Features of T-cell immunity in female patients with recurrent genital herpes of varying severity

Objective. To conduct a comprehensive analysis of peripheral blood T-lymphocyte subpopulations and the Neutrophil-to-Lymphocyte ratio in female patients with recurrent genital herpes of varying severity. Methods. A cross-sectional single-center study was conducted between 2022 and 2025 and included 56 female patients aged 26–68 years diagnosed with A60 «Anogenital herpesviral infection». The patients were divided into three groups according to recurrence frequency: Group I (mild, n=11), Group II (moderate, n=24), and Group III (severe, n=21). Flow cytometry was used to determine the levels of T-lymphocytes (CD3+CD19–), T-helper cells (CD3+CD4+), and cytotoxic T-lymphocytes (CD3+CD8+). The immunoregulatory index (CD4+/CD8+) and Neutrophil-to-Lymphocyte ratio (N, ×109/l /L, ×109/l) were calculated. Statistical analysis was performed using StatTech 4.14.3 software and included the Shapiro—Wilk test, Kruskal—Wallis test, Dunn’s test with Holm correction, and Pearson’s correlation coefficient (R). Differences were considered statistically significant at p<0.05. Results. The study revealed a statistically significant increase in CD3+CD19- T lymphocytes with increasing disease severity (p<0.001). Although no significant intergroup differences were observed in CD3+CD4+ (p=0.079) or CD3+CD8+ (p=0.444) cell levels, strong positive correlations with CD3+CD19– cells were identified (R=0.858 and R=0.822, respectively; p<0.001), confirming a balanced adaptive immune response. Mean immunoregulatory index values remained stable across the groups (p=0.901) and were within the physiological reference range (1.92—1.98). However, an individual decrease in the index to below 1.2 was detected in 10.71% of patients in Group II and 5.36% of patients in Group III. This decrease was associated with a compensatory increase in CD3+CD8+ cells and was confirmed by correlation analysis (R=−0.599; p<0.001). The Neutrophil-to-Lymphocyte ratio in all groups (1.43—1.59) remained below the reference threshold, which was consistent with lymphocytosis observed in 62.5% of patients. Correlation analysis confirmed that a decrease in the Neutrophil-to-Lymphocyte ratio was pathogenetically associated with activation of the T-cell compartment (R=–0.500; p<0.001). Conclusion. Greater severity of herpesvirus infection is associated with increased T-lymphocyte activity. The identified changes in the cellular component of adaptive immunity are markedly compensatory in nature. The immunoregulatory index represents a significant criterion for assessing the effectiveness of viral replication control.