RU2179849C2 - Method to treat female recurrent genital herpes - Google Patents

Abstract

FIELD: medicine, venerology. SUBSTANCE: the method puts forward to apply in combination Valtrex antiviral preparation, Neovir immunomodifying preparation and the one which has an impact upon urinary tract microflora - Acylact. Female patients are prescribed to use Valtrex per 0.5 g twice daily, a course lasts for 5 d, simultaneously Neovir is prescribed per 250 mg intramuscularly, 10 injections in 2 stages: the first 6 injections at 48-hlong interval, the last 4 injections at 7-d-long interval. When Valtrex intake is over, Acylact should be prescribed as vaginal suppositories per 5 doses daily, for nocturnal use, for 10 d. Before and after therapy a vaginal lysozymic activity is determined to evaluate the level of urinary tract biocenosis, vaginal pH, flora by calculating a total microbial amount (due to inoculation upon a bloody agar). EFFECT: prolonged terms of remission by 4-5 times in 75.9% female patients. 1 tbl _

Description

 The invention relates to medicine, namely to venereology, is intended for outpatient treatment of patients with recurrent genital herpes (RHG).

 The leading role in the pathogenesis of herpes virus infection belongs to the interferon link of the immune system, as evidenced by several authors of the study (Jumigo P.A., 1990., Kuratulaev K.N., 1991, Khaldin A.A., 1995, Sukhikh G.T., Vanko L.V., Kulakov V.I., 1997).

 A known method of treatment of RHG using a comprehensive etiological and pathogenetic treatment aimed at inhibiting the reproduction of herpes simplex virus and to increase the immunological reactivity of the body. As an antiviral drug, acyclovir, famciclovir, alpizarin, ribamidil, methisazone are used. For immunocorrection, interlock, reaferon, half-dan, neovir, ridostin, tactivin, etc. are used (Vladimirova E.V. Herpetic infection of the skin and mucous membranes. Herald of dermatology and venereology 1997; 2: 45-51).

 However, known treatments for RHG have a limited positive effect, because increase remission time by 2-2.5 times only in 75% of patients.

 Known drug neovir. With parenteral administration, the drug causes the rapid formation in the body of high titers of endogenous interferons. As a result, a state of resistance to viruses is formed in the cells, and immune responses are also induced to destroy the virus and the affected cells.

 Known drug valaciclovir (valtrex), intended for oral therapy of herpetic infections. Using this drug can reduce the duration of relapse to 4.8 days, but it does not affect the duration of remission.

 Known drug acylact. Acylact is a microbial mass of live acidophilic lactobacilli, which have high antagonistic activity against a wide range of pathogenic and conditionally pathogenic microbes, which determines the corrective effect of the drug in cases of genital bacteriocinosis disorders.

 The aim of the invention is to increase the timing of remission in women with RHG.

 This goal is achieved by the integrated use of the antiviral drug valtrex, an immunomodulatory drug neovir and a drug that affects the microflora of the genitourinary tract - acylact.

 The invention is implemented as follows.

 Patients with RHG during relapse (the first 48-72 hours) are prescribed valtrex 0.5 g 2 times a day for 5 days, a course dose of 5 g, at the same time, 250 mg neovir is administered intramuscularly 10 injections in two stages, the first six injections with an interval of 48 hours, the last four injections with an interval of 7 days (immediately before injection, the drug is diluted with 1.5 ml of a 0.5% solution of novocaine). After taking valtrex, acylact is prescribed in the form of vaginal suppositories in 5 doses daily, at night, for 10 days.

 Before the appointment and after therapy in patients, the lysozyme activity of the vagina is determined to assess the biocenosis of the genital tract (Kazakov A.V., Telyakova G.V., Scherbakova N.V. Method for rapid diagnosis of the inflammatory process of the female genital area. 1990), pH vagina, flora with the calculation of the total microbial number (by sowing on blood agar).

 A table is presented with its own data on the dynamics of lysozyme activity and vaginal pH.

 The results of a comparative analysis before and after treatment indicate that under the influence of therapy, the pH of the vagina normalizes with an increase in lysozyme activity.

 Using the proposed method is illustrated by the following examples.

 Example 1

 Patient S., 27 years old. Diagnosis: Recurrent genital herpes, severe course. RGG suffers for 3 years. Relapses lasting 8-10 days occurred 1 time in 1-1.5 months. For treatment during relapse, the patient used external drying agents, antiviral ointments, herbal adaptogens, and vitamin therapy. Under the action of treatment, relapse resolved 2-3 days faster, but therapy did not affect the timing of remission.

