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Genital Herpes in Women

Genital Herpes in Women Related Articles

Genital Herpes Facts

  • There is no "safe" sex.
  • Condoms do not necessarily prevent sexually transmitted diseases.
  • Genital herpes is a viral infection that can cause painful genital sores and causes recurrent outbreaks.
  • Many people are infected with herpes virus and are not aware of the infection.
  • The herpes virus is spread by direct person-to-person contact.
  • An infected person may transmit the virus to others even if no symptoms are present.
  • There is no cure for genital herpes, but viral shedding and outbreaks can be reduced with antiviral medications.

What Are Sexually Transmitted Diseases (STDs)?

Sexually transmitted diseases (STDs) are infections that can be transferred from one person to another through any type of sexual contact. STDs are sometimes referred to as sexually transmitted infections (STIs) since they involve the transmission of a disease-causing microorganism from one person to another during sexual activity. It is important to realize that sexual contact includes more than just sexual intercourse (vaginal and anal). Sexual contact includes kissing, oral-genital contact, and the use of sexual "toys," such as vibrators. STDs probably have been around for thousands of years, but the most dangerous of these conditions, infection with the human immunodeficiency virus (HIV), was only recognized in recent decades.

Many STDs are treatable, but effective cures are lacking for others caused by viruses, such as HIV, HPV, hepatitis B, and hepatitis C. Even gonorrhea, once easily cured, has become resistant to many of the older traditional antibiotics. Many STDs can be present in, and spread by, people who do not have any symptoms of the condition and have not yet been diagnosed with an STD. Therefore, public awareness and education about these infections and the methods of preventing them is important.

There really is no such thing as "safe" sex. The only truly effective way to prevent STDs is abstinence. Sex in the context of a monogamous relationship wherein neither party is infected with a STD also is considered "safe." Most people think that kissing is a safe activity. Unfortunately, syphilis, herpes, and other infections can be contracted through this relatively simple and apparently harmless act. All other forms of sexual contact carry some risk. Condoms are commonly thought to protect against STDs. Condoms are useful in decreasing the spread of certain infections, such as Chlamydia and gonorrhea; however, they do not fully protect against other infections such as genital herpes, genital warts, syphilis, and HIV. Prevention of the spread of STDs is dependent upon the counseling of at-risk individuals and the early diagnosis and treatment of infections.

How Do You Get Genital Herpes?

Genital herpes, also commonly called "herpes," is a viral infection by the herpes simplex virus (HSV) that is transmitted through intimate contact with the mucous-covered linings of the mouth or the vagina or the genital skin. The virus of this STD enters the linings or skin through microscopic tears. Once inside, the virus travels to the nerve roots near the spinal cord and settles there permanently.

When an infected person has a herpes outbreak, the virus travels down the nerve fibers to the site of the original infection. When it reaches the skin, the typical redness and blisters occur. After the initial outbreak, subsequent outbreaks tend to be sporadic. They may occur weekly or even years apart.

Is Genital Herpes Contagious?

Genital herpes infection is definitely contagious from the time of itching to the time of complete healing of the ulcer, usually within two to four weeks. However, as noted previously, infected individuals can also transmit the virus to their sex partners in the absence of a recognized outbreak.

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What Causes Genital Herpes in Women?

Two types of herpes viruses are associated with genital lesions: herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2). HSV-1 more often causes blisters of the mouth area while HSV-2 more often causes genital sores or lesions in the area around the vagina and anus. The outbreak of herpes is closely related to the functioning of the immune system. Women who have suppressed immune systems, because of stress, infection, or medications, have more frequent and longer-lasting outbreaks.

It is estimated that as many as 50 million people in the United States are infected with genital HSV. Genital herpes is spread only by direct person-to-person contact. It is believed that 60% of sexually active adults carry the herpes virus. Part of the reason for the continued high infection rate is that most women infected with the herpes virus do not know that they are infected because they have few or no symptoms. In many women, there are "atypical" outbreaks where the only symptom may be mild itching or minimal discomfort. Moreover, the longer the woman has had the virus, the fewer the symptoms they have with their outbreaks. Finally, the virus can shed into the vagina in women who are not experiencing any symptoms.

What Are the Symptoms and Signs of Genital Herpes Symptoms in Women?

Symptoms of genital herpes are similar in men and women. Once exposed to the virus, there is an incubation period that generally lasts three to seven days before a lesion develops. During this time, there are no symptoms and the virus cannot be transmitted to others.

  • An outbreak usually begins within two weeks of initial infection and manifests as an itching or tingling sensation followed by redness of the skin.
  • Next, a blister forms. The blisters and subsequent ulcers that form when the blisters break are usually very painful to touch and may last from seven days to two weeks.

Specific signs and symptoms of herpes in women include tiny, fluid-filled blisters (vesicles) on the vulva and vaginal opening. When the vesicles rupture, painful ulcers are the result. In a majority of females, inflammation of the cervix is involved (cervicitis). Cervicitis may be the only sign of genital herpes in some women. Women with genital herpes may have pain with urination along with infection and inflammation of the urethra (urethritis).

How Is Genital Herpes in Women Diagnosed?

Genital herpes is suspected when multiple painful blisters occur in a sexually exposed area. During the initial outbreak, fluid from the blisters may be sent to the laboratory to try to culture the virus, but cultures only return a positive result in about 50% of those infected. In other words, a negative test result from a blister is not as helpful as a positive test result, because the test may be a false-negative test. However, if a sample of a fluid-filled blister (in the early stage before it dries up and crusts) tests positive for herpes, the test result is very reliable. Cultures taken during an initial outbreak of the condition are more likely to be positive for the presence of HSV than cultures from subsequent outbreaks.

There are also blood tests that can detect antibodies to the herpes viruses that can be useful in some situations. These tests are specific for HSV-1 or HSV-2 and are able to demonstrate that a person has been infected at some point in time with the virus, and they may be useful in identifying infection that does not produce characteristic symptoms. However, because false-positive results can occur and because the test results are not always clear-cut, they are not recommended for routine use in screening low-risk populations for HSV infection.

Other diagnostic tests such as polymerase chain reaction (PCR) to identify the genetic material of the virus and rapid fluorescent antibody screening tests are used to identify HSV in some laboratories.

What Is the Treatment for Genital Herpes in Women?

Although there is no known cure for herpes, there are treatments for the outbreaks. There are oral medications, such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex), that prevent the virus from multiplying and even shorten the length of the eruption. Although topical (applied directly on the lesions) agents exist, they are generally less effective than other medications and are not routinely used. Medication that is taken by mouth, or in severe cases intravenously, is more effective. It is important to remember that there is still no cure for genital herpes and that these treatments only reduce the severity and duration of outbreaks.

Because the initial infection with HSV tends to be the most severe episode, an antiviral medication usually is warranted. These medications can significantly reduce pain and decrease the time until the sores heal, but treatment of the first infection does not appear to reduce the frequency of recurrent episodes.

In contrast to a new outbreak of genital herpes, recurrent herpes episodes tend to be milder, and the benefit of antiviral medications is only derived if therapy is started immediately prior to the outbreak or within the first 24 hours of the outbreak. Thus, the antiviral drug must be provided for the patient in advance. The patient is instructed to begin treatment as soon as the familiar pre-outbreak "tingling" sensation occurs or at the very onset of blister formation.

Finally, suppressive therapy to prevent frequent recurrences may be indicated for those with more than six outbreaks in a given year. Acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) may all be given as suppressive therapies.

What Is the Prognosis for Genital Herpes in Women?

Recurrent outbreaks are common for people with genital herpes. About 90% of those infected report repeat outbreaks. While some people may develop only one to two outbreaks each year, others will have up to eight outbreaks a year. The symptoms are milder in most recurrent attacks than in the primary infection. If recurrent attacks are severe (typically more than six per year), antiviral medications as suppressive therapy may be recommended.

How Do You Prevent Genital Herpes in Women?

Herpes can be spread from one part of the body to another during an outbreak. It is also possible to spread the herpes virus infection even if you are not having an outbreak, so no prevention method is 100% effective. Still, certain preventive techniques can reduce your chances of spreading the infection to others.

  • It is important not to touch the eyes or mouth after touching the blisters or ulcers.
  • Thorough hand washing is a must during outbreaks.
  • Clothing that comes in contact with ulcers should not be shared with others.
  • Couples that want to minimize the risk of transmission should always use condoms if a partner is infected. Unfortunately, even when an infected partner isn't currently having an outbreak, herpes can be spread.
  • Couples may also want to consider avoiding all sexual contact, including kissing, during an outbreak of herpes. It is important to avoid sexual contact from the time the initial symptoms begin (if present) until the lesions have crusted over.
  • Since an active genital herpes outbreak (with blisters) during labor and delivery can be harmful to the infant, pregnant women who suspect that they have genital herpes should tell their doctor. Women who have herpes and are pregnant can have a vaginal delivery as long as they are not experiencing symptoms or actually having an outbreak while in labor.

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Reviewed on 10/31/2018
References
Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES:

Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2011.

Richwald, Gary A, MD. "The Diagnosis and Management of Genital Herpes: The Silent Epidemic." Medscape.

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