Symptoms and Shedding of Genital Herpes in Women

Genital herpes is caused by the herpes simplex virus. Most infections are cause by HSV type 2 (HSV-2), but an increasing number are caused by the HSV-1 serotype. HSV-1 genital herpes tends to be associated with decreased severity of symptoms as compared to HSV-2. The incidence of genital herpes caused by HSV1 is highest in the college age population.

Some of the symptoms common to both HSV1 and HSV2 genital herpes infection in women include:

- Vesicular and/or ulcerative lesions on external genitalia, perianal region, buttocks

- Vulvar or perianal fissures

- Mild discomfort, itching, severe local pain

- Dysuria (discomfort with urination)

- Vaginal or urethral discharge

- Sacral parasthesia

- Tender regional lymphadenopathy (swollen lymph nodes)

- Fever, malaise, myalgias, headache

- Aseptic meningitis, disseminated disease occurs rarely

However, many genital herpes infections are asymptomatic. In fact, 75-90% of women are unaware of having an HSV infection. Additionally, women may confuse their symptoms with other causes. For example, in women with actual genital herpes symptoms are often erroneously attributed to:

- Recurrent yeast infections, urinary tract infections (UTIs), bacterial vaginosis

- Allergies to condoms, semen, spermicides, pantyhose

- Irritation from sexual intercouse

- Heat rash

- Hemorrhoids

Nearly all HSV-2 seropositive persons have active infection with intermittent shedding of the virus from their genital areas. Most have mild disease and symptoms, if any.

Asymptomatic viral shedding occurs in the absence of genital lesions. Rates of shedding may actually be similar in people with or without symptomatic disease. HSV-2 infections tend to be associated with more frequent and prolonged asymptomatic shedding.

An individidual may develop a primary infection, nonprimary infection or recurrent infection with herpes.

Primary herpes infection:

A primary HSV infection is the first ever HSV infection a person acquires.

- Average incubation period after exposure- 4 days (range 2 to 12 days)

- Average duration of lesions is 19 days

Nonprimary herpes infection:

A nonprimary herpes simplex infection occurs when an individual has one subtype of herpes (ex. HSV-1) and acquires a second subtype of herpes (ex. HSV-2).

- Associated with fewer lesions and systemic symptoms than primary infection

Recurrent herpes infection:

A recurrent herpes infection occurs when a person has 2 or more symptomatic flares of genital herpes.

- Typically less severe, shorter duration than primary or nonprimary infections (average duration is 10 days)

- Up to 50% of patients have prodromal symptoms prior to eruption:

Local mild tingling, shooting pains in buttocks, legs, and/or hips

Genital herpes is easily diagnosed and easily treated. Genital herpes is also easily prevented by using condoