What Is Genital Herpes in Women?

• Herpes is very common.
• Among people aged 14 to 49, an estimated one out of every six people (15.5% of the population) have been infected with HSV-2, the virus that is predominantly responsible for genital herpes.
• Estimates suggest that in the U.S., 776,000 people become infected every year.
• The viral infection is more common in women than in men.
• Spread from men to women is known to occur more readily than from women to men.
• According to WHO estimates, HSV-1 infects 67% of all humans under the age of 50. The majority of infected people are not aware they are infected.

Many people infected with genital herpes have mild symptoms or symptoms that are mistaken for another condition. It also is possible to be infected with the virus and have no herpes symptoms. Not every woman who is infected may be aware of the infection.

Common symptoms

When signs and symptoms are present, they consist of:

• Typically painful fluid-filled blisters (that may appear like "pimples") around the vaginal area
• Blisters around the vagina, anus, or buttocks
• Ulcer formation after the blisters break open
• Blisters take 2 to 4 weeks to heal.

Signs of the first outbreak

With the first outbreak of genital herpes, a person may also experience flu-like symptoms including:

• Fever
• Chills
• Body aches
• Swollen lymph nodes

Immediately prior to an outbreak, there may be an itching, burning, or tingling sensation of the skin.

After the initial infection, a person may or may not have outbreaks later in life.

• In women, genital herpes usually causes blistering lesions on the vulva and around the vaginal opening that progress to ulcer formation.
• The infection spreads to involve the cervix in most cases, leading to cervicitis (inflammation of the cervix).
• In some women, cervicitis may be the only sign of genital herpes infection.
• Infection and inflammation of the urethra accompany the infection in some women, leading to pain on urination.

• The average incubation period (time until symptoms develop) of herpes after exposure is 4 days, but symptoms may develop anywhere from 2 to 12 days after you have been exposed to the virus.
• Individual outbreaks of herpes vary among affected people in terms of their frequency and severity.
• Outbreaks can be related to the function of the immune system and are typically worse in cases in which the immune system is suppressed.
• For example, at times of physical or emotional stress, during illness, or when taking certain medications, genital herpes outbreaks may be more likely.

Herpes refers to the herpes simplex virus (HSV), which is transmitted by direct person-to-person contact. 

• HSV-1 causes cold sores (oral herpes) around the mouth
• HSV-2 causes genital lesions.
• Genital herpes is acquired through sexual contact of any type that involves contact with the genital areas.
• Genital herpes also can be caused by mouth to genital contact (oral sex) with a person who has cold sores or herpes infection of the mouth.
• Transmission of herpes from an infected male to a female partner is more likely than transmission from an infected woman to a male partner.

The herpes viruses enter the skin or mucous membrane through tiny, even microscopic, breaks in the tissue when there is skin-to-skin contact with an infected person.

• Because an infected person may spread the disease even when he or she does not have signs or symptoms of herpes, avoiding sexual contact with someone with active blisters does not guarantee protection against the infection.
• Even normal appearing skin can spread the infection. Clothing that touches genital skin ulcers may transmit herpes simplex virus to others that wear the clothing.

• In most cases in which the characteristic signs and symptoms are present, they are sufficient to establish a diagnosis of genital herpes infection.
• Laboratory tests, such as viral culture and nucleic acid amplification (polymerase chain reaction or PCR) tests to detect the genetic material of the virus, are also available.
• Immunologic tests to identify antibodies to genital herpes are other possible tests to establish whether there is an infection.

• Genital herpes is treated by primary care providers including internal medicine and family medicine specialists, as well as pediatricians for adolescents.
• For women, gynecologists are often the treating physicians.
• In certain circumstances, other specialists may be consulted, including urologists and infectious disease specialists.

• There is no cure for genital herpes, and once a person is infected with genital herpes, the infection persists throughout the individual's life, with the potential for recurrent outbreaks.
• People vary in the number and severity of outbreaks they experience.
• For those with frequent outbreaks, taking antiviral medications as suppressive therapy can decrease the frequency and severity of outbreaks. There are also treatments to manage the symptoms.

Antiviral medicines are available that can help manage the severity and duration of outbreaks, if taken immediately prior to (when there are tingling or unusual skin sensations but no blisters) or within 24 hours of a herpes outbreak. The medications typically used are

• acyclovir (Zovirax),
• famciclovir (Famvir), or
• valacyclovir (Valtrex).

These are all typically taken by mouth. In severe cases of viral infection, antiviral medications may be given intravenously, but this is not usually needed for herpes. Topical medications that are applied directly to the herpes sores are also available, but these are less effective than oral medications and are not generally used.

All of these medications may also be given daily as suppressive therapy to decrease the number of outbreaks in people who have frequent herpes outbreaks (more than six outbreaks per year).

• Oral antiviral medications may be used during pregnancy.
• One serious concern with genital herpes in pregnancy is transmission of the infection to the baby during delivery. In an infant, genital herpes infection can spread through the bloodstream and have serious consequences.
• Cesarean delivery (C-section) is performed for women who go into labor while there is an active outbreak of genital herpes in order to prevent infection of the baby during birth.
• The American College of Obstetricians and Gynecologists recommends that pregnant women with recurrent genital herpes be offered oral antiviral medication at or beyond 36 weeks until delivery in order to increase the chances of being able to deliver vaginally.

• There are no home or natural remedies available for genital herpes, and as mentioned above, the infection cannot be cured.
• Home remedies such as warm baths, keeping the blisters dry after washing, and wearing loose-fitting, cotton underwear may help soothe symptoms.

• The HIV virus that causes AIDS is not the same as the genital herpes virus.
• However, having the ulcers and sores of herpes makes it more likely to contract HIV if exposed, or to transmit HIV if you have been infected.
• The ulcers of genital herpes cause breaks in the skin that make spreading the HIV virus to a sex partner more likely during sexual contact.

• Herpes can be spread both during an outbreak and by infected people even when there is no outbreak of the condition, so prevention can be difficult.
• While condoms may help prevent the spread of genital herpes to sexual partners during sexual activity, the infection also can be spread from skin contact in areas not covered by a condom, or during oral to genital contact.
• If you are having an outbreak, thorough hand washing and not sharing clothing that has touched the herpes sores can also help prevent transmitting the virus to others.