipients are different.
2. Viferon suppositories with a dosage of 1,000,000 IU are prescribed twice a day rectally. This is great, which not only stimulates immune system, but also blocks the replication of the virus.
3. Acyclovir and Zovirax ointments are prescribed if the rash is external. Apply six times a day in a thin layer on a dry surface.

Treatment of relapses

Mild and moderate relapses are also treated with complex therapy.

1. Acyclovir and Famciclovir are prescribed three times a day for five days in a row, and twice a day for five days.
2. Suppositories Viferon and twice a day.
3. Zovirax ointment, Acyclovir 6-7 times a day.

Suppressive therapy

In this way, protracted, severe herpetic urethritis and prostatitis are treated. It takes a whole year to suppress the virus. In this case, write:

1. Acyclovir 200 mg four times a day for a year.
2. Famciclovir 250 mg twice daily for a year.

Treatment of such diseases begins immediately, no matter the severity of the disease. In advanced cases, the infection can go from a mild stage to a severe one and bring with it bacterial complications.

You should know that antibiotic therapy for herpetic urethritis and prostatitis is prescribed only in severe cases complicated by an associated bacterial infection.

What will help in treatment?

First of all, you need not to lose heart, but to get ready for good treatment.

• get enough sleep;
• rest more;
• lead a healthy lifestyle;
• adjust your diet;
• avoid stress.

Consequences of insidious diseases

Unfortunately, it is impossible to say that these are safe infections. They entail a series of unpleasant moments. If effective and correct therapy is not started in time, diseases are fraught with:

1. Male and female infertility.
2. Loss of libido.
3. Inhibition of sperm activity.
4. Sexual dysfunction.
5. Constant problems with urination.

Herpetic urethritis is a viral pathology that affects the genitals. It is characterized by a variety of clinical manifestations. According to research data, scientists have established a tendency towards the spread of urethritis, including the herpetic type, among the population. The main cause of the disease is the herpes virus, which, once it enters the body, remains there forever. The development of pathology occurs when immunity decreases or infection from a sexual partner, when the virus penetrates through microcracks or wounds on the mucous membrane of the genital organs.

General characteristics of herpetic urethritis

The causative agent of the pathology is the herpes virus type 2. Infection occurs through close contact with an infected person. Damage to the genitourinary system occurs during sexual intercourse.

The disease is diagnosed in both men and women. On initial stages development of herpetic type urethritis is asymptomatic. Signs of the disease appear in cases where immunity is reduced.

But in situations where infection occurs for the first time, the symptoms are pronounced. In the absence of therapy, the disease becomes latent over time. Exacerbation is observed under the influence of various factors. That is why the disappearance of signs of herpetic urethritis does not indicate a complete recovery.

The virus continues to reside in the body and can cause not only re-development of the pathology, but also infection of the sexual partner.

Causes

The main reason for the development of the disease is reduced immunity. The virus can enter the body through sexual contact with an infected person through microcracks, wounds or abrasions on the mucous membrane and skin of the genital organs.

Herpesvirus also enters the body when infected with chickenpox. After treatment, it remains in the body and, under the influence of certain factors, can cause urethritis. The risk of developing the disease increases if you have:

• infectious lesions;
• reduced immunity;
• chronic diseases;
• exposure to toxic and poisonous substances.

Improper nutrition and injury to the mucous membrane of the genital organs can influence the occurrence of symptoms of herpetic urethritis.

Signs and symptoms

The first signs of the disease appear 3-7 days after infection. The pathology is characterized by the presence of rashes that affect the genitals. They form on the inner surface of the foreskin, penis, urethra, labia and vaginal mucosa. Over time, the vesicles burst, and ulcers form in their place.

In severe cases, the rashes are small, have a red border and merge into large lesions. Associated symptoms are:

1. Painful sensations.
2. Inflammation of the lymph nodes.
3. Discharge from the urethra. In men they are scanty and are observed in the morning in the form of a small drop. A woman has a special anatomical structure genitals. As a result of this, the discharge changes its intensity and color. In some cases, an unpleasant odor appears.
4. Burning in the urethra.
5. Tingling.

If the disease develops for the first time, the symptoms are always pronounced. But they completely disappear after 1-2 weeks. Relapses are not characterized by intense symptoms. The interval between them can be from 10 days to several years, depending on the condition of the body and lifestyle.

In certain cases, with herpetic urethritis, a secondary infection is observed. At the same time, the duration of the disease increases, the patient’s condition worsens, and the manifestations become more intense.

