Herpetic infection of the genitourinary system in men. Genital herpes - symptoms, treatment Treatment of herpetic urethritis in men

Herpetic urethritis is a disease characterized by a vivid clinical picture, capable of becoming chronic over time. Pathology is becoming more and more common today. Therefore, it is necessary to know exactly what symptoms it manifests itself and how to treat it.

What are the reasons herpetic urethritis, patients are often interested in their doctors, and how to recognize the disease in a timely manner.

What pills to drink with this disease, and how can you protect yourself from this disease?

Herpetic urethritis: causes of pathology

The main cause of the pathology is herpes type 1 and type 2 with herpetic urethritis. Herpes simplex virus infected today a large number of people, and the prevalence of infection continues to rise. But why someone develops a disease, and someone lives all his life, not even knowing that he is sick, patients are interested.

The role of immunity in the development of the disease cannot be overstated. The fact is that herpes is an infection that can be in the patient's body for a long time without showing itself.

For the first time, a pathogenic microorganism usually makes itself felt if, for some reason, the body's immune defenses are reduced. A drop in the level of immunity inevitably leads to the manifestation of clinical symptoms.

Today, doctors identify the following factors that contribute to the onset of symptoms of the disease:

• frequent, prolonged in duration and high in intensity stressful effects that adversely affect the immune system;
• the rhythm of life, leading to disruption of sleep and wakefulness, due to which the immune system cannot fully recover;
• malnutrition, abuse harmful products which negatively affect the general condition of the body;
• contact with respiratory viruses that cause a sharp drop in immunity;
• the presence of congenital or acquired immunodeficiency (for example, herpetic urethritis is diagnosed as one of the manifestations of an immunodeficiency state);
• hormonal shakes, which are especially characteristic of women during the period of bearing a child, menopause, and also monthly before menstruation;
• chronic diseases of the liver, lungs, heart and other organs and systems, which have a debilitating effect on the human body, can contribute to the development of symptoms of the disease.

The appearance of symptoms of herpetic urethritis in most cases indicates that the patient's immunity has suffered serious damage for some reason. In healthy people, signs of the disease are not detected.

Symptoms of herpetic urethritis

Get infected with the herpes simplex virus disease-causing, can be done in different ways.

In the first place in terms of implementation is sexual contact, especially if it is not protected by barrier contraceptives.

Sex can be dangerous even if people use a condom. Since the virus can, among other things, be transmitted by touch, and not only through body fluids. In addition to the sexual way, the contact-household way is often realized. In this case, transmission occurs through shared hygiene items such as towels. It is also possible to infect a small child during childbirth.

Symptoms of herpetic urethritis are usually pronounced, especially if the clinical picture develops for the first time. The patient complains about:

• the appearance of a rash in the genital area, causing significant inconvenience;
• strong, which is accompanied by every urination;
• an increase in body temperature to subfebrile values, and sometimes even higher;
• sharp deterioration general well-being, complaints of fatigue, decreased performance;
• apathetic mood, lack of interest in things that previously aroused interest;
• a feeling that is episodic (often patients describe the pain as unbearable, acute);
• frequent urge to empty Bladder, which may not always end in the release of urine;
• complaints of a feeling of fullness in the bladder, even if the patient has just gone to relieve himself.

Herpetic urethritis in women and men may differ in localization.

In the fair sex, the presence of pathological formations on the external genital organs is usually not noted. All of them are located exclusively in the urethra. With men, the situation is different.

In the representatives of the stronger sex, rashes can cover not only the inner part of the urethra, invisible to the eye, but also the penis itself. As a result, rashes can be injured by rubbing against clothing while walking or making other movements. Therefore, herpetic urethritis in men may be accompanied by a small release of blood.

Classification of herpetic urethritis

The infection is divided by doctors into 4 main forms. The division into forms is based on the severity of the symptoms of the disease.

• Light form

The first episode is easy. The patient may complain of a small number of rashes localized intimately, but complaints of fever and deterioration in general well-being, indicating general intoxication, are missing. Pathology recurs no more than 4 times a year.

The first episode is a bit more difficult. The rash is characterized as more widespread, very thick, conspicuous. Localization is possible not only in the genital area, but also in other places. Fever, deterioration of health and other symptoms of viral intoxication are still absent. Relapses occur 5 or more times a year.

• Severe form

If the infection is severe, the initial episode is considered severe. A thick, numerous eruption is found in the urethra, causing the patient great discomfort, which is difficult or impossible to ignore. The rash may spread to other parts of the body. There are complaints about the symptoms of general intoxication, although mild. The patient draws the doctor's attention to an increase in temperature, a deterioration in general well-being.

• very severe form

A very severe form is characterized by frequent relapses that are difficult to control even with medication. The patient complains of a pronounced spread of the rash, which is easily noticed by the doctor during the examination. Also, you can not ignore the high temperature and severe symptoms of intoxication. The frequency of recurrence of the disease directly depends on the form of the disease and the characteristics of the patient's immunity.

