Clinical and immunological features of the variants of the course of recurrent genital herpes

Background. The variety of clinical forms of genital herpes (GH) is associated with the virological properties of infectious agents (herpes simplex virus type 1 or 2), which have immunosuppressive properties and mechanisms for escaping the body’s immune surveillance. Chronic infection leads to immunodeficiency, which is manifested by a decrease in the functional activity of immunocompetent cells, dysregulation of immune mechanisms and, as a consequence, ineffectiveness of the antiviral response mechanisms. These factors are responsible for long-term persistence, reactivation of the virus and recurrence of the disease.Objective. Identification of the features of clinical manifestations, immune and cytokine statuses of patients with arrhythmic, monotonous and subsiding variants of the course of GH in order to their use in clinical diagnostic algorithms for the appointment of adequate immunotropic therapy.Methods. 58 women and 34 men aged 26 to 45 years with GH caused by the herpes simplex virus type 1 or 2 voluntarily participated in the study. All patients were divided into groups: group I - with arrhythmic course of disease (the duration of remission between relapses from 2-3 weeks to 2-3 months), group II - with monotonous (6-8 relapses per year with remissions lasting 2-6 weeks), and group III - with subsiding ones (increase in the duration of remission from 3 months to 9 months over time). Clinical manifestations, immune and cytokine statuses were analyzed.Results. According to the severity of clinical manifestations, GH relapses were 2-2.5 times more severe in the arrhythmic variant compared to the monotonous and subsiding variants. The monotonous course occupied an intermediate place, but was characterized by the most pronounced feeling of general malaise; clinical symptoms were less severe in subsiding variant of relapse. In an arrhythmic course of GH, T-cell cytotoxic reactions were activated (the blood CD8 and CD4 levesl increased, the immunoregulatory index decreased); the total pool of T-lymphocytes (CD3), NK-cells (CD16), the α-, β-, γ-interferon, interleukin-2 and tumor necrosis factor α levels decreased. In a monotonous variant of GH relapse, changes in the immune status and cytokine content were less pronounced; in a subsiding variant, an increase in the level with normal immunograms was characteristic.Conclusion. The results of the study indicate the activation of antiviral immunity in the subsiding course of recurrent GH and its exhaustion - in arrhythmic one. The revealed features of clinical manifestations, immune and cytokine statuses of patients with arrhythmic, monotonous and subsiding variants of the course of GH make it possible to supplement the clinical diagnostic capabilities with adequate immunotropic therapy

genital herpes, clinical and immunological features