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Genital Herpes Symptoms in Women

Recurrent Genital Symptoms in Women May be Caused by Herpes

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Updated May 29, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Genital herpes is a lifelong disease that causes painful outbreaks of blisters in the genital area. Herpes simplex virus can infect men and women equally, but the pattern of infection is different.

Genital Herpes Transmission
The herpes simplex virus is transmitted during close personal contact through the exchange of saliva, semen, cervical fluid, or vesicle fluid from active lesions. The virus generally does not infect the dead, keratinized cells in the epidermis. It must come in contact with mucosal cells or abraded skin to begin replication and infection.

Genital Herpes Transmission in Women
Women are approximately 4 times more likely to acquire a herpes simplex type 2 infection than men. Susceptible women have a higher likelihood of contracting genital herpes from an infected man than a susceptible man becoming infected by a woman. In other words, if a non-infected man and woman each have intercourse with an infected partner, the woman is more likely than the man to contract a herpes simplex virus infection.

Why Women are at Greater Risk with Genital Herpes
Women may be more susceptible to genital herpes infections because:

  • The genital area has a greater surface area of cells moist with body fluids (mucosal cells) than men.
  • Hormone changes during a woman’s menstrual cycle may affect the immune system, making it easier for the herpes simplex virus to cause an infection.

First Genital Herpes Outbreak in Women
The first genital herpes outbreak is more painful and lasts longer than recurrent genital herpes outbreaks in both men and women. However, women tend to have more severe disease and higher rates of complications during the first genital herpes outbreak. In women, herpes lesions can occur anywhere in the genital area including the vulva, inside the vagina, on the cervix, and urethra. Herpes lesions can also occur in areas other than the genital area such as the buttocks and thighs. These first lesions are infectious for an average of 3 weeks, longer than in men and longer than recurrences in women, because the blisters contain a large number of infectious viral particles.

Other Symptoms with the First Genital Herpes Outbreak
In addition to a rash in the genital area, women can also get swollen lymph nodes in the groin and burning with urination. Complications of the first outbreak in women include difficulty urinating in 10 percent to 15 percent of women and meningitis, an inflammation of the fluid surrounding the brain in up to 1 out of 4 women.

Confusing Symptoms with Genital Herpes in Women
Even though women may have more severe disease, they may have symptoms that are not attributed to herpes. A woman who has herpes lesions inside the vagina or on the cervix may have pelvic pain and discharge that may be misdiagnosed as a yeast infection, cervicitis (an inflammation of the cervix), or pelvic inflammatory disease. Herpes lesions that involve the urethra may be misdiagnosed as a urinary tract infection or bladder dysfunction. With recurrent infections, women may experience only irritation in the genital area without a rash. It is important that women with vaginal discharge or recurrent vaginal symptoms be tested for herpes.

Sources:

CDC. "Sexually Transmitted Diseases Treatment Guidelines, 2006." Morbidity and Mortality Weekly Report. 55(2006): 16-20.

Habif, Thomas. "Warts, Herpes Simplex, and Other Viral Infections." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 381-388.

Yeung-Yue, Kimberly. "Herpes simplex viruses 1 and 2." Dermatologic Clinics 20(2002): 1-21.

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