Herpetic urethritis: approaches to diagnosis

How to take tests for herpetic urethritis, many patients are interested in their attending physicians. In most cases, smear and blood tests are performed for herpetic urethritis. If it is decided to conduct a study using a smear, then it is recommended to take it in the area of ​​​​localization of the rash. A scraping may also be performed there.

With a pronounced course of infection, good results are also obtained by assessing the blood that is taken from a vein, as in a classic study. Further, the patient can undergo three diagnostic options:

• ELISA is the most common and cheapest option, during which antibodies secreted by the body to fight viral particles are detected or excreted;
• PCR is a more expensive, but also more reliable method, in which pathogen DNA is isolated even in the smallest concentrations;
• Antigen highlighting, in which blood treated with special reagents is highlighted, and pathogenic parts are highlighted in a special color.

The immunogram and the role of the immunologist in herpetic urethritis, if it often recurs, are enormous. With the help of an immunogram, it is possible to determine whether there are any violations in the activity of immunity. And the immunologist will help decipher the data of the immunogram and will treat the patient if the immunity is somehow impaired.

Treatment methods for herpetic urethritis

Treatment is selected by the doctor in each case individually. The choice of drugs, their dosages and features of use depends on the severity of the infection, the general health of the patient and a number of other features. Most often, the following treatment regimen is possible:

As an alternative to Acyclovir, Famciclovir or Valaciclovir can be used. The first drug is drunk 5-6 times a day for the same period, and the second is used twice a day in the same course. The drugs are similar, the differences in them are explained only by different excipients.

An alternative to Acyclovir in the form of an ointment can be Zovirax, which has similar effects. It is important to remember that if a patient has concomitant infectious diseases, therapy should be aimed not only at eliminating the herpes simplex virus.

Which doctor to contact many patients ask. First of all, it is recommended to visit a urologist or dermatovenereologist. Which will be able to diagnose and choose the right therapy. Additionally, a visit to an infectious disease specialist, immunologist-allergist may be recommended.

Fundamentals of prevention of herpetic urethritis

Prevention of the disease is very simple, although non-specific. First of all, it is necessary to exclude sexual and domestic infection with herpetic urethritis. For this it is recommended:

• observe safety rules when having sex, using barrier contraceptives, especially if the partner is unreliable;
• observe simple rules personal hygiene;
• refuse to use common hygiene items such as towels, washcloths, etc.;
• lead healthy lifestyle life, normalizing sleep and wakefulness, giving preference to wholesome food;
• regularly undergo preventive examinations with a urologist or gynecologist;
• do not delay contacting a doctor if any alarming symptoms appear.

Compliance with preventive measures will help to significantly reduce the likelihood of contracting this unpleasant infection. However, unfortunately, it will not completely rule it out.

If symptoms appear that may indicate an infection with a pathology, one should not hesitate to contact a doctor. Herpetic urethritis is dangerous for both men and women. In the representatives of the stronger sex, a neglected disease leads to a decrease in sexual activity, infertility. And women, in addition to infertility, with severely neglected pathology, may encounter fusion of the labia minora.

If you suspect herpetic urethritis, contact a competent venereologist.

Bacterial urethritis. The causative agents are: staphylococci, streptococci, Escherichia coli, gardnerella, etc. The infection can enter the urethra through sexual contact, as well as due to its spread from the genitourinary tract with pyelonephritis, prostatitis, vesiculitis, urethral injury. More than 230 strains of bacteria have been isolated, which, under a certain situation, are able to recognize 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, sluggish. Less commonly, bacterial urethritis becomes acute.

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

Gardnerella, as a rule, cause oligosymptomatic urethritis, often ending in self-healing.

Bacterial urethritis often (in 30% or more) ends with 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 fall ill with urogenital chlamydia every year in Russia.

Chlamydia go through extracellular and intracellular stages of development. A mature extracellular infectious form is an elementary body that can penetrate intracellularly. Intracellular elementary bodies are transformed into reticular bodies capable of growth and division. Elementary bodies are resistant, and reticular bodies are susceptible to antibiotic therapy.

The average duration of the incubation period is 3-4 weeks. The source of infection is a patient with an asymptomatic form of an 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 violation of hygiene rules).

In men, chlamydial urethritis in 70% of cases proceeds as an asymptomatic or asymptomatic inflammation (with scanty mucopurulent discharge), which can last for several months. Much less often (in 5%), urethritis can be acute, while 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 perhaps more abundant discharge from the urethra, especially in the morning. IN initial stages disease affects the anterior urethra, with chronic course inflammation passes to the posterior urethra and becomes total. In 30-40% of observations, symptoms of prostatitis, vesiculitis, epididymitis, funiculitis join.

Chlamydial infection does not cause permanent immunity, therefore 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 lesions of the genitourinary organs, eyes, joints (like asymmetric reactive arthritis), as well as damage to the skin, mucous membranes and internal organs. It develops as a complication of untreated chlamydia.

