Turkiye Klinikleri Journal of Internal Medical Sciences

Cinsel Yolla Bulaşan Hastalıklar Özel Sayısı
Genital Herpesin Klinik Tanısında ve Tedavisinde Güncel Yaklaşımlar
RECENT APPROACH TO THE DIAGNOSIS AND TREATMENT OF GENITAL HERPES
Güzin ÖZARMAĞANa, Kurtuluş Didem YAZGANOĞLUa
aDermatoloji AD, İstanbul Üniversitesi İstanbul Tıp Fakültesi, İSTANBUL
Turkiye Klinikleri J Int Med Sci. 2006;2(11):56-61
Article Language: TR
ÖZET
 Genital herpes, gelişmiş ülkelerde en çok görülen genital ülser hastalığıdır. Enfeksiyon hayat boyu sürer ve tekrarlayan ataklarla seyredip ciddi psikososyal morbiditeye yol açabilir. Son yıllarda herpes simpleks virüsü (HSV) enfeksiyonlarının tanı ve tedavisinde çeşitli gelişmeler olmuştur. Tanıda kullanılan en basit yöntem sitolojik olup, geleneksel tanı yöntemi virüs kültürüdür. Bunun yanında, antijen saptamaya yarayan diğer tanı yöntemlerinden elektron mikroskobisi ve immünofloresans, immünoperoksidaz, ELİSA gibi immünolojik yöntemler de kullanılır. Monoklonal antikorlar ile de tiplendirme yapılabilmektedir. HSV antijenini göstermede son yöntemler DNA hibridizasyonu, polimeraz zincir reaksiyonu (PZR) ve loop-aracılı izotermal amplifikasyondur. Bunlar, duyarlı olmakla beraber masraflıdırlar. Serolojik testlerden kompleman fiksasyonu, nötralizasyon, immünfloresans, immünoperoksidaz, radyoimmünassay, ELİSA tip ayrımında güvenilir değildir. Son zamanlarda tipe spesifik serolojik testler geliştirilmiş olup, "immunodot enzyme assay", tipe spesifik glikoprotein antijenleri (gG-1 ve gG-2) ve "Western blot assay" bunlar arasındadır. Bunlar diğer tüm serolojik yöntemlere göre daha spesifik ve sensitiftir. Genital herpes tedavisi, mevcut klinik tablo ve hastanın beklentileri doğrultusunda değerlendirilir. Asiklovir, valasiklovir, famsiklovir gibi sistemik antiviral ajanlar, hastalığın süresi ve şiddetini kısaltıp, atak sıklığını güvenilir bir şekilde azaltırlar. Ancak bunların latent virüsü eradike etmeyeceği, ilaç bırakılınca tekrarlama riskini ve şiddetini etkilemeyeceği bilinmelidir. Antiviral tedaviye direnç durumunda, özellikle immünsüpresyonlu hastalarda, foskarnet ya da ülkemizde bulunmamakla birlikte sidofovir, alternatif tedavi seçenekleridir. Resikimod, immün yanıt düzenleyici bir ilâç olup, genital herpes için yeni bir tedavi alternatifi olarak gündeme gelmiş, ancak daha sonra etkisiz olduğu belirlenmiştir. Günümüzde, HSV için etkili popülasyon kontrol yöntemleri bulunmamakla beraber, çeşitli aşıların geliştirilmesi ve bunların uzun süreli kullanımlarında etkinlik ve güvenilirliklerinin kanıtlanmasıyla bunun değişebileceği düşünülmektedir.

Anahtar Kelimeler: Genital ülser, herpes simpleks virüsü, asiklovir, valasiklovir, famsiklovir
ABSTRACT
 Genital herpes is the most common cause of genital ulceration in developed countries. Infection is life-long, may present with frequent episodes and may result with serious psychosocial morbidity. There have been major developments in the diagnosis and treatment of herpes simplex virus (HSV) in the last decade. The simplest method of diagnosis is cytology while the traditional one is virus culture. Several antigen detection techniques such as electron microscopy, immunofluorescence, immunoperoxidase staining and ELISA are available. Typing can be performed with monoclonal antibodies. The recent methods of HSV antigen detection are DNA hybridization, polimerase chain reaction (PCR) and loop-mediated izothermal amplification. Although they are sensitive, they are also expensive. Complement fixation, neutralization, immunofluorescence, immunoperoxidase, radioimmunoassay and ELISA are serologic assays that are widely available, but none of these reliably differentiates antibodies to type-specific and type-common antigens. Recently, type-specific assays have been developed. These include immunodot enzyme assay, type-specific glycoprotein antigens (gG-1 and gG-2) and Western blot assay, which are more sensitive and specific compared with the others. Treatment of genital herpes is decided according to the clinical presentation and characteristics of the patient. Acyclovir, valaciclovir, famciclovir are systemic antiviral agents that can reduce disease severity, shorten disease period and prevent recurrences. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued. Foscarnet or cidofovir are alternative drugs in case of resistance to acyclovir. Resiquimode is an immune modifier that is a new treatment option for genital herpes. Currently there are no effective population control measures for HSV. This may change with the advent of HSV vaccines, if their safety and long-term efficacy are confirmed.

Keywords: Genital ulcer, herpes simplex virus, acyclovir, valaciclovir, famciclovir

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30.03.2014

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