What tests to take

Diagnosis of the disease is based on the results of a number of laboratory tests:

• vaginal or urethral smear;
• PCR diagnostics;
• direct immunofluorescence reaction.

In women, a smear is taken from the urethra, and in men, a scraping is taken from the mucous membrane of the urethra. The method helps to detect the presence of a virus and determine its type.

The results of PCR diagnostics are ready within a few hours, which allows immediate initiation of therapy.

Direct immunofluorescence reaction – modern method detection of the herpes virus. It is carried out using a special apparatus that illuminates the cell nuclei with bright green light.

Drugs: treatment regimen

Treatment of herpetic urethritis is difficult. This is due to the fact that the pathology often occurs latently. Therapy is carried out in several stages:

1. Elimination of the first appearance of pathology.
2. Treatment of relapse.
3. Suppressive therapy.

If herpetic type urethritis has been diagnosed for the first time, acyclovir is used. The drug is taken three times a day, 400 mg for 7-10 days. When using a dosage of 200 mg active substances a, should be taken five times a day for no more than 10 days.

Famciclovir may also be used. Experts recommend taking 250 mg 5 times a day. The course of therapy depends on the degree of development of the disease, but cannot be more than 10 days.

Therapy should be started immediately after the first signs of the disease appear.

Only in this case can a positive result be achieved. If one course of treatment was not enough, the doctor may prescribe a second one.

If there is a relapse of herpetic type urethritis, then treatment should begin on the first day of symptoms. In case of repeated development of pathology, the following are recommended:

• acicovir at a dosage of 400 mg three times a day for five days;
• famciclovir, active substance content 125 mg, three tablets per day, course of treatment is five days;
• valacyclovir, you need to take 1g twice for five days.

To prevent the development of the disease, the suppressive therapy regimen is as follows:

1. Acyclovir. 400 mg 2 tablets per day.
2. Valaciclovir. 500 mg once daily.
3. Famciclovir. Dosage 250 mg twice daily.

In cases where herpes urethritis is diagnosed, therapy is supplemented with immunomodulators. They help support immunity. Also recommended are remedies to relieve symptoms of intoxication in the body.

Complications and consequences

If herpes-type urethritis is left untreated, consequences may develop. The pathological process spreads to the urinary tract over time, provoking the development of the following diseases:

• cystitis;
• cooperite;
• vesiculitis;
• erectile dysfunction in men;
• vaginitis in women;
• paraurethritis;
• prostatitis.

All diseases negatively affect the ability to conceive and bear fruit.

That is why, when the disease is diagnosed, treatment should be started immediately.

Preventive measures

The main rule of prevention is to reduce the risk of microflora disruption. Experts recommend:

1. Eat properly. You need to stop consuming unhealthy foods, which include fast food and convenience foods.
2. Eliminate stress, neuroses and prolonged depression.
3. Treat genital tract infections in a timely manner.
4. Use contraception during sexual intercourse.
5. Follow the rules intimate hygiene. It is necessary to have vaginal sex after anal sex only after washing. Water procedures should be performed not only by women, but also by men.

In addition, it is necessary to have regular sex life and avoid frequent changes of sexual partners. Following the rules of prevention will help reduce the risk of developing the disease.

Herpetic urethritis is a disease in which pathological process affects the genitals. The cause of symptoms is the herpes virus, which can penetrate the mucous membranes during unprotected sexual intercourse. Treatment is always long-term, and the disappearance of symptoms does not indicate complete recovery. Once the herpes virus enters the body, it remains there forever. Ointments or antiviral drugs. That is why it is important to observe hygiene and prevention rules.

Bacterial urethritis. The causative agents are: staphylococci, streptococci, E. coli, gardnerella, etc. Infection can enter the urethra through sexual contact, as well as due to its spread from the genitourinary tract with pyelonephritis, prostatitis, vesiculitis, urethral trauma. More than 230 strains of bacteria have been isolated that, under certain situations, can cause inflammation of the urethral mucosa.

The average duration of the incubation period for bacterial urethritis is 12-14 days (from 2 to 20 days). More often, their clinical course is asymptomatic and sluggish. Less commonly, bacterial urethritis becomes acute.

Urethritis caused by diplococci similar to gonococci (pseudogonococci) usually occurs as acute urethritis.

Gardnerella, as a rule, causes low-symptomatic urethritis, often ending in self-healing.

Bacterial urethritis often (in 30% or more) results in complications (balanoposthitis, epididymitis, prostatitis, cystitis, etc.).

Chlamydial urethritis.