Trichomonas urethritis.

Trichomonas is transmitted sexually. Domestic transmission is rare. It can persist in urine for up to 24 hours, in semen for several hours, and survive in damp laundry. The incubation period for Trichomonas urethritis averages 5-15 days. There are the following forms of trichomoniasis: acute, subacute, chronic, trichomonas-denunciation.

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

With subacute urethritis, the symptoms are less pronounced, discharge from the urethra occurs in small amounts, purulent. The first portion of urine contains purulent flakes.

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

Mycoplasmal urethritis.

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

Infection with mycoplasma infection occurs mainly through sexual contact. Intrauterine infection of the fetus was also established during its passage through the infected birth canal. Mycoplasma attaches to the epithelium of the urethra, can be carried by spermatozoa; in addition, it colonizes the foreskin. The incubation period lasts from 3 to 5 weeks.

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

Herpetic urethritis.

Cause 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 mainly sexually from a patient with genital herpes. Often, the genital virus is also transmitted from a herpes carrier who does not have symptoms of the disease. The method of infection with the virus can be genital-genital, 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 postpartum period with active herpetic manifestations in the mother or medical personnel.

During the initial infection with the herpes simplex virus, the virus enters the cells of susceptible mucosal or skin surfaces. Then it is captured by sensory nerve endings and is transferred to the nerve cells of the dorsal ganglion roots, where it is stored. Infection can be latent when the virus is present in the body without causing disease; and virulent when herpes is activated and causes local lesions. The disease in this case proceeds as chronic, relapsing, cyclic with localized, rarely generalized manifestations.

The initial symptoms of herpetic urethritis may be general complaints: fever, weakness, myalgia, headache. At the same time, there is a burning sensation in the urethra, which increases during urination, soreness of the lymph nodes. On the head, the skin of the penis, on the visible part (possibly on the invisible) of the mucosa of the urethra, a typical development of herpetic elements is noted, accompanied by a burning sensation, itching, and pain in the genital area. Initially, vesicles appear, which erode, become wet, then dry up, forming crusts, which fall off as epithelization progresses. Temporary hyperemia and pigmentation remain at the site of the lesion. A light yellow discharge may appear from the urethra.

Clinical manifestations of 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. Stressful situations, overheating, hypothermia, decreased defensive forces organism, etc. Herpes, destroying immune system human, can cause secondary immunodeficiency.

Some researchers note the connection of genital herpes with cervical cancer and prostate cancer.

Candida urethritis.

It is caused by opportunistic yeast-like Candida fungi, of which there are more than 150 species. 7 species are pathogenic for humans.

Candidiasis of the genital organs is more common in women, less often in men. An important role in the pathogenesis of the disease belongs to a decrease in immunity, dysbacteriosis, beriberi, hormonal disorders, diabetes, the condition of the mucous membranes of the skin! Candidiasis lesions are often combined with other pathogens of sexual infections (chlamydia, ureaplasmas, viruses, etc.).

The incubation period for candidal urethritis lasts from 2 weeks to 1 month, almost always proceeds torpid, rarely begins subacutely. The onset of the disease is accompanied by parasthesia, itching, burning, scanty discharge (thick, mucous). At the same time, diffuse and limited whitish-gray plaques appear on the mucous membrane of the urethra, under which a 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, there is a lesion of the head and foreskin of the penis. In this case, swelling, hyperemia of the foreskin and glans penis are observed, with areas of whitish-gray plaque, which, when removed, form surface erosion and cracks. Scarring of erosions and cracks in a chronic course can lead to the formation of cicatricial phimosis.

The presence of various types of urethritis pathogens requires timely treatment for a qualified medical care, for a comprehensive examination and the appointment of competent etiotropic treatment. Based on our medical clinics a comprehensive diagnosis of infections transmitted through sexual contact is being carried out. The equipment of our centers allows us to quickly and efficiently treat urethritis of any etiology

Our experts will be happy to help you!

For citation: Gomberg M.A. Clinical analysis of a case of genital herpes in a young woman // BC. 2010. No. 12. S. 782

