Prophylaxis of herpetic infections reactivation before the planned pregnancy

Abstract

The aim of the work – to estimate serum and molecular-genetic markers of chronic CMV-, HSV1- and HSV2-infection reactivation, that can result in the prenatal pathology, and also to offer the effective medicamentous prophylaxis of these herpetic infections at the stage of pregnancy planning. Materials and methods. 42 women with serum and/or molecular-genetic markers of chronic herpetic infections reactivation and a high risk of fetus damage were examined at the stage of repeated pregnancy planning. Results. Significance of clinical and laboratory signs of chronic herpetic infection reactivation has been estimated. Repeated detection of IgM to СMV in blood can be interpreted as a sign of chronic CMV-infection exacerbation. However, an absolute value has СMV genetic material detection in blood (PCR method), but not in saliva. Repeated seroconversion of IgA and IgM to HSV1/2 and also НSV1 DNA in blood or НSV2 DNA in urogenital mucus detection can be interpreted in the same manner. High level of IgG to СMV, HSV1 and HSV2 do not indicate the corresponding chronic herpetic infection reactivation. Avidity of аnti-CMV IgG, аnti-НSV2 IgG at chronic herpetic infections also is always high. An increase in IgG corresponding levels in 4 times and more in pared serum samples does not occur in the case of herpetic infection reactivation. Complex prevention of congenital herpetic infections targeting women from the risk group should be taken at the stage of pregnancy planning by adding a cytokine-like preparation “Allokin-alpha” to the etiotropic therapy. In contrast to basic treatment only, such combination allows to avoid herpetic infections reactivation (СMV, HSV1 and HSV2) during pregnancy in 100 % of cases. Conclusions. For detection of СMV reactivation the focus should be primarily on the clinical and other laboratory signs of CMV-infection: temperature rise, liver enlargement, leukocytosis and monocytosis, increase in lymphoblasts number, increase in activity of alanin-, aspartataminotranspherase and γ-glutamiltranspeptidase. As distinct from infectious mononucleosis, there are no lymphadenopathy and tonsillitis. Typical lip or perioral vesicular exanthema, aphthae on the mucous membrane of oral cavity and so on (orofacial herpes), vesicular rash on the mucous membrane of vulva, vagina, and cervix uteri (genital herpes) with a local itch, tenderness, burning sensation and general intoxication manifestations are of key importance clinical sings for reactivation of chronic НSV infection diagnostics. Titer of IgG to СMV, HSV1 and HSV2, increase in their level in pared serum samples and also their avidity in chronic herpetic infections are no reliable criteria for reactivation. The women from the risk group at the stage of pregnancy planning are advised to prevent the congenital herpetic infection by means of complex valaciclovir intake 0.5 g 2 times daily for 7–10 days and 6 hypodermic injections of “Allokin-alpha” in a dose of 1 mg on alternate day. cytomegalovirus infections, herpes labialis, genital herpes

Keywords

• cytomegalovirus infections
• herpes labialis
• genital herpes