Caused by obligate intracellular bacteria, which are the most common cause of urethritis in men. According to various researchers, 1.5 million people in Russia fall ill with urogenital chlamydia every year.

Chlamydia goes through extracellular and intracellular stages of development. The mature extracellular infectious form is an elementary body capable of penetrating intracellularly. Intracellularly, elementary bodies transform into reticular bodies capable of growth and division. Elementary bodies are resistant, and reticular bodies are susceptible to antibiotic therapy.

The average incubation period is 3-4 weeks. The source of infection is a patient with an asymptomatic form of acute or chronic disease.

Transmission occurs by contact (sexual) through genital-genital, genital-anal and oral-genital contacts, as well as non-sexually - through the placenta, during childbirth, through household contact, due to contamination (from the genitals to the eyes with hands, in case of violation of hygiene rules).

In men, chlamydial urethritis in 70% of cases occurs as a low-symptomatic or asymptomatic inflammation (with scanty mucopurulent discharge), which can last for several months. Much less often (in 5%), urethritis can occur acutely, and the inflammation is not much different from gonococcal lesions. In 25% of cases, chlamydial urethritis can have a subacute course, not much different from chronic, except for more abundant discharge from the urethra, especially in the morning. In the initial stages of the disease, the anterior urethra is affected; in the chronic course, the inflammation spreads to the posterior part of the urethra and becomes total. In 30-40% of cases, symptoms of prostatitis, vesiculitis, epididymitis, and funiculitis occur.

Chlamydial infection does not cause lasting immunity, so reinfection is possible due to the exchange of infection with partners. In 2-4% of cases, Reiter's disease develops against the background of chlamydial urethritis.

Reiter's disease. It is characterized by systemic damage to the genitourinary organs, eyes, joints (like asymmetric reactive arthritis), as well as damage to the skin, mucous membranes and internal organs. Develops as a complication of untreated chlamydia.

Trichomonas urethritis.

Trichomonas is transmitted sexually. Household transmission of infection is rare. It can persist in urine for up to 24 hours, in semen for several hours, and survive in wet underwear. The incubation period for trichomonas urethritis is on average 5-15 days. There are the following forms of trichomoniasis: acute, subacute, chronic, trichomoniasis.

At acute form the inflammatory process proceeds rapidly with abundant mucous-foamy discharge on the first day and mucopurulent discharge from the urethra from the second day with frequent and painful urination.

In subacute urethritis, the symptoms are less pronounced, discharge from the urethra occurs in small quantities, and is purulent. The first portion of urine contains purulent flakes.

With chronic trichomonas urethritis, itching, burning, a crawling sensation in the urethra, and frequent urination come to the fore. Urethral discharge is scanty. Since in chronic urethritis the inflammatory process moves to the posterior urethra, complications develop in the form of prostatitis, vesiculitis, epididymitis, and with a long course, the formation of urethral strictures is possible.

Mycoplasma urethritis.

They are caused by bacteria that have a plastic shell and contain DNA and RNA. The ability of mycoplasmas to take any form allows them to penetrate bacterial filters.

Infection with mycoplasma infection occurs primarily through sexual contact. Intrauterine infection of the fetus and during its passage through the infected birth canal have been established. Mycoplasma attaches to the urethral epithelium and can be transferred by sperm; in addition, it colonizes the foreskin. The incubation period lasts from 3 to 5 weeks.

There are no specific signs for mycoplasma urethritis. As a rule, urethritis of mycoplasma origin is chronic. In this case, there are often lesions of the prostate gland, seminal vesicle, and epididymis, which leads to infertility. By attaching to the head of the sperm, mycoplasma can reduce its fertilizing ability. Under certain conditions, mycoplasma infection can cause inflammatory processes in the genitourinary organs (cystitis, pyelonephritis). Urogenital mycoplasmosis is often combined with intestinal damage (enterocolitis).

Herpetic urethritis.

Caused by two serotypes of DNA containing herpes simplex viruses HSV-1 and HSV-2. Herpes is one of the most common human infections.

The disease is transmitted primarily through sexual contact from a patient with genital herpes. Often, the genital virus is transmitted from a carrier of herpes who does not have symptoms of the disease. The method of infection with the virus can be genitogenital, oral-genital, genital-anal. There is a risk of neonatal infection of newborns, which can occur both during the passage of the birth canal and in the postpartum period with active herpetic manifestations in the mother or medical personnel.