Patient Zh., 24 years old, turned to a dermatovenereologist.
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 sacrum.
Disease history. Similar symptoms have been bothering me for the last 3 years. Repeatedly addressed to gynecologists and urologists. Urinalysis showed leukocytosis, while bacteriological examination of urine did not reveal flora growth. Based on the clinical picture of Zh., a diagnosis of cystitis was made and various antibiotics were prescribed, most often ciprofloxacin. After the course antibiotic therapy each time there was relief, 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 the holidays, or active and prolonged sexual intercourse. In addition, over the past 4 years, the patient had three times vaginal discharge, also accompanied by a burning sensation. She did not go to gynecologists, but on the advice of a friend who, according to her, had similar symptoms, she used clotrimazole suppositories. Within 5-6 days, the discharge and discomfort stopped. The last exacerbation was much more severe than before, and coincided with the return of her husband from a business trip (a week before the onset of symptoms). Without going to the doctors, the patient again used the usual tactics that helped her earlier 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 when one or another treatment applied did not lead to the disappearance of symptoms at 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 aggravation that arose after the return of her husband, the patient decided to undergo an examination.
The patient took the last aggravation very seriously, because she began to suspect her husband of infidelity. I became irritable and thought about divorce. The sexual life has gone wrong. I consulted with my friends, began to look for an explanation of my symptoms on the Internet. Because of the suspicions that arose, this time I decided not to go to a gynecologist or urologist, which I did earlier when similar symptoms appeared, but to a dermatovenereologist in order to be carefully examined for sexually transmitted infections (STIs).
Life history and gynecological history. Menstruation from the age of 14, established immediately. Married 4 years. The husband is 5 years older than Zh., and is the patient's first and only sexual partner. Zh. did not have any pregnancies. Until now, spouses have been protected during sexual intercourse with a condom in order to prevent unwanted pregnancies. Sometimes the husband noted the presence of small abrasions on the head of the penis, then the spouses did not use a condom, and in order to prevent unwanted pregnancy, they practiced coitus interruptus.
inspection data. Physical examination of the patient revealed no anogenital warts, molluscum contagiosum, scabies, and pubic lice.
When examining the vulva, a slight hyperemia was revealed in the area of ​​the vestibule of the vagina and sponges of the urethra. Milky discharge from the vagina was noted, somewhat more abundant than normal, without an unusual smell. The cervix on examination without features. Slight hyperemia around the opening of the cervical canal. The pH value of the 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. Directly related to the disease, for which it was necessary to establish the cause of the patient's symptoms.
2. Prevent possible wrong conclusions about her husband's infidelity and try to find reasons to get the patient out of a depressive state.
Obviously, both these tasks had to be solved in parallel, since the patient's psychological state could be reflected in her desire to cooperate with the doctor and trust him.
Consider the actions of the doctor, taking into account the tasks.
Since it became clear from the conversation with the patient that her main concern was related to the suspicion of infection with a sexually transmitted infection, for which there were reasons, it was necessary to establish the possible cause of the symptoms as soon as possible and to establish whether a recent infection with an STI had occurred.
The doctor explained to J. that, although she did not have convincing data for the presence of a fresh STI, but, realizing that this issue was most of all of concern to the patient, he suggested, in the process of searching for the causes of her recurrent symptoms, to conduct an examination for all major STIs.
This decision reassured Zh. solved both of her concerns and also strengthened her confidence in the doctor.
Surveys to identify possible causes diseases.
The main question was the following: for which infections should the patient be examined, given her history and suspicions of the possibility of a recent STI infection?
The patient's complaints suggested the presence of an infection in the vagina (discharge) and in the urinary tract (crimping during urination). In addition, the information reported by the patient, important for the detection of a possible infection, was that the complaints appeared about a week after her husband's return 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.
As shown in 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 mainly between these three nosologies. In addition, vaginal discharge can also be associated with inflammatory processes in the cervical canal, which can be caused by C. trachomatis, N. gonorrhoeae, or M. genitalium.
UT is considered the most common sexually transmitted infection. The incubation period for UT is not more than a week. The detection of this infection could indicate an STI infection from the husband. Local application clotrimazole in trichomoniasis would not lead to the complete disappearance of symptoms.
BV, although not an STI, is considered the most common cause of abnormal vaginal discharge and is considered a vaginal dysbiosis. Its occurrence could have nothing to do with getting the infection from the husband.
UC is also widespread, accounting for about 1/3 of cases in the structure of infectious lesions of the vagina, but it does not apply to STIs, as well as BV. Clotrimazole could indeed lead to the disappearance of symptoms if candidiasis was its cause.
Thus, of the three main causes of vaginal discharge, only UT could indicate the infection of our patient with an STI.
With regard to C. trachomatis, N. gonorrhoeae, or M. genitalium, it is impossible to exclude their presence in a patient without special examination, but the likelihood of vaginal discharge as early as a week after potential infection with these infections seemed unlikely. The fact is that only a very pronounced inflammation in the cervical canal can manifest itself as discharge from the vagina, 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 a possible role of this infection in this nosology. But with gonorrhea, the incubation period is quite short (3-5 days). With none of these infections, the effect of the use of clotrimazole should not be expected. In any case, it was necessary to examine the patient for all these infections.
Causes of symptoms from urinary tract
Frequent urination and a burning sensation are the main signs of urethritis or cystitis. What can be the cause of these diseases? The most common cause of urethritis and cystitis are 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. However, in the case of our patient, it would be unlikely that the intravaginal application of clotrimazole in this case would have had an effect. The cause of cystitis and urethritis can also be yeast-like fungi of the genus Candida, but again, in these cases, the symptoms would not go away after the intravaginal use of clotrimazole suppositories.
But what about viruses? In particular, the herpes simplex virus (HSV)? Could HSV be the cause of the urinary tract symptoms that our patient described?
The fact that HSV can cause urethritis has long been known. 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 classic symptoms of genital herpes.
Are there any grounds for assuming the viral nature of the problems troubling our patient?
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 growth of bacteria in culture, but not with herpetic urethritis.
.. With herpetic urethritis, as a rule, there is no frequent and imperative urge to urinate, because, 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.
And how to distinguish candidal lesions 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 it may be a manifestation of a herpes infection.
What are the differences?
Differences - microbiological: in the presence of recurrent itching of the genitals and a negative result of the native test for the presence of a yeast infection, an examination for HSV should be performed.
