Study Of Relationship Between Nongonococcal Urethritis And Herpes Simplex Virus And Curative Effect Of Antivirus Therapy

Background: Nongonococcal urethritis ranks as one of the most commonsexually transmitted diseases. From the 1960s , NGU has become the primary STD in the west. As for our country, the incidence rate of NGU has increased rapidly recently and the reported cases have been more than gonorrhea for the first time in 2001. As is well known, the major pathogens that causing NGU are chlamydia trachomatis (CT) and mycoplasm including ureaplasma urealyticum (UU), mycoplasma hominis (MH) and mycoplasma genitalium (MG) et al. More recently, however,non-chlamydia trachomatis and non-mycoplasm NGU has been accounted for 50% of the total of NGU. Most patients with recurrent symptomatic or persistent NGU receive negative test results for chlamydia trachomatis and mycoplasm, and the cause of such NGU is unclear. Numerous bacteria, viruses, and protozoa have been implicated as etiologic agents for NGU, although definitive proof for causation with most of these agents is lacking. Therefore, managing cases with recurrent or persistent NGU is one of the most difficult problems in venereology. A possible relation to other infections has been a question of common interest. Such as NGU owing to herpes simplex virus has been attracted attention already. But there are few reports in our country.Objective: First of all, we wished to investigate the possible aetiological role of herpes simplex virus in patients with nongonococcal urethritis especially who were3all negative in CT,UU and MH. Secondly, we wanted to observe the curative effect of antivirus drug (famciclovir) treatment in patients who were positive in HSV and negetive in CT,UU and MH.Methods: Urethral and cervix swab specimens from 286 patients with NGUand 51 normal subjects were processed for detection of HSV by PCR. At the same time, the specimens from patients with NGU were tested for UU and MH by culture and for CT by Clearview Chlamydia. 38 Patients who were positive in HSV and negative in CT,UU and MH were sorted into two groups randomly.The treatment group patients were treated with a 7-days course of 250 mg of famciclovir taken orally three times daily.The control group patients were taken no antibiotic. Outcome measures included clinical resolution of signs, symptoms of NGU and detection of HSV by PCR as above.Results: The positive rate of HSV in 286 patients with NGU was 25.5 %; thepositive rate of HSV in 144 patients who were all negative in CT,UU and MH was 26.4%; the positive rate of HSV in 51 normal subjects was 5.9%.There were significant difference between these two groups and the control group(P<0.01). The positive rate of CT,UU and MH in 286 patients with NGU was 15.7%, 32.8%and 12.5% respectively. The positive rate of combined infection with more than two pathogen was 18.2%. The positive rate of HSV in 175 men with NGU was 21.1%; The positive rate of HSV in 111 women with NGU was 32.4%. There were significant difference between different sexuality(P<0.05). After given antivirus drug treatment, the total rate of effective in 23 patients who were positive in HSV and negative in CT,UU and MH was 73.9%. There was significant difference between treatment group and control group without giving any antibiotic (P<0.01). Through detecting HSV, 19 patients were positive in HSV and 19 patients turned into negative in HSV. There was significant difference between these two groups in the total rate of effective(P<0.01).Conclusion: Our findings suggested that HSV can be a significant etiologicagent of NGU. It seemed that women have higher risk in suffering HSV infection than men. In our opinion, it should be necessary to detect HSV in patients with NGU especially who were always negative in CT,UU and MH or who experienced persistent symptoms and frequent recurrenced following treatment in STD clinic. To aim directly at these patients, if they were positive in HSV, it was necessary to use antivirus therapy.