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Female Genital Herpes: a Complete Guide to HSV

Learn everything about herpes with this complete guide about female genital herpes: symptoms, signs, early diagnosis, and scientifically proven treatment.

Genital herpes, caused by the herpes simplex virus (HSV), is a common and highly contagious sexually transmitted infection (STI). The term herpes is derived from a Greek word meaning “to creep or crawl” and is about 2,000 years old, when it referred to the spreading nature of herpetic (blisters or ulcer) skin lesions. The virus can cause fluid-filled bumps that can break open and ooze a clear fluid. They can be found in any area of the genital region. However, many people who have contracted genital herpes do not have any symptoms.

There are two types of herpes simplex virus. HSV-1 is generally transmitted orally, causing oral herpes or genital herpes in some cases. HSV-2 is commonly transmitted sexually causing genital herpes. 

According to the Centers for Disease Control and Prevention (CDC), approximately 776,000 new cases of genital herpes infection occur in the United States annually. 

The CDC believes that the rate of genital herpes may be even higher than that because of the increasing number of cases of genital herpes caused by herpes simplex virus type 1 (HSV-1), which used to cause only oral herpes. 

The World Health Organization estimates that more than 3.7 billion people worldwide under the age of 50 (67 percent of the population) have the HSV-1 infection and approximately 417 million people worldwide under the age of 50 have the HSV-2 infection. It goes on to state that the presence of HSV-2 in the human body increases the risk of acquiring and transmitting the human immuno-deficiency virus (HIV).

Someone who has been infected by the herpes virus may be asymptomatic (having no symptoms) or can have mild symptoms that go unrecognized. If you suspect that you may have been exposed, it’s important to be aware of what to look for. A genital herpes outbreak can be characterized by one or more blisters or ulcers. These blisters can be painful, and if they rupture, may ooze clear fluid. They can be located on the genitalia, perineum, buttocks, and upper thighs. In addition, newly infected individuals often have symptoms that include fever, body aches, and swollen lymph nodes.

Today, there are 100 known herpes viruses, but only eight can infect humans. 

Genital herpes can be transmitted to any sexually active person and can be caused by two different herpes viruses. These viruses are known as herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).

Genital herpes caused by HSV-1 can be asymptomatic or may have mild symptoms that go unrecognized. Many infected people report experiencing a tingling, itching, or burning sensation before the appearance of any sores. When these sores do appear, they are characterized by one or more genital or anal blisters/ulcers that can be very painful. If these blisters open, they can ooze clear fluid and then develop a crust-like covering. After an initial genital herpes outbreak, symptoms may recur. Fortunately, with genital herpes caused by HSV-1, subsequent recurrences are milder and much less frequent.

Many times, the first episode of a genital herpes outbreak looks and feels the same, whether it’s caused by HSV-1 or HSV-2. The presentation of the blisters or ulcers looks exactly the same. Unlike HSV-1, HSV-2 may cause frequent, symptomatic genital ulcers. Recent studies have demonstrated that the HSV-2 is frequently shed and can be transmitted from the genitals even when there are no symptoms. 

HSV-2 shedding can also be detected throughout the genital tract and may be associated with genital tract inflammation. Researchers believe that this is what may contribute to the increased risk of acquiring HIV.

Genital herpes is caused by the herpes simplex viruses. Herpes simplex viruses are pathogens and can adapt to the body’s different conditions and cause a wide variety of medical conditions.

Genital herpes can be transmitted by HSV-1 or HSV-2 and is a lifelong condition. The average incubation period for an initial herpes infection is four days after exposure, but may range from 2 to 12 days. 

During this time, the newly infected person has no symptoms of the virus. Many studies have shown an increase in the number of people whose first episode of genital herpes is caused by HSV-1. 

HSV-2 is characterized by viral cells that shed off of the infected genital area. HSV-2 shedding consists of approximately 14 episodes per year. 

When HSV-2 is transmitted, the infected partner is usually asymptomatic. Studies consistently report that most people with a genital HSV infection are unaware of its presence. 

The clinical features of female genital herpes can include: 

  • Blisters may appear on the genitalia, vaginal opening, perineum, buttocks, upper thighs, or perianal areas.
  • In moist areas, blisters may rupture, leaving painful ulcers.
  • The vaginal tissue can become red and swollen.
  • General symptoms may include fever, body aches, swollen lymph nodes, or headaches.
  • Cervicitis (inflammation of the cervix)
  • Painful urination or difficulty with urination

There are several different ways that genital herpes can be diagnosed depending on the stage of the exposure. A blood test can diagnose the virus before any physical symptoms appear. If there are physical symptoms, a health care provider or gynecologist can do an evaluation.