Table 1 presents differential diagnosis based on own clinical experience, various pathological conditions, which in women may be accompanied by a burning sensation in the urogenital region.
Based on the data in the presented table, HSV is the most likely cause of such a variety of symptoms that the patient described. Such an assumption, of course, requires confirmation and does not cancel 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 work with the patient: what infections should she be examined for in order to establish the cause of her symptoms, and also to determine the possibility of her having an STI.
Examination plan for G. for STIs
.. Microscopy of smears from the vagina and urethra with Gram stain.
.. Native preparations for testing for bacterial vaginosis, candidal infection and trichomoniasis.
.. PCR to detect N. gonorrhoeae, C. trachomatis, M. genitalium.
.. Culture for T. vaginalis.
Serological diagnosis to rule out STIs:
. diagnosis of HIV infection;
. RPR test to detect syphilis;
. determination of HBsAg and antibodies to VG-C;
. determination of type-specific IgG to HSV-1 and HSV-2.
Why HSV-1 and 2 IgM testing should not be performed during routine STI screening
. The current IgM tests have serious drawbacks:
. Cross-activity between IgM to HSV-1 and 2 is possible.
. With herpetic HSV-1 infection on the lips, positive tests HSV-2 ⇒ False diagnosis of genital herpes infection ⇒ Inadequate treatment and unwanted emotional problems when it comes to starting a family or long-term relationships.
. A cross-reaction with other herpes viruses is possible: CMV, Epstein-Barr and others.
.. 35% of people with HSV-2 reactivation may have IgM ⇒ the test does not distinguish between a new infection and an existing one.
. Such a test may be warranted in neonates 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 were not transplacental from the mother.
The results of the survey J.
In patient Zh., all tests for STIs were negative, except for a positive type-specific test for HSV-1 and HSV-2.
Counseling J.
After analyzing the results, the doctor explained to the patient that she is a carrier of HSV infection, which, obviously, periodically causes all the symptoms that bother her in last years, which completely fit into the natural course of HSV infection, and the “effect” of the drugs used by Zh. actually coincided in time with the end of the next exacerbation of herpes 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 manifested itself in the form of a blistering rash, for example, on the lips. This is always a very crucial moment for a doctor, because during the initial diagnosis of HSV infection, it is very important to conduct competent counseling, answering all possible questions of a patient who has heard about his diagnosis for the first time.
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 went to 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 to discuss with a patient during a primary episode of genital herpes:
1) a possible source of infection;
2) the 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) the consequences of infection by an infected man of an uninfected partner during pregnancy;
8) the possibility of notifying partners.
As can be seen from this list of recommended questions for discussion, this list is even wider than those that interested G. Of all the points presented here, only the consequences of infection by an infected man of an uninfected partner during pregnancy were not relevant to our case, since J. was already infected.
In the process of counseling our patient, it finally became possible to reasonably begin to consider the second important topic in order to prevent possible wrong conclusions regarding her husband's adultery and try to find arguments to improve the patient's state of mind.
In principle, it is not the task of medical counseling to conduct an "investigation to convict one of the partners of adultery." On the contrary, a great success of a doctor can be recognized as a situation when, despite the diagnosis of STIs in the spouses, which unequivocally indicates the fact of infidelity, they conduct counseling 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.
Here 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 history data, it can be assumed that the infection occurred after marriage and the source of infection, apparently, was the spouse. But at the same time, it cannot be ruled out that the spouse could have had HSV even before marriage, and the infection persists in a latent or, possibly, asymptomatic state. To clarify this issue, it was necessary to talk to Zh.'s husband and examine him.
. Why had neither gynecologists nor urologists ever examined her for herpes before?
The rules of deontology suggest that colleagues should not be accused of mismanaging a patient. We must try to find an explanation for the perfect diagnostic error that would not make the patient want to sue the doctors without fail - 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 such consequences. The explanation, which suited the patient quite well, was this: most likely, the doctors previously relied too much on clinical manifestations that are quite typical for both candidiasis and bacterial cystitis, and therefore did not consider it necessary to carry out additional research. Perhaps 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 follow at all that the husband contracted this infection while in marriage. It is possible that he acquired it before marriage. It can also be said for sure that the coincidence of Zh.'s last exacerbation has nothing to do with her husband's return from a business trip, where, according to Zh., he could have contracted an STI. Rather, the cause of the last exacerbation could be prolonged active sex, after which Zh. had exacerbations before. By the way, relapses after traumatization, even minor, which is quite likely with active sex, are just very typical for herpes infection.
After discussing the situation, it was decided to invite Zh.
The results of the examination of the patient's spouse Zh.
K., husband Zh., came for examination. In a conversation with a doctor, he stated that before marriage he had had sexual intercourse and among his partners there may have been those who had a herpes infection. He never had manifestations of a 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: husband Zh. was seropositive for HSV-1 and 2.
This greatly surprised the husband of our patient, because, as he claimed, he never had symptoms of the disease. The doctor had to consult his wife as well.
First of all, the doctor explained to him that, according to the current understanding of herpes infection, people who test positive for type-specific serological tests for HSV-2 are almost always infected with this virus and can transmit it to other people even in cases where they have never had symptoms. this infection.
The doctor referred to American data, according to which 22% of people over the age of 14 in the United States are carriers of HSV-2 infection, and only 10% of these people knew that they were infected.
The fact that herpes infection never manifested itself in husband Zh. meant that it was subclinical in him. Moreover, it is with this course of infection that the partner is most often infected. So it is not surprising that, despite the absence clinical manifestations herpetic infection, husband Zh. transmitted HSV to his wife.
Now it's time to discuss the situation with both spouses and outline an action plan to control the herpes infection, especially since before the last visit to the doctor they planned the birth of a child.
Couples counseling
This is a necessary part of counseling when it comes to permanent sexual partners, since it is an infection that they will have to live with for the rest of their lives, and only professionally competent counseling 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, tk. elimination of the latter is impossible. So, the doctor invited both spouses for the 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 they could detect was HSV, both HSV-1 and HSV-2.
2. Symptoms that periodically bothered Zh. can be explained by the presence of this particular infection.
3. The source of infection is husband Zh., whose HSV infection proceeded subclinically.
4. Based on the anamnesis and data obtained during the examination of Zh.'s spouse, it can be concluded that he acquired HSV infection before marriage with Zh.
5. Finally, the doctor discussed the issue of existing therapeutic options.

