Mikhail A. Gomberg

Anogenital warts (AGWs) — one of the most common sexually transmitted infections (STIs). The disease forms medical, economic and socio-psychological burden — from patients’ quality of life deterioration and risk of oncological complications development to significant financial costs for treatment. Official registration of AGWs in Russia does not reflect the real epidemiological situation. At the same time, the disease’s cases registration is an important part of the public health system and allows to control the spread of human papilloma virus (HPV), identify risk groups, as well as schedule and evaluate preventive measures. Currently, here is no effective etiotropic therapy for HPV-associated diseases in the doctors’ arsenal, and the used destructive treatment methods are aimed at eliminating the clinical manifestations of the infection rather than eradicating the virus itself, that leads to a high frequency of relapse after treatment. In this regard, it is evident that priority is being given to measures aimed at HPV infection prevention, among which vaccination is the most effective method. The accumulated worldwide experience of vaccination of people of both sexes with quadrivalent HPV vaccine demonstrates high safety, persistent immune response and clinical efficacy, which is expressed in the reduction of morbidity not only with HPV but also with malignant HPV-associated diseases and plays a key role in the formation of collective immunity.

Genital herpes is one of the most common sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management and follow‐up of the condition as well as for minimizing transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalization with complications, including urinary retention, meningism or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy and coinfection with human immunodeficiency virus.

Erythema multiforme — a disease that is sometimes a clinical conjecture because it can be represented by a wide morphological range of skin and mucous membrane lesions. Etiological factors for the erythema multiforme are diverse, and still numerous studies have shown that herpes simplex virus (HSV) is one of the most common causes of disease development. The detection rate of HPV DNA in lesions during examinations using nucleic acid amplification techniques reaches 70%, which allows to identify a single form of disease associated with HPV in clinical practice — herpes-associated erythema multiforme (HAEM). We present the descriptions of clinical observations of patients with different clinical forms of HAEM — simple papular, vesiculobullous, as well as atypical pigmented, which, along with typical eruptions on the oral cavity’s mucous membrane, was represented by the formation of hyperemia foci in the rounded or oval form on the skin of torso, upper extremities, the central part of them acquired an unusual hyperpigmented character in dynamics, transforming into atypical 2-zone foci with indistinct boundaries. The presented clinical observations once again confirm the variability of HAEM clinical manifestations, as well as the importance of the study of medical history data and laboratory examination conduction using nucleic acid amplification techniques to identify HPV DNA in the presence of clinical manifestations allowing to determine this diagnosis.

Introduction. The role of human papilloma viruses is well-studied in a number of cancers. However, the role of urogenital HPV infection and its association with pathospermia, male infertility, and genitourinary tract inflammatory diseases are understudied. Objective. To determine the prevalence of HPV in patients with chronic prostatitis and infertility. Materials and methods. Quantitative PCR was used to detect high carcinogenic risk (HCR) HPV in the ejaculate of 489 males aged 22–65. Group 1 included infertile males with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), Group 2 included males with idiopathic infertility (without CP/CPPS), Group 3 included fertile males with CP/CPPS, Group 4 included healthy fertile males (control group). Results. 64 (14.6%) of the examined males had HPV. None of the males from the control group had HCR HPV in the ejaculate. Group 1 had a significantly higher number of all HPV genotypes (40 (22.2%) of 180) than Group 2 (25 (14.3%) of 175) and Group 3 (13 (15.9%) of 82). HPV viral load was highest in Group 3 (~2500 copies/100.000 cells). Conclusion. HCR HPV is associated with male infertility and chronic prostatitis/chronic pelvic pain syndrome. The association of mixed infection with various HPV types with infertility and high HPV viral load with CP/CPPS was shown.

Objectives. To present a case report of male infertility associated with cytomegalovirus infection and the outcome of antiviral treatment. Clinical observation. A 31-year-old man presented with a history of 6 years of infertility. No pathology was revealed in his wife. High loads of cytomegalovirus (CMV) were detected by PCR: in expressed prostatic secretion (EPS) 8700 copies/ml, in ejaculate – 598 440 copies/ml. Sperm examination revealed necrozoospermia and leukospermia. CMV-associated accessory gland infection was verified. The patient was treated with valacyclovir 500 bid for 90 days and interferon α2β suppository (Viferon®) 1 million IU for 30 days. All sperm parameters improved in 1 month after initiation of antiviral treatment. Sperm concentration and motility increased × 1.5 and × 1.4 respectively, sperm viability and leukocyte count achieved reference values. At the same time, CMV loads decreased: EPS to 300 copies/ml, the ejaculate to 54 000 copies/ml. After 3 months (by the end of the antiviral treatment): EPS-negative, the ejaculate – 6060 copies/ml; after 6 months: EPS – negative, the ejaculate 3900 copies/ml. Within 6 months, the woman became pregnant and gave birth to a healthy baby girl. After 3 years, there was a second pregnancy and the birth of a healthy boy. Conclusion. The male factor has been established as the cause of infertility in a married couple; the only probable etiological agent of pathozoospermia was cytomegalovirus infection. The use of complex antiviral and immunotherapy (interferon α2β with antioxidants, Viferon®) provided positive dynamics in clinical, sperm and laboratory parameters, which led to the conception and birth of two children.

К вопросу о ранней диагностике базальноклеточного рака (описание клинического случая)