During the initial infection caused by the herpes simplex virus, the virus penetrates the cells of the susceptible surfaces of the mucous membrane or skin. It is then captured by sensory nerve endings and transported to the nerve cells of the dorsal root ganglia, where it is stored. Infection can occur latently, when the virus is present in the body without causing illness; and virulent when the herpes is activated and causes local lesions. The disease in this case occurs as chronic, recurrent, cyclical with localized, less often generalized manifestations.

The initial symptoms of herpetic urethritis may be general complaints: fever, weakness, myalgia, headache. At the same time, a burning sensation appears in the urethra, which intensifies during urination, and pain in the lymph nodes. On the head, skin of the penis, on the visible part (possibly also on the invisible) mucous membrane of the urethra, the typical development of herpetic elements is noted, accompanied by a feeling of burning, itching, pain in the genital area. First, bubbles appear, which erode, become wet, then dry out, forming crusts that fall off as epithelization occurs. Temporary hyperemia and pigmentation remain at the site of the lesion. Light yellow discharge may appear from the urethra.

Clinical manifestations of the primary infection last about 3 weeks, local symptoms appear on the 2-14th day. Recurrent infection in the presence of antibodies to the virus is less pronounced. The clinical picture develops within 8-15 days. Recurrence is promoted by stressful situations, overheating, hypothermia, decreased body defenses, etc. Herpes, by destroying the human immune system, can cause secondary immunodeficiency.

Some researchers note a connection between genital herpes and cervical cancer and prostate cancer.

Candidal urethritis.

Caused by opportunistic yeast-like fungi Candida, of which there are more than 150 species. 7 species are pathogenic to humans.

Candidiasis of the genital organs is more common in women, less common in men. An important role in the pathogenesis of the disease belongs to decreased immunity, dysbacteriosis, vitamin deficiency, hormonal disorders, diabetes, and the condition of the mucous membranes of the skin! Candidomatous lesions are often combined with other pathogens of sexually transmitted infections (chlamydia, ureaplasma, viruses, etc.).

The incubation period for candidal urethritis lasts from 2 weeks to 1 month, almost always proceeds torpidly, and less often begins subacutely. The onset of the disease is accompanied by parasthesias, itching, burning, and scanty discharge (thick, mucous). In this case, diffuse and limited whitish-gray deposits appear on the mucous membrane of the urethra, under which sharp hyperemia is determined. Candidal urethritis often occurs against the background of treated prostatitis, epididymitis vesiculitis, cystitis caused by other pathogens.

Often with candidal urethritis, damage to the head and foreskin of the penis is observed. In this case, swelling, hyperemia of the foreskin and glans penis are observed, with areas of whitish-gray plaque, when removed, surface erosions and cracks are formed. Chronic scarring of erosions and cracks can lead to the formation of cicatricial phimosis.

The presence of various types of urethritis pathogens requires timely access to qualified medical care, to conduct a comprehensive examination and prescribe competent etiotropic treatment. Our medical clinics provide comprehensive diagnostics of infections transmitted through sexual contact. The equipment of our centers allows us to quickly and efficiently treat urethritis of any etiology

Our specialists will be happy to help you!

Genital herpes (GG) in men detected several times less frequently than in women; in addition, their infection often occurs in a low-symptomatic or asymptomatic form. Therefore, the true role of the herpes simplex virus (HSV) in the development of pathology of the male genitourinary system (MPS) is often underestimated. However, in men suffering from chronic inflammatory diseases pelvic organs, in 50-60% of cases it is possible to detect HSV in the discharge of the genitourinary system.

Genital infection occurs during close physical contact with a patient or virus carrier during genital, oro-genital, rectal and oral-anal contact. In most cases, primary infection is asymptomatic. Subsequently, carrier status of the herpes simplex virus (HSV) or a recurrent form of the disease develops. The frequency of relapses in men and women is the same, but in men they last longer.

The variety of clinical manifestations of urogenital herpes, the presence of atypical, subclinical and asymptomatic forms of the disease, involvement in infectious process Many body systems often make it difficult to differentiate this disease from other infections of the genitourinary system.

Complaints of itching, burning, scanty mucous discharge from the urethra, sanguineous discharge from the rectum, and indications of pain can suggest the herpetic nature of the lesion in the urogenital tract in the absence of typical manifestations on the skin and mucous membranes. Also, a sign of viral herpes can be the recurrent nature of pelvic organ disease (PID) or resistance of the disease to previous antibiotic therapy.

In addition, patients often note a tendency to colds, fear of drafts, periodic general weakness, malaise, low-grade fever, depressive states. Patients with HH often experience pain, which patients do not always associate with exacerbations of herpes.

