What Is Genital Herpes in Women?

Reviewed on 4/28/2022
Illustration of the herpes virus.
Genital herpes is caused by the herpes simplex virus (HSV) and is sexually transmitted. Symptoms of genital herpes include painful blisters and often fever, body aches, and swollen lymph nodes for the first outbreak. 

Genital herpes is a common sexually transmitted infection (STI) caused by an infection with the herpes simplex virus (HSV). There are two types of herpes.

  • HSV-1 is most commonly associated with blisters and ulcers around the mouth known as cold sores (oral herpes).
  • HSV-2 is associated with blistering lesions in genital areas that are exposed during sexual contact.

However, both types of herpes simplex virus can infect the mouth or the genital areas, meaning that genital contact (oral sex) with a cold sore on the mouth can lead to genital herpes. Likewise, kissing someone with a cold sore can spread the herpes simplex virus infection.

After the first outbreak of herpes, the virus travels through the nerves and resides in nerve tissue within the body. Reactivations, or repeat occurrences of the blisters, can occur throughout an individual's lifetime. Among people aged 14 to 49, an estimated one out of every six people has the infection.

Genital herpes vs. human papillomavirus (HPV)

Genital herpes is not the same thing as genital warts. Genital warts are flesh-colored growths that appear on the sexually exposed areas due to infection with certain types of human papillomavirus (HPV).

Does genital herpes affect women more than men?

  • Herpes is very common.
  • Among people aged 14 to 49, an estimated one out of every six people (15.5% of the population) has 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.

What are genital herpes symptoms and signs?

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:

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

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

Are genital herpes symptoms in women different than men?

  • 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 during urination.

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How long does a herpes outbreak last?

  • 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.

How do you get genital herpes? Is herpes viral?

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 the herpes simplex virus to others that wear the clothing.

How is genital herpes diagnosed?

  • 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.

What kind of doctors treat genital herpes?

  • 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.

Is there a herpes cure?

  • 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.

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What are medications and treatment options for genital herpes?

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

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).

How is genital herpes treated during pregnancy?

  • Oral antiviral medications may be used during pregnancy.
  • One serious concern with genital herpes in pregnancy is the transmission of the infection to the baby during delivery. In an infant, a 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.

Are home remedies or natural treatments effective for genital herpes?

  • 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.

Is there a link between genital herpes and HIV?

  • 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.

Is it possible to prevent genital herpes?

  • 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.

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References
United States. Centers for Disease Control and Prevention. Genital Herpes.
<http://www.cdc.gov/std/herpes/http://www.cdc.gov/std/herpes/>

Villa, A. "Genital Herpes Infection: Beyond a Clinical Diagnosis." Medscape. Accessed Apr 25, 2016.
<https://www.medscape.com/viewarticle/451062https://www.medscape.com/viewarticle/451062>

WHO. "Herpes simplex virus." Updated Jan 2016.
<http://www.who.int/mediacentre/factsheets/fs400/en/>

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