2024 guidelines (S3) for the therapeutic management of patients with genital herpes - 10/09/26

Doi : 10.1016/j.annder.2026.103507

E. Joly ^a,^{^{1
Equal contribution.}}, L. Lothmann ^a,^{^{1
Equal contribution.}}, K. Diallo ^a, S. Fouere ^b,^{^{2
Equal contribution.}}, S. Hantz ^c,^{^{2
Equal contribution.}}, A. Bertolotti ^a,^d,^⁎

^a CHU Réunion, Service des Maladies Infectieuses – Dermatologie, Saint Pierre, La Réunion, France

^b CeGIDD Saint-Louis, Fernand-Widal, Le Checkpoint, Hôpitaux Universitaires Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France

^c INSERM, RESINFIT, U1092, Université de Limoges, Service de bactériologie-virologie-hygiène, Centre National de Référence des Herpèsvirus, CHU de Limoges 87000 Limoges, France

^d Inserm CIC1410, CHU Réunion, Saint Pierre, La Réunion, France

^⁎ Corresponding author at: Service de Maladies Infectieuses – Dermatologie, CHU de la Réunion, Site SUD, La Réunion, France. Service de Maladies Infectieuses – Dermatologie CHU de la Réunion Site SUD La Réunion France

Abstract

Introduction

Genital herpes, caused by Herpes simplex virus (HSV), is a sexually transmitted infection that is the leading cause of genital ulcers in many countries around the world. Although many treatments exist for this condition, their prioritization is often unclear. This study aimed to develop French national recommendations for the treatment of genital herpes in both immunocompetent and immunocompromised (ID) adults, pregnant women (PW), and adolescents.

Methods

These guidelines were developed by a multidisciplinary working group (WG) following the methodology of the Haute Autorité de Santé. No conflicts of interest were declared. A systematic review (SR) of the literature was conducted using PubMed and Embase, covering publications up to June 1, 2024. The protocol was published in PROSPERO (CRD42023399760) after drafting and submission to a multidisciplinary panel of reviewers. Risks of bias were assessed using various tools.

Results

A total of 127 sources were analysed, including randomised controlled trials (RCTs), SRs, and guidelines. Recommendations were formulated for oral, parenteral, and topical treatments. Key management strategies for primary infection and recurrence were summarised in a clinical algorithm. The methodological quality of the included evidence varied, and many studies were dated. Data gaps were identified for specific populations, particularly PW and ID.

Conclusion

These new French guidelines provide updated, evidence-based recommendations derived from a systematic review for the management of genital herpes across diverse populations and clinical scenarios.

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Keywords : Recommendations, HSV, Genital herpes, Treatment, Guidelines

Abbreviations : ACL, AE, AGREE II, AMSTAR 2, CI, FCL, GH, HAS, HIV, HR, HSV, IC, IMC, NSIMC, SIMC, IFN, IV, MA, MD, PI, PRISMA, PW, RCT, RIGHT, RoB, ROBIS, RR, SR, STI, VLC, WG, WoG