Herpes of the external genitalia in men

Clinically, herpes of the external genitalia can occur in typical, atypical and subclinical (asymptomatic) forms. Manifest or typical is a form of the disease in which the infectious process occurs with clinical manifestations.

It is believed that the atypical and asymptomatic (unrecognized) form of herpes is associated with changes in the viral genome and is more dangerous because Asymptomatic virus carriers are the main source of disease in the population. Absent or mild symptoms do not prevent them from having sexual intercourse, which allows them to infect a partner during the most contagious period of the disease.

Herpetic infection (HI) of the external genitalia in men can affect:

• penis (the area of ​​the outer and inner leaves of the foreskin, coronary sulcus, scaphoid fossa, and less commonly the head and shaft of the penis are affected)
• scrotum
• skin of the pubic area,
• crotch,
• hips,
• buttocks,
• perianal area

Objective symptoms

• Hyperemia and swelling of the skin and mucous membranes in the affected area.
• Single or multiple vesicular elements (vesicles) localized in the affected area.
• After opening the vesicular elements, small ulcerations are formed that heal within a few days. When a secondary infection occurs, ulcers appear;
• Sometimes the inguinal lymph nodes become enlarged and painful.

Subjective symptoms with the manifest (typical) form of genital herpes in men:

• Deterioration of general condition (headache, chills, malaise, low-grade fever);
• Itching, burning, rawness, pain in the affected area;
• Pain during sexual intercourse;
• When the rash is localized in the urethral area - itching, burning, pain when urinating (dysuria).

In the manifest form of the disease in men, the development of pronounced clinical manifestations (clinical manifestation) is often more benign than in women.

Urethral herpes (herpetic urethritis)

Herpetic urethritis(GU) is urethritis caused by the herpes simplex virus. Work in recent years has shown that herpetic urethritis is detected in 42–46% of cases in men suffering from recurrent genital herpes.

Herpes simplex virus types 1 and 2 are found in the urethra in more than 1/3 of men with urethritis that occurs after unprotected oral-genital contact. Viral urethritis in men that developed as a result of penetrative oral sex is characterized by a significantly more frequent association with HSV type 1.

With herpetic urethritis, general symptoms dominate and both genital and extragenital manifestations of infection are detected.

Subjectively Urethral herpes is manifested by pain in the form of a burning sensation, a sensation of heat, heightened sensitivity along the urethra at rest and during urination, and pain at the beginning of urination.

Incubation period in the development of GU remains unclear, but probably lasts several months, less often weeks or days.

At clinical examination hyperemia and swelling of the urethral sponges are determined, and scanty mucous discharge from the external opening of the urethra periodically appears.

Current of GU subacute or sluggish with periodic remissions and relapses. The urethral discharge usually predominates epithelial cells and mucus, leukocytosis periodically appears. With a mixed infection, urethral discharge becomes more abundant and opaque. With a two-glass sample, the urine in the first portion is transparent, but contains inflammatory products in the form of floating threads and flakes.

Diagnosis GU is diagnosed based on the isolation of HSV from material taken from urethral discharge in cell culture or detection of the HSV antigen by PCR. This kind of laboratory testing is necessary to differentiate viral urethritis from bacterial ones.

The organs of the MPS in men are interconnected anatomically and physiologically, so the results of laboratory research must be assessed comprehensively. So, for example, if HSV is detected in urine or urethral discharge, this suggests that the prostate gland is involved in the infectious process, even if HSV is not detected in prostate juice, but there is clinical evidence of long-term prostatitis.

Bladder herpes (herpetic cystitis)

The leading symptoms of herpetic cystitis are the appearance of pain at the end of urination, dysuria and hematuria (blood in the urine). Patients have a urinary disorder: the frequency, nature of the stream, and the amount of urine change. Herpetic cystitis in men is usually secondary and develops as a complication during exacerbation of chronic herpetic urethritis or prostatitis.

Herpes of the anal area and rectum

Herpetic lesions of the anal area occur in both heterosexual men and homosexuals. The lesion is usually a recurrent fissure.

When the sphincter and mucous membrane of the rectal ampulla are damaged (herpetic proctitis), patients are bothered by itching, burning sensation and pain in the affected area, small erosions occur in the form of superficial cracks with a fixed localization, bleeding during defecation. The appearance of rashes may be accompanied by sharp bursting pain in the sigmoid region, flatulence and tenesmus, which are symptoms of pelvic irritation nerve plexus. A diagnosis of herpetic proctitis can only be made based on the results of a virological examination of the patient.

