性器ヘルペスの臨床的検討とアシクロビル錠による治療成績

Abstract

性器ヘルペス154例の疫学的検討とアシクロビル錠による治療学的検討を行った.1)性器ヘルペスは近年増加傾向にあった.2)皮疹の範囲と鼠径リンパ節腫脹は初発では両側に, 再発では片側にみられることが多かった.3)皮疹の性状は初発では散在性に広がり, 再発では集簇性に固まってみられることが多かった.4)外陰部痛, 下肢疼痛, 下肢違和感などの局所症状と倦怠感, 食思不振などの全身症状は女性の方が男性より高頻度にみられた.5)発熱, 倦怠感, 食思不振などの全身症状は初発の方が再発よりも高頻度にみられた.6)ウイルス型別ではHSV-1型は初発男性で15.8%, 初発女性で27.7%に認められた.7)直接蛍光抗体法による診断は, ウイルス分離培養法により診断された検体の約60%において診断可能であった

A clinical study for genital herpes was conducted on 154 patients and the efficacy of treatment with oral acyclovir was investigated in 51 of these patients. The diagnosis was confirmed by direct immunofluorescence or viral isolation from the lesion. This disease has increased in both males and females in recent years and was found in 2.3-2.9% of the out-patients examined in 1986. Seventy percent of the patients were between 20 and 30 years old. About 70% of the male patients had phimosis. In patients with the first infection, bilateral eruption (62%) and lymphadenopathy (54%) were more common than unilateral lesions. However, in those with recurrent infection, unilateral eruption (72%) and lymphadenopathy (52%) were more common. Sixty two percent of those with the first infection had scattered eruption on external genitalia, but 71% with recurrent infection, had lesions concentrated in several areas. Local symptoms such as pain in the external genitalia (male: female, 16%: 85%), pain in the lower extremities (26%: 45%), discomfort in the lower extremities (20%: 41%) and systemic symptoms such as malaise (22%: 48%) and anorexia (4%: 35%) were seen more frequently in females than in males. In addition, systemic symptoms such as fever (first episode: recurrent episode, 36%: 4%), malaise (34%: 9%) and anorexia (18%: 2%) were seen more frequently in patients with the first episode than in those with recurrence. HSV type 1 infections were found in 16% of males and 28% of females with the first episode, but were less common in the recurrent episode, 0% and 13%, respectively. Direct immunofluorescence was positive in 75 (59%) of 128 samples diagnosed by viral isolation. Treatment with oral acyclovir tablets, 200 mg five times daily, was very effective in 26 of 30 patients (87%). No side effects were observed. In this study, acyclovir tablet has been shown to be a very effective and well-tolerated treatment for genital herpes infections.