Genital herpes is usually diagnosed based on a physical exam and the results of laboratory tests, including:

  • Blood test
  • Viral culture
  • Polymerase chain reaction test

Unfortunately, there is no cure for HSV-1 or HSV-2.

Because of this, it’s important to be aware of how to prevent, identify, and treat outbreaks. Prevention is key when it comes to avoiding the infection and the possible complications associated with the herpes simplex virus. It’s important for anyone who is infected, or thinks that they may have been exposed to herpes, to take precautions. If there is a current outbreak (oral or genital), skin-to-skin contact should be avoided. This includes kissing and any unprotected sex, including oral sex. Anyone who is infected with herpes simplex, even without visible symptoms, can pass it to another person. Because of this, it’s important to take precautions during every sexual encounter.

Here are some of the ways that people can protect themselves from genital herpes.

  • Using a condom during sex helps protect against herpes and other STIs.
  • Make sure that both partners are tested for HSV and that the results of the tests are in before engaging in unprotected sex.
  • Currently, vaccines are being developed.

Herpes simplex virus (1 and 2) involves a complex cycle of events. Herpes simplex viruses are considered latent infections, meaning they are a type of persistent, lifelong viral infection passed through sexual contact. The virus enters the body through the genital or oral mucosal tissues or sores of the skin, and then replicates. Following the incubation period, one or more lesions may appear. This is considered the primary infection.

While the blisters form, rupture, crust over, and finally disappear, the virus makes its way into a group of nerve cells (ganglia) near the spinal cord that supply the nerve fibers in the primary infected area. Viral DNA can remain dormant here until the body is stressed. When this happens, the virus reactivates, begins multiplying again, and travels through the nerve fibers back to the skin. This reaction causes eruptions of blisters in the same area of skin that was previously affected. This is referred to as a secondary infection. When that infection clears, the virus can become latent again, sometimes for months or years, and then the cycle starts all over. 

The herpes virus can infect different parts of the body, including various organs and tissues. This is particularly true if the infected person has a compromised immune system.  

The herpes simplex viruses can cause inflammation and infection in the following body systems:


  • HSV-1 can cause pneumonitis (inflammation of the lungs).
  • HSV pneumonia (viral infection of the lungs) is usually associated with people who have a compromised immune system (e.g., AIDS). Generally, this infection is due to herpes simplex virus type 1. Pneumonia due to herpes simplex virus type 2 is extremely rare.


  • Acute urinary retention (not being able to completely empty the bladder) caused by herpes simplex is usually due to the presence of irritation and swelling during active outbreaks. This condition is typically caused by HSV-1.
  • Pelvic inflammatory disease can result from herpes simplex. As stated previously, the herpes virus can cause inflammation and tissue changes when it attacks the cervix. A study published in 2015 also identified a significant correlation between HSV and ectopic pregnancies.


  • Disseminated herpes simplex virus 2 affects multiple regions of skin. 
  • Oral lesions caused by HSV-2 have been identified, usually as a result of oral sex.
  • Neonatal infection can happen when an infected mother passes the virus to a baby during delivery. 

Brain/Nervous system

  • Aseptic meningitis is a condition that can be caused by HSV and results in swelling of the protective membranes that surround the brain and spinal cord. A study published in 2016 presented a case study of a woman who experienced aseptic meningitis several times after being diagnosed with HSV-2. The last reported occurrence was 11 years after the previous treatment.
  • Encephalitis can occur when HSV travels to the brain. This infection (called herpes encephalitis) begins with confusion, fever, and seizures and can be fatal.
  • Alzheimer’s disease (AD). Recent studies have suggested that there is a connection between HSV-1 and AD. These studies propose that when latent HSV-1 in the brain is repeatedly reactivated, it may contribute to the symptoms associated with AD. 

Antiviral drugs are available by prescription only. There are numerous drugs available, but no current antiviral treatments can eliminate an HSV infection for good. Early treatment is very important with the first oral or genital infection. It’s important to be aware that treatment does not prevent the virus from moving into the nerves and causing chronic (long-term) infection. Treatment may, however, decrease the severity of the symptoms and shorten the length of time of the outbreak. Alternative treatments include topical treatments and intravenous therapy for severe cases. 

Taking antiviral drugs does not prevent an infected person from passing it to their partner. Using protection when either partner is infected (or when test results aren’t clear yet) can help prevent transmission.

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