Choice of strategy in the fight against HSV infection
1. Treatment of each episode of manifestation 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. The treatment of each episode of manifestation of genital herpes (HH) infection is called episodic therapy.
It is understood as the ingestion of antiviral drugs at the time of exacerbation of the infection. This strategy is recommended for patients with rare, clinically silent exacerbations and in the presence of a well-defined prodromal syndrome, during which the drug 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 guidelines for the management of immunocompetent adult (with normal immune status) patients with genital herpes, the recommendations of the International Forum for the Treatment of Herpes, as well as the clinical guidelines for the treatment of genital herpes RADV, which is also reflected in the instructions for the use of antiherpetic drugs in the Russian Federation, with primary infection or recurrence of a previously untreated herpes infection, the following treatment regimens with etiotropic (antiherpetic) drugs should be prescribed: on average
. Acyclovir 200 mg x 5 times / day. 5 days
400 mg x 3 times / day. 5 days
. Valaciclovir 500 mg x 2 times / day. 5 days
. Famciclovir 250 mg x 3 times / day. 5 days
For all subsequent relapses of chronic herpes infection in immunocompetent adult patients, it is recommended to prescribe acyclovir and valacyclovir 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 recurrence of HSV infection or suppressive (preventive) therapy of HH.
This approach implies daily intake of etiotropic antiviral drugs continuously for a long time (4-12 months).
Indications for suppressive therapy are:
1. severe course with frequent exacerbations;
2. absence of a prodrome;
3. special circumstances (vacation, wedding, etc.);
4. while taking immunosuppressive therapy;
5. with psychosexual disorders;
6. to avoid the risk of transmission of infection.
According to the above international and Russian clinical guidelines, which is also reflected in the instructions for the use of antiherpetic drugs in the Russian Federation, the following schemes are prescribed for the suppressive therapy of HH for a long time (4-12 months) with a 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 / 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 the anamnesis, did not exceed 6 per year. Nevertheless, among the indications for suppressive therapy were those that were related to it. Thus, relapses in Zh. always occurred in the absence of a prodrome, often occurred during a change in climate during a vacation, and were accompanied by psycho-sexual disorders.
The doctor explained that the choice of antiherpetic therapy tactics may vary depending on the circumstances, and suggested that J. decide for herself which treatment option she prefers at the present time.
Having received so much new information, J. 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 the control of herpes infection.
At her next appointment, the patient reported that, after weighing various circumstances, she was inclined to believe that suppressive therapy was preferable in her situation, since it would help her not only cope with the occurrence of exacerbations, but also find peace after the stress and establish marital relations.
After discussing the available therapeutic options with the doctor, it was decided to suppressive therapy with valaciclovir (Valtrex) daily, 1 tablet of 500 mg. The joint decision in favor of Valtrex was based both on the existing recommendations for the treatment of HH, and on the fact that since the patient would have to take the drug for a long time, it was preferable for her to take the drug no more than 1 time per day, and Valtrex seemed to her the most acceptable in terms of cost.
Zh. was prescribed Valtrex and was asked to come for a consultation with a doctor 3 months after its use according to the suppressive therapy regimen: 1 tablet (500 mg) 1 time per day, regardless of food and liquid intake.
Final consultation. Pregnancy planning
Zh. came to the appointment after 3 months. During this time, while taking Valtrex, 1 tablet (500 mg) 1 time / day. She didn't have a single relapse. The patient's mood was good. Relationship with her husband improved. They vacationed together in the Italian Alps, skiing. Despite hypothermia, there were no exacerbations of herpes infection during suppressive therapy with Valtrex. The patient decided to continue therapy and asked if she could plan a pregnancy.
The doctor explained to Zh. that, according to the European guidelines for the management of patients with genital herpes, when pregnancy occurs, the obstetrician-gynecologist should be informed about the presence of HSV infection.
With regard to the continuation of suppressive therapy, when planning a pregnancy, it should be discontinued. If an exacerbation of a herpes infection occurs during pregnancy, you should visit a doctor to decide on the need for treatment.
Although there is a risk of transmission of HSV infection from mother to fetus during pregnancy, in the case of G. this risk is minimal, because she already has antibodies to this virus and a serious danger to the fetus can only be with an exacerbation of HSV infection by the time of delivery. At this point, treatment should be prescribed. Taking into account the presence of HSV in her husband, the situation during the pregnancy of J. would be much more difficult, since there would be a serious threat to the fetus if the seronegative mother were infected during pregnancy.
J. was quite satisfied with the consultation and grateful that, with the help of the doctor, she finally learned to fully control her illness 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 Website. 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 guidelines Russian Society of Dermatovenerologists (RODV). Ed. A.A. Kubanova, Moscow, Dex-Press, 2008.

