Clinical and Immunological Rationale for the Treatment of Chronic Nonbacterial Prostatitis/chronic Pelvic Pain Syndrome (Category IIIB) Due to Herpes Virus Infection
Authors: І. І. Горпинченко  , А. І. Федорів  
Published: February 2020

The objective: to improve the effectiveness of treatment of patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome (category IIIB) due to herpes virus infection by evaluating the clinical and immunological features of this pathology.Materials and methods. 146 patients with chronic nonbacterial prostatitis (121 herpes virus etiology and 25 without detected viral infection) and 25 healthy young men were examined. The patients were divided into groups. Among all patients with herpesvirus etiology prostatitis, 46 patients had ejaculate DNA of herpes simplex virus 1/2 type (HSV 1/2 type), which made up the 1st comparison group, in 41 patients – DNA of cytomegalovirus (CMV) – II group comparison, and in 34 patients – the DNA of both viruses, respectively, the III comparison group. When assessing the immune status of patients, we studied the level of interferon-gamma (IFN-γ) in the blood serum and the content of secretory immunoglobulin A (sIgА) in the patients ejaculate; to assess the state of local inflammation, we studied the cytokine status of patients by examining the level of pro-inflammatory interleukin 6 (IL-6) and anti-inflammatory interleukin 10 (IL-10) in ejaculate patients. Symptoms of prostatitis were assessed by assessing the general condition by the total score (S+L) of the IPSS chronic prostatitis symptom scale. During the study, patients with prostatitis of viral etiology were treated, which were previously divided into subgroups of each of the groups that received traditional treatment according to the protocol and traditional treatment with the inclusion of Valtrovir, Overin, and Novirin, depending on the presence of the corresponding pathogen in the patients ejaculate. The above indicators of immunity and symptoms of prostatitis were compared after treatment with the corresponding indicators of patients with prostatitis of non-viral etiology (group IV control) and healthy patients (group V).Results. According to the results of the study revealed significantly higher immunosuppression rates in patients with chronic abacterial prostatitis compared with healthy patients (p<0.05). When comparing the indicators of the immune and cytokine status in patients with viral and non viral prostatitis, significantly higher immunosuppression rates were identified respectively in the first, which confirms the role of herpes viruses in the development of prostatitis. After treatment (both traditional and advanced), all patients showed a positive dynamics of immunity and symptoms (p<0.05).However, when comparing the levels of IFN-γ, sIgА, IL-6, IL-10, scores (S+L) after both types of treatment, the best results were found in patients after advanced treatment (p<0.05).Conclusion. The role of herpes viruses in the development of chronic nonbacterial prostatitis is proved. The etiopathogenetic therapy of patients with viral prostatitis is substantiated much more effective in comparison with traditional treatment.