Genital Herpes In Women

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The genital herpes virus is a sexually transmitted infection (STI), which commonly results in two varying, but similar conditions – herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Herpes Simplex 1 in females predominantly affects the mouth region, resulting in cold sores; and Herpes Simplex 2 in females will usually affect the vagina and surrounding areas.  

The World Health Organisation (WHO) estimates that two-thirds of the population under 50 are living with the HSV-1 virus, and that HSV-2 infects females almost twice as often as males.

Women with genital herpes will often experience the pain and discomfort attributed to an outbreak, alongside feelings of increased anxiety and distress.

In addition to detailing the signs, symptoms and treatments for genital herpes, this article will examine how lifestyle, diet and even grooming changes can effectively combat the frequency, duration and severity of herpes in women.

 

How does herpes affect a woman?

Herpes simplex 1 in females will usually result in cold sores or blisters around the mouth. They are often obvious and painful. HSV-1 is predominantly spread through mouth-to-mouth contact such as kissing; however, HSV-1 can be contracted through oral sex. Genital herpes caused by HSV-1 recurs less frequently than instances caused by HSV-2.

Herpes simplex 2 in women will usually result in sores in and around the vagina, thighs and buttocks. It is most commonly contracted through sexual contact. The first outbreak is usually the worst, with subsequent outbreaks usually less severe than the first outbreak. The recurrence of outbreaks tends to decrease over time.

 

Female genital herpes symptoms

The first outbreak will usually occur a few weeks after contracting the infection. Symptoms start with a tingling, burning or itching sensation around the affected area, prior to the emergence of sores.

Additionally, symptoms of a new infection may include fever, body aches and swollen lymph nodes. After an initial episode, which can be severe, symptoms may recur. These symptoms recur periodically, although the frequency, duration and severity of outbreaks are often less severe than the first episode and tend to decrease over time.

Early stages

Initial outbreaks of genital herpes can result in a range of symptoms that may be mistaken for other conditions. The first outbreak will usually occur a few weeks after contracting the infection. 

Flu-like symptoms such as fever, body aches and chills, occasionally accompany the first flare-up, although these associated signs of infection will usually be milder in subsequent outbreaks. 

The beginning stage, also known as the prodrome phase, is where symptoms are initially detected. Early indicators of the virus at this stage include redness, itchiness or tingling around the genital area. Accompanying symptoms may also include painful urination due to irritation in the labia. Inflammation of the cervix can also occur at the onset of an initial breakout.

The most commonly associated indicators of a herpes outbreak for women are the formation of blisters around the vagina. This includes the outer area of the vagina, such as the vulva and outer labia, as well as the inner vagina (inner labia). Anal herpes, a form of HSV-2, may also present during a flare-up; however, during the early stages, these sores are sometimes mistaken for the emergence of haemorrhoids or piles. Herpes sores can also be confused with friction sores, due to their similarity in appearance. Any sensitivity or tingling in the genital area should be observed if concerns about HSV-2 exist due to recent sexual encounters.

As the virus progresses through stages, the effects on the genitals themselves will become pronounced.

Symptoms of a herpes outbreak on the vagina

After the initial symptoms, you may notice some tiny, firm white or red bumps with an uneven or jagged outline beginning to appear on the vagina. The appearance is similar in nature to a rash.

Scratching or itching these sores will result in oozing white, cloudy fluid. Opening the blisters can leave painful ulcers that can be further aggravated by clothing that comes in contact with the skin.

These lesions can show up anywhere around the genitals and the surrounding areas, including:

  • The vulva, or external sex organ of the female body. Although multiple anatomical locations of the vagina could present symptoms of an infection, this area is one of the few on which the blisters can be visible to the eye.
  • The vaginal opening can experience discomfort or irritation during a genital herpes outbreak. Herpes on the vagina may result in the colour surrounding the area reddening, or a rash may form on or around the vagina lip. Sores and ulcers of the vagina caused by a herpes outbreak typically last between one to two weeks. This area is often slow to heal, as skin around the genital area is moist and oxygen deprived. The scabbing process that precedes healing occurs faster in areas of the body that are naturally dry.
  • Herpes inside the vagina can be particularly difficult to detect, and are at times confused for other STIs that cause inflammation, such as gonorrhoea. The Centers for Disease Control and Prevention (CDC) outline the similarities between the two STIs, which could mask correct identification of the cause of inflammation.


Vaginal discharge is not a symptom of herpes 

Although vaginal discharge is not a commonly associated symptom of genital herpes, in rare cases, those who experience recurrent outbreaks may also get discharge. Discharge associated with herpes often takes the form of a thick and clear white or partially cloudy liquid, similar to chlamydia discharge. This symptom will usually occur in tandem with blisters and other symptoms during an outbreak.

The liquid is often accompanied by a strong odour, which can become more pronounced or pungent after engaging in sexual activity. Women infected with the herpes virus may also notice some blood or discharge in their urine.

