Vaginal Herpes: Risks, Symptoms and Treatments

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    Dr. Leah Millheiser, MD Headshot
    Medically reviewed by Leah Millheiser, MD Written by Our Editorial Team Last updated 2/12/2020

    As with most sexually transmitted infections, no woman wants to live with genital herpes. But literally hundreds of millions of women all around the world do. 

    Genital herpes erpes is an incurable — but treatable — virus. It’s also a common one.  

    Understanding genital herpes is empowering — whether you have it or are hoping to avoid it — as knowing what you’re up against gives you the information needed to act. Whether that means preventing genital herpes, lessening the frequency of outbreaks, easing the pain and discomfort of symptoms or preventing transmission to your partner. 

    The point is, the more you know about genital herpes, the less about it you have to fear. 

    What is Herpes? 

    Herpes is a common virus in men and women. Genital herpes is most commonly caused by Herpes Simplex Virus Type 2 (HSV-2), but less commonly can be caused by HSV-1, a different strain of the virus that is typically the cause of oral herpes. It is a sexually transmitted infection, spread by close contact with an infected person, generally through sexual activity.  

    Genital herpes can be transmitted even when an infected individual doesn’t have any symptoms. This mode of infection is called asymptomatic viral shedding.

    There is no cure for genital herpes; it is a lifelong virus that you will carry forever once infected. Herpes outbreaks involve painful blisters and sores on your genitals and even inside your vagina and on your cervix.

    Because of the nature of the virus and its symptoms, genital herpes can be an embarrassing diagnosis. But it doesn’t have to be. It’s common, and the symptoms can be managed.

    A Note on HSV-1 vs. HSV-2 

    Genital herpes isn’t the only kind of herpes. HSV-1 is known as the main cause of oral herpes and is another strain of the virus. HSV-1 is typically transmitted through kissing, sharing eating utensils or cups, razors or towels with someone who has the virus. However, HSV-1 can be spread to the genitals during oral sex, too, leading to genital herpes. Likewise, HSV-2 can — although less commonly — be the cause of oral herpes.

    How Many Women Have It? 

    As many as 11.9 percent of U.S. people between the ages of 14 and 49 have a genital herpes infection, according to the Centers for Disease Control and Prevention. 

    Unfortunately for women, the infection is more easily spread to them during heterosexual sex, so it is more common in women than in men. The CDC estimates nearly 16 percent of women were infected with genital herpes during 2015-2016, compared with 8.2 percent of men.

    Genital herpes is also more common in African-American women. The U.S. Department of Health and Human Services estimates that one out of every two African American women between the ages of 14 and 49 has  HSV-2. 

    Symptoms of Vaginal Herpes 

    Not everyone who contracts HSV-2 develops symptoms, but if you do, your first outbreak will likely be your most severe. The symptoms typically arise between two and 12 days after being exposed to the virus. During the initial outbreak, you may experience flu-like symptoms including fever, muscle aches and swollen lymph nodes.

    In the first and subsequent outbreak, you may experience: 

    • Itching and burning in the genital and/or anal areas.
    • Vaginal discharge
    • Lesions or blisters on the vulva, vagina, anus and thighs
    • Scabs as the sores crust over and heal
    • Difficulty or pain when urinating, depending on the location of the sores

    In more rare cases, the symptoms of herpes can be so mild they go unrecognized and may be mistaken for insect bites, a yeast infection, pimples or other small abrasions. 

    A day or two before you experience an outbreak, you may have a warning period, known as a “prodrome.” The symptoms of a prodrome can include itching, tingling, burning and/or pain in the site where the sores will develop. It's important to know that you’re contagious during this prodrome period. 

    Vaginal Herpes Diagnosis 

    The easiest time to receive a genital herpes diagnosis is during a outbreak. Your doctor may take a sample from one of your sores to test for the virus. Other diagnostic tests include a PCR or polymerase chain reaction test to look for and identify the herpes virus you have or a blood test to look for herpes antibodies. However, you may not develop antibodies to the virus that are detectable in your blood for several months following the initial infection.

    When you go to your doctor, it may be helpful to have notes on what your symptoms are, when they started and how long they’ve been present. Your doctor may ask about your sexual history, including whether you’ve had other sexually transmitted infections in the past.

    Outbreak Recurrence 

    When you’ve contracted herpes, you’ll likely experience your first outbreak within a few weeks or less. Once the symptoms resolve, the virus goes dormant within your body. You still have the virus; it’s just not symptomatic.

    Genital herpes lies dormant in your body, waiting for an opportunity to "wake up." Once it does, it travels through the nervous system to the surface of the genital skin or inside of the vagina, where lesions develop.

    The number of outbreaks people experience each year once they’re infected varies widely, and unfortunately, it’s unknown what, exactly, triggers a recurrent outbreak — though some women tie recurrences to illness or stress.

    Treatments for Vaginal Herpes 

    Because there is no cure for genital herpes, medical interventions are designed to treat the symptoms, or outbreaks. Prescription antiviral medications such as acyclovir (Zovirax®) and valacyclovir (Valtrex®) can: 

    • Speed the healing of the genital herpes lesion(s) 
    • Lessen the severity of your symptoms
    • Lessen the duration of your symptoms
    • Reduce the frequency of outbreaks
    • Minimize the risk of transmitting the virus to an uninfected sexual partner

    These drugs can be prescribed during an outbreak or used daily even when you have no symptoms. Known as “suppressive therapy,” taking antivirals daily may prevent outbreaks and lower the risks of passing the virus to your sexual partner(s).

    The pain of an outbreak can also be managed with over-the-counter pain relievers, ice packs, warm baths, wearing loose clothing and keeping the affected area dry.

    Preventing Transmission

    Safe sex seems like the no-brainer way to protect yourself from any sexually transmitted infection, but condoms can’t completely protect you or your partner from HSV-2.That’s because condoms simply don’t cover everywhere the virus is present.

    The Centers for Disease Control and Prevention says the “surest” way to prevent transmission is to practice abstinence. But for most of us, that’s unrealistic. 

    People with genital herpes don’t have to be in the middle of an outbreak to spread the virus (called asymptomatic viral shedding), though it is more common when symptoms are present. So, if you or your partner have an outbreak, it’s best to avoid sexual contact. During periods where there are no symptoms, safe sex practices (i.e., using latex or polyurethane condoms) are essential every time you are sexually active with an uninfected partner.

    For those already infected, suppressive antiviral therapy can reduce the likelihood of spreading the infection as it reduces asymptomatic viral shedding. Your doctor may recommend this if you have HSV-2 and are sexually active.

    Genital Herpes Complications in Women 

    Though herpes isn’t a deadly condition, it can cause complications. 

    Pregnant women may spread genital herpes to their infant during delivery. The CDC calls this one of the “most serious complications” of genital herpes. This risk is lower if you contracted HSV-2 before becoming pregnant rather than during pregnancy. The likelihood of passing the infection on is low, but neonatal herpes can cause serious problems in an infant, so talk closely with your doctor about the risks if you’re pregnant or planning to become pregnant. Antiviral medications may reduce the risk of transmission.

    Other potential complications of genital herpes include: increased risks of other sexually transmitted infections, bladder problems due to lesion locations and, less commonly, meningitis.

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.