Clinical and laboratory examination using the indicated methods revealed hemolytic staphylococcus, non-hemolytic streptococcus, streptobacteria, total microbial number 10 ⁷ , lysozyme activity negative, vaginal pH 5.0.

During relapse, the patient was prescribed valtrex 0.5 g 2 times a day for 5 days, a course dose of 5 g, simultaneously with 250 mg neovir intramuscularly 10 injections in two stages, the first six injections with an interval of 48 hours, the last four injections with interval of 7 days. After taking valtrex, acylact was prescribed in the form of vaginal suppositories in 5 doses daily, at night, for 10 days. Against the background of treatment, subjective sensations in the form of a burning sensation, soreness at the site of rashes regressed in 2 days, rashes in 4 days. After the treatment, the total microbial number in the genital tract decreased to 10 ⁵ , the flora - lactobacilli, corynebacteria, lysozyme activity of the vagina 5 mm, the pH of the vagina is 4.0. Adverse reactions and complications were not noted. Remission lasts 5 months.

 Example 2

 Patient P., 25 years old. Diagnosis: Recurrent genital herpes, moderate severity. Suffers RGT 5 years. Relapses lasting 5-7 days occurred 1 time in 2-3 months. For treatment during relapse, the patient took 200 mg acyclovir 5 times a day, 5 days. Against the background of taking the drug, a rash occurred in 4 days, but the therapy did not affect the timing of remission.

Clinical and laboratory examination using the indicated methods in the genitourinary tract revealed non-hemolytic streptococcus, staphylococcus, streptobacteria, total microbial number 10 ⁶ , lysozyme activity - negative, vaginal pH - 5.0.

During relapse, the patient was prescribed valtrex 0.5 g 2 times a day for 5 days, a course dose of 5 g, simultaneously with 250 mg neovir intramuscularly 10 injections in two stages, the first six injections with an interval of 48 hours, the last four injections with interval of 7 days. After taking valtrex, acylact was prescribed in the form of vaginal suppositories in 5 doses daily, at night, for 10 days. Against the background of treatment, subjective sensations in the form of burning, itching at the site of rashes regressed in 1 day, rashes in 3 days. After the treatment, the total microbial number in the genital tract decreased to 10 ⁵ , the flora - lactobacilli, diphtheroids, corynebacteria, lysozyme activity of the vagina 4 mm, vaginal pH 4.0. Adverse reactions and complications were not noted. Remission lasts 12 months.

 By the proposed method and applying the indicated methods to monitor the effectiveness, 21 patients with RHG were treated in the UrNII DV and I, the control group - 16 people. No side effects were detected during treatment. In 75.9% of patients, remission periods increased 4-4.5 times (from 4 to 12 months), in 24.1% of patients 2.5 times (from 3 to 10 months), the duration of relapse from 7-10 days decreased to 3-4 days (2.4 times).

 To assess the condition of the genital tract microbiocenosis and the effect of the proposed treatment method on its correction (to increase the time of remission, reduce the duration of relapse) in patients, the lysozyme activity of the vagina (by the specified method), vaginal pH, total microbial number and types are determined before treatment and after it microorganisms (seeding of the genital tract on blood agar).

Before treatment, in patients with RHG, the shift of the vaginal pH to the alkaline environment prevailed with negative lysozyme activity of the vagina, the total microbial number was 10 ⁴ -10 ⁵ in 57.1% of patients, 10 ⁶ in 28.6%, 10 ⁷ in 14.3 %, streptobacteria, hemolytic streptococcus and staphylococcus, non-hemolytic streptococcus with a low content of lactobacilli predominated in the flora, which indicates a disturbed biocenosis of the genital tract.

After therapy, normalization of the vaginal pH (3.8-4.2) was observed in 100% of patients, lysozyme activity of the vagina to 2 mm in 47.6% of patients, from 2 to 4 mm in 28.6%, more than 4 mm in 19%, the total microbial number remained at a predominant value of 10 ⁴ -10 ⁵ (in 52.4% of patients), however, hemolytic streptococcus and staphylococcus were not found in the genital tract, the percentage of lactobacilli was significantly increased.

 The use of the proposed method for the treatment of RHG in women allows to increase the remission period by 4-4.5 times in 75.9% of patients, which is more pronounced than when using the known method.

Claims (1)

 A method of treating recurrent herpes in women, including the use of antiviral and immunomodulated drugs, characterized in that patients are prescribed valtrex 0.5 g 2 times a day, a course of 5 days, at the same time, 250 mg neovir is administered intramuscularly, 10 injections in two stages, the first six injections with an interval of 48 hours, the last four injections with an interval of 7 days, after the end of taking valtrex, acylact is prescribed in the form of vaginal suppositories in 5 doses daily, at night, for 10 days.

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