Whilst vaginal discharge is possible in the event of a HSV-2 outbreak, it is rare. In order to rule out the possibility of other STIs such as chlamydia, a woman experiencing significant vaginal discharge should consult a medical professional.

 

What are other symptoms of genital herpes in women?

The herpes simplex virus can affect different areas of the body, but is primarily located around the mouth and genital region.

Mouth

Medically defined as herpes labialis, oral herpes is predominantly attributed to an HSV1 infection; although, in some cases, HSV2 can cause oral herpes. This will usually be the case during oral sex.

Once the virus enters the mucous membrane and skin, slight burning, or irritation – often mistaken for dry, chapped lips – gives rise to cold sores or fever blisters, on or around the lips, or within the mouth. These cold sores gradually become crusty and dry, although the healing process for sores that appear inside the mouth take longer to heal. The healing process of previously-burst blisters occur over a greater period of time due the constantly-moist environment inside the body.

Anus

The anus is another area women may mistakenly attribute a herpes flare-up to haemorrhoids or piles. Anal herpes will usually affect individuals who engage in anal intercourse. 

A herpes rash around the anus typically presents in the form of tiny, fluid-filled blisters emerging from a red and raw skin base. The blisters will rupture, progressively leading to ulcers before crusting over as they heal. Left untreated, the rash typically lasts two to four weeks. Due to difficulty inspecting the anus, many women may not realise irritation or sensitivity in and around the anus is the result of a herpes outbreak.
Women affected by the emergence of anal herpes often have unseen lesions inside the anus. Internal and rectal herpes blisters can lead to erosion due to the mechanical trauma from passing stool. This irritation can also lead to a secondary infection from the bacteria in stool. Proctitis, identified as a medical condition resulting in inflammation of the anus, often causes drainage that manifests in bloody or pus-like liquid, accompanied by a foul odour. The condition of herpes-related proctitis is particularly painful.

Buttocks

The perineum – delicate skin located between the vagina and rectum – is often irritated or inflamed during an outbreak, and is often described as honey-comb like blisters or sores. These tiny lesions most commonly occur in cluster-like formations. Herpes on the buttocks themselves are sometimes mistaken for pimples with light coloured centres. They often take the shape of a cluster formation on the skin of the lower back, buttocks or groove between. Discomfort when urinating or defecating is often felt due to the proximity of the lesions to the genitals. 

Thighs

The groin and inner thighs are places that present HSV-2 symptoms and are commonly mistaken for razor burn or heat irritation. Friction sores should raise suspicion, especially in the event that a woman has come into contact with an individual experiencing an outbreak. The observation of swollen lymph nodes surrounding the groin often precedes a herpes outbreak.

Cervix

Herpes on the cervix can be difficult to spot; however, this area is particularly sensitive if a flare-up ensues. Whilst visual indicators may be difficult to spot in the cervix, the pain associated with a flare-up in this region will be alarming. Inflammation of the cervix is often associated with symptoms of a genital herpes outbreak. Areas such as the cervix take longer to heal in the event of rupturing blisters that need to scab over in order to heal, as the moisture impedes the drying-out process necessary for the process to complete.

 

The first herpes outbreak is typically the worst

The initial herpes outbreak often occurs within a couple weeks of contracting the virus from an infected individual. This is known as the incubation period, where HSV is multiplying inside the body until the point it causes an outbreak. The first outbreak of herpes is usually the most severe, lasting approximately two to three weeks. Subsequent outbreaks are often less pronounced, and flare ups tend to decrease over time.

Common early stage symptoms of herpes in women may include:

  • A tingling, itching or burning sensation in the vaginal or anal area
  • Flu or fever-like symptoms
  • Pain in the legs, buttocks, or vaginal area
  • A change in vaginal discharge
  • Swollen glands
  • Headache
  • An increasingly uncomfortable feeling of pressure in the area beneath the abdomen
  • Difficulty urinating, or pain during bowel movements


In many cases, the flu-like and body ache symptoms that occur during the initial presentation of the HSV-2 virus do not appear in subsequent outbreaks.

 

How is it spread?

The herpes simplex virus can be spread from genitals sore to the lips, or from a cold sore to the genital area. A woman becomes infected via skin to skin contact with an infected person.

Genital herpes in females can be spread through the following methods:

  • Skin to skin contact with someone who has the infection
  • Mouth to genital contact such as oral sex
  • Sharing sex toys with an infected person

 


How can women test for herpes?

Signs of herpes in women aren’t always easily detectable. They are often mistaken for similarly-presenting conditions. Consideration should be taken if irritation or redness begins to develop in the genital areas. One should ask a healthcare provider for an examination in the event of symptoms or after coming into contact with someone who is infected. 