Herpetic urethritis is a viral pathology that affects the genitals. It is characterized by a variety of clinical manifestations. According to research, scientists have established a trend towards the spread of urethritis, including the herpetic type among the population. The main cause of the disease is the herpes virus, which, having entered the body once, remains there forever. The development of pathology occurs with a decrease in immunity 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 pathology is the herpes virus of the second type. Infection occurs through close contact with an infected person. Defeat genitourinary system occurs during sexual intercourse.

The disease is established in both men and women. In the initial stages of development, herpetic 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 over time flows into a latent state. Exacerbation is observed under the influence of various factors. That is why the disappearance of signs of herpetic urethritis does not mean a complete recovery.

The virus continues to be in the body and can cause not only the re-development of 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 chicken pox. After treatment, it remains in the body and, under the influence of certain factors, can cause urethritis. The risk of developing the disease increases in the presence of:

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

Influence on the onset of symptoms of herpetic urethritis can be malnutrition and trauma to the mucous membrane of the genital organs.

Signs and symptoms

The first signs of the disease appear 3-7 days after infection. 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 on the vaginal mucosa. Over time, the vesicles burst, and ulcers form in their place.

In severe lesions, 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 scarce 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 selection change their intensity, 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 state 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, the manifestations become more intense.

What tests to take

Diagnosis of the disease is carried out on the basis of the results of a number of laboratory tests:

• smear from the vagina or urethra;
• PCR diagnostics;
• direct immunofluorescence reaction.

A smear is taken from the urethra in women, and scrapings are taken from the mucosa of the urethra in men. The method helps to detect the presence of a virus and determine its type.

The results of PCR diagnostics are ready after a few hours, which allows you to immediately start therapy.

The direct immunofluorescence reaction is a modern method for detecting the herpes virus. It is carried out using a special apparatus that illuminates the cell nuclei with a bright green light.

Drugs: treatment regimen

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

1. Elimination of the first appearance of pathology.
2. Relapse treatment.
3. suppressive therapy.

If the herpetic type urethritis was established 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 can not be more than 10 days.

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

Only in this case it is possible to achieve a positive result. In the case when one course of treatment was not enough, the doctor may prescribe a second one.

If there is a recurrence of herpetic urethritis, then treatment should be started on the first day of the onset of symptoms. With the re-development of pathology, it is recommended:

• acicovir at a dosage of 400 mg three times a day for five days;
• famciclovir, the content of active substances is 125 mg, three tablets per day, the course of treatment is five days;
• valacyclovir, you need to take 1 g 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 a day.
3. Famciclovir. Dosage 250 mg twice a day.

In the case when herpes urethritis is established, therapy is supplemented with immunomodulators. They help support the immune system. Means for relieving symptoms of intoxication of the body are also recommended.

Complications and consequences

If left untreated, herpes-type urethritis may develop consequences. The pathological process over time spreads to the urinary tract, 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.

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

Preventive measures

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

1. Healthy food. It is necessary to abandon the consumption of junk food, which includes products fast food and fast food.
2. Eliminate stress, neurosis and prolonged depression.
3. Timely treat infectious lesions of the genital tract.
4. Use contraceptives during intercourse.
5. Follow the rules intimate hygiene. Having vaginal sex after anal sex is necessary only after washing. Water procedures must be performed not only by a woman, but also by a man.