Herpes prostate (herpetic prostatitis)

IN modern classification Prostatitis Viral prostatitis is regarded as an infectious complication of viral urethritis. In clinical practice, the diagnosis of chronic herpetic prostatitis is rarely made by urologists. The reason, apparently, is that virological diagnostic methods are not included in the standard examination of patients with chronic prostatitis, and patients are traditionally examined for sexually transmitted infections of a non-viral nature. However, according to various authors, prostatitis is caused or maintained by HSV in 3-20% of cases.

In the development of viral prostatitis, the urethrogenic route of transmission is most often observed, and the descending (urogenic) route is rare - when viruses penetrate from infected urine during cystitis through the excretory ducts of the prostate gland (PG).

In the clinical course of prostatitis, functional changes are noted - reproductive changes (decreased sexual desire), pain syndrome (with irradiation to the external genitalia, perineum, lower back) and dysuria.

Chronic herpetic prostatitis is characterized by frequent and persistently recurrent nature. In most cases, exacerbation of chronic prostatitis is preceded by the appearance of herpetic eruptions in the genital area. The appearance of vesicular-erosive elements (vesicles and ulcerations) may coincide with the appearance of complaints from the pancreas.

Often in patients with recurrent genital herpes (RGH), prostatitis occurs latently. In these patients, the diagnosis of prostatitis is made based on the appearance of leukocytosis in the prostate secretion and a decrease in the number of lecithin grains.

It must be remembered that herpetic prostatitis can exist as an isolated form of herpetic infection. In this case, there are no symptoms of RGG and HSV is not detected in the urethral discharge. The etiological diagnosis is based on the detection of the herpes simplex virus in the secretion of the prostate gland, while there is no pathogenic flora in the secretion and in the third portion of urine.

Herpetic prostatitis leads to the formation of immunosuppression, resulting in the formation of secondary immune deficiency syndrome. This allows us to consider it not only a viral, but also a largely immune-mediated disease.

Herpetic infection of the pelvic organs

A feature of GG is its multifocality. The pathological process often involves the lower part of the urethra, the mucous membrane of the anus and rectum, which can occur secondary to the occurrence of herpes of the external genitalia, or can occur as an isolated lesion.

Based on the characteristics of clinical manifestations, it is advisable to divide herpetic lesions of the pelvic organs in men into:

• herpes lower section urogenital tract, anal area and rectal ampulla;
• herpes of the upper genital tract.

Herpes of the lower urogenital tract manifests itself in two clinical forms: focal, characterized by the appearance of vesicular-erosive elements typical of herpes simplex mucous membranes, and diffuse, in which the pathological process proceeds as a nonspecific inflammation. In this case, the urethra may be affected, bladder, anus, rectal ampulla.

Herpes of the upper genital tract may strike prostate gland, seminal vesicles.

• Typical clinical picture Herpetic infection of the upper genitourinary tract is manifested by symptoms of nonspecific inflammation. It is very difficult to establish the real incidence of damage to the internal genital organs in men, since in 40–60% of cases the disease occurs without subjective sensations.
• In subclinical form herpes of the internal genitalia, the patient has no complaints; Clinical examination does not reveal symptoms of inflammation. With dynamic laboratory research smears of urethral discharge in the prostate secretion periodically reveal an increased number of leukocytes (up to 30–40 or more in the field of view), indicating the presence of an inflammatory process.
• Asymptomatic form herpes of the internal genitalia (asymptomatic viral shedding) is characterized by the absence of any complaints and objective clinical symptoms inflammation. During a laboratory examination of the discharge of the urogenital tract, HSV is isolated, while in smears there are no signs of inflammation (leukocytosis).

HSV and male infertility

HSV is an agent that disrupts spermatogenesis and has the ability to infect male germ cells (sperm). Studies have shown that HSV is present not only in seminal fluid or on the surface of cells, but also inside the sperm themselves. At the same time, in the ejaculate of HSV-infected patients, a decrease in the concentration of sperm is observed, as well as an increase in the frequency of occurrence of abnormal gametes - sperm with microheads and a cytoplasmic drop on the neck. Thus, HSV can lead to disruption of the formation and differentiation of sperm and the development of pathospermia. It has been shown that HSV is detected more often in the ejaculate of patients with infertility than in the sperm of men without reproductive disorders. A number of studies prove that asymptomatic GI can lead to decreased fertility in men as a consequence of the negative effect of the virus on spermatogenesis.