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Genital herpes simplex — Clinical Guidelines

Overview

Genital herpes is a prevalent, lifelong sexually transmitted infection caused by herpes simplex virus types 1 and 2, often managed by urologists due to its clinical and psychosocial complexities 1.

Diagnosis

Key Diagnostic Criteria: Atypical presentations common; clinical history crucial 1.

Recommended Tests: Polymerase chain reaction (PCR) is the preferred diagnostic test 1.

Grading: No specific grading system mentioned; diagnosis relies heavily on clinical context and laboratory confirmation 1.

Management

First-Line Treatments: Nucleoside analogs (e.g., acyclovir, valacyclovir) are primary 1 3.

Adjunctive Treatments: Suppressive therapy to reduce recurrences and transmission 1.

Preventive Strategies: Counseling and partner notification are critical 1.

New Therapies: Under investigation, but specific drugs/doses not detailed in abstracts 1.

Special Populations

Pregnancy: Regular screening advocated; visible active lesions warrant consideration for cesarean delivery 6.

Recurrent Genital Herpes in Pregnancy: Routine genital examination during labor recommended; caesarean section considered with active lesions 6.

HSV-1 Infections: Individuals with genital HSV-1 remain at risk for HSV-2 acquisition 4.

Key Recommendations

Use PCR for definitive diagnosis of genital herpes (Evidence: Strong 1).

Initiate nucleoside analog therapy early to manage symptoms and reduce complications (Evidence: Strong 1 3).

Implement suppressive therapy to decrease recurrence and transmission risk (Evidence: Moderate 1).

Regularly screen pregnant women for genital herpes, especially with active lesions during labor (Evidence: Moderate 6).

Counsel patients comprehensively on infection nature, diagnosis, and preventive strategies (Evidence: Expert opinion 1).

References

1 Mantica G, Kranz J, Cai T, Geerlings S, Köves B, Schubert S et al.. Managing Genital Herpes: A Mini-review for Urologists from the European Association of Urology Guidelines Panel for Urological Infections. European urology focus 2026. link 2 Meller N, Levy I, Yinon Y, Kassem R, Baum M. Genital herpes management in pregnancy: Knowledge and practices of healthcare providers. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2026. link 3 Patel R, Moran B, Clarke E, Geretti AM, Lautenschlager S, Green J et al.. 2024 European guidelines for the management of genital herpes. Journal of the European Academy of Dermatology and Venereology : JEADV 2025. link 4 Wald A. Genital HSV-1 infections. Sexually transmitted infections 2006. link 5 Renfrew MJ, Hannah W, Albers L, Floyd E. Practices that minimize trauma to the genital tract in childbirth: a systematic review of the literature. Birth (Berkeley, Calif.) 1998. link 6 Brocklehurst P, Carney O, Ross E, Mindel A. The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice. British journal of obstetrics and gynaecology 1995. link

Genital herpes simplex