In addition, it is necessary to have a regular sexual life and exclude the frequent change of sexual partners. Compliance with 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 the symptoms is the herpes virus, which can penetrate the mucous membranes during unprotected intercourse. Treatment is always long, and the disappearance of symptoms does not mean complete recovery. Once in the body once, the herpes virus remains there forever. Ointments or antiviral drugs. That is why it is important to observe hygiene and preventive measures.

The antigen enters a healthy body most often during sexual intercourse, less often - from the toilet bowls of public toilets, from towels and in case of non-compliance with personal hygiene. He is insidious in that he may not show himself 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 is little studied and difficult to diagnose. The most susceptible to infection are representatives from 26 years to 56 years.

Manifestations of the disease

Herpetic prostatitis, although very rare, does occur. It never goes unnoticed. The only thing is that the infection can simply be misdiagnosed. And the men themselves, in general, are not in a hurry for 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 manifestation. common cold and are only treated 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;
• a very bad headache;
• burning sensation in the perineum;
• severe pain in the pelvic, and sometimes in the lumbar region;
• defecation processes may be disturbed (constipation, diarrhea);
• severe pain when urinating;
• temporary sexual dysfunction;
• loss of libido.

According to the latest symptoms of herpetic prostatitis, men generally think that age-related changes are beginning, for which they have already prepared and tuned in to them, and many take the first manifestations for SARS and treat 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 recurring ones that cause a lot of problems. Not only does the treatment of herpetic prostatitis last about a month, the infection can re-occur up to five times. If repetitions of the disease are observed six or more times a year, urgent help from a general practitioner and an immunologist is necessary. The symptoms of the chronic form of the disease are weak, but entail irreversible disturbances in the work of the prostate: a constant burning sensation, severe discomfort during urination, palpable pain in the perineum and lower back during movement and sexual intercourse, sexual dysfunction is pronounced. Unfortunately, if left untreated, protracted forms of herpetic prostatitis, which can last for years, lead to infertility and impotence.
2. Acute. Passes with a pronounced clinical picture with burning, itching, fever, urinary retention and soreness, weakness and lethargy. If you do not start treatment during this period, there is a very high risk that the infection will take chronic form. The action 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 the strengthening of immunity.

Viral urethritis in women and men

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

1. The appearance of a rash in men on the penis, in the region of the head, in the urethra, on the inside of the foreskin.
2. In women, the rash is localized near the urethra or inside.
3. Unbearable burning when urinating.
4. Heat.
5. A sharp deterioration in well-being.
6. General depression of mood, apathy.
7. Periodic unbearable pain in the urethra.
8. Constant urge to urinate.
9. Persistent sensation of an always full bladder.

Diagnose herpetic urethritis using ureteroscopy, it looks like a cluster of small erosive formations.

Another distinctive phenomenon in herpurethritis is mucous discharge from the urinary canal, especially in the morning. When the infection is started, bacteria join, then the discharge becomes purulent.

Forms of infection

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

1. Light. 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, rashes are plentiful, there are general ailments.
3. heavy. Characterizes itself as a recurrence of infection more than five times a year, 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, 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;
• travel 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 able to penetrate the nuclei of human cells, change their structure and live 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 may differ only in the type of biomaterial taken and a number of devices.

Both women and men necessarily carry out a not very pleasant procedure - ureteroscopy, in which the specialist accurately determines the presence of a rash, its prevalence and localization.

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

• scrapings from the urethra of women and men;
• urine;
• blood from a vein;
• semen;
• mucus secreted 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 for analysis from a vein in the morning on an empty stomach, then, by diluting its serum, the concentration of immunoglobulins is monitored, the results are measured in titers.
2. PCR– polymerase chain reaction method; here the biomaterial can be all of the above, with the help of chemical reactions determine the presence of the virus.
3. Method for highlighting antigens- the blood is treated with a special solution, and then highlighted, the viral formations stand out 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 showed itself, they act like this:

1. Assign three times a day, a course of seven days; or five to six times a day for 10 days; or Valaciclovir twice a day for 10 days. This similar preparations, in them only excipients are different.
2. Viferon suppositories with a dosage of 1,000,000 IU are administered rectally twice a day. This is an excellent one that not only stimulates the immune system, but also blocks the reproduction of the virus.
3. Ointments Acyclovir and Zovirax are prescribed if the rash is outside. 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. Ointment Zovirax, Acyclovir 6-7 times a day.

Suppressive therapy

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

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

Treatment of such diseases begins immediately, no matter how severe the disease is. In a neglected version, an infection from a mild stage can turn into a severe one and bring bacterial complications with it.

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

What will help in the treatment?

First of all, you need not lose heart, but tune in to a good treatment.

• get enough sleep;
• rest more;
• live a healthy life;
• 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. Persistent problems with urination.