The most commonly administered genital herpes test involves taking a swab from an open sore. The accuracy of results is determined by the quality of the sample. Signs of herpes in women must be prevalent in order to ascertain a positive test result, as asymptomatic individuals will not have blisters from which a sample can be taken. The female herpes test does not differ from methods used in diagnosing herpes in men.

 

How to prevent herpes outbreaks

Herpes in women can be contained, not cured. In order to reduce the duration, severity and frequency of outbreaks, the following preventive measures should be taken:

  • Keep stress in check. While influencing factors can vary from woman to woman, exposure to extreme environments that create stress on the body should be reduced. This includes physical or emotional stimulus which promotes cortisol production in the body and triggers the nerve response that could encourage reactivation of the virus. Other common triggers include infections, hormones, exposure to UV light and certain medication.
  • Mind the diet. Certain diets may impede the frequency of herpes outbreaks in women. Alcohol, coffee, nuts, popcorn, and chocolate may encourage HSV-2 flare-ups, and some studies indicate that the amino acid arginine – found in grains and legumes – may encourage flare-ups. When monitoring dietary changes, it is important to note that every woman may experience differing triggers.
  • Consult a physician. Medication such as aciclovir and valaciclovir can restrict the frequency of outbreaks, and any changes to medications or herbal supplements should be brought to the attention of a healthcare professional to determine the potential implications associated with the herpes virus.
  • Monitor the effects of current hygiene regimens. Although it may seem to be helpful, some women report that frequent bathing or showers – or utilising multiple skincare products – aggravates herpes symptoms. Some products, including soaps, laundry care and fragrances contain chlorine and other potential irritants that clog the mucous membranes and activate outbreaks.
  • Take it easy. Lifestyle adjustments should be taken into account when attempting to restrict the frequency of herpes outbreaks for women. Lack of sleep and elevated stress levels can lower immune system function, resulting in an increased risk of recurring symptoms. Mindfulness, meditation and self-care routines can boost immune function, which in turn slows the recurrence of herpes episodes.

 


How to deal with a period during an outbreak

Genital herpes does not affect a woman’s menstrual cycle, as they are regulated by hormones. HSV-2 has no correlation to a woman missing their period. However, outbreaks may occur during a period, as hormonal changes can make it easier for herpes to cause symptoms during this time. It is believed that hormonal changes in the body result in immune system imbalances that can encourage the virus to cause symptoms of herpes in women. 

 

How women can avoid getting genital herpes 

Consistent and proper use of condoms can reduce the risks associated with genital herpes transmission. Although this method offers some preventative aid, transmitting or acquiring genital herpes can still occur due to the herpes virus shedding in areas not covered by the condom. Contraceptives, while effective in limiting the chances of pregnancy, do not reduce the transmission of HSV-2.

Avoiding skin to skin contact with an infected individual is the surest way to prevent contracting the herpes virus. A reduction in the number of sexual partners also helps to limit potential exposure. Abstaining from sexual contact – especially if a partner with herpes is experiencing an outbreak – is another way to limit the transmission possibilities. 

Women involved in a long-term, mutually monogamous relationship with a partner who has been tested for STIs and is known to be uninfected, is the surest way to avoid catching herpes.  

 

Does herpes impact female fertility?

Herpes, in most cases, does not affect a woman’s ability to become pregnant. Although herpes causes worrying symptoms like blisters around the genitals, manifestations of the virus do not affect the reproductive organs.

 

What happens if you are pregnant with herpes?

According to the National Health Service (NHS), genital herpes contracted during pregnancy may put the baby at risk of contracting neonatal herpes. While this condition can prove fatal, in most cases, an infant administered antiviral medication goes on to live a healthy life, despite infection. If you contract genital herpes for the first time after weeks 28 of pregnancy, you may be offered antiviral treatment from diagnosis, till pregnancy.

The risk of a baby contracting neonatal herpes is low if a woman has had genital herpes before. You may be offered antiviral therapy from week 36 of your pregnancy, to reduce the chances of an outbreak during birth. Depending on your situation, a caesarean birth may be an option.

 

Is female herpes curable?

Female herpes outbreaks can be restricted with proper treatment, but there is currently no cure. Taking a daily herpes suppression therapy can make it less likely to pass the sexually transmitted infection onto a partner, although the virus remains contagious throughout all phases of outbreak.

For women who are otherwise healthy, living with herpes shouldn’t cause any long-term medical complications or affect their ability to maintain intimate relationships. The herpes simplex virus affects millions of women around the world, and many people with herpes enjoy relationships with their partners.

Recurrent outbreaks are common, and the treatments designed to combat the effects will have a significant impact on the severity, duration and frequency of flare-ups. Outbreak treatment can help to heal herpes sores faster than allowing them to heal naturally. 

Combining medications and preventative measures as part of a preventative protocol can afford infected women comfort and an improved quality of life while living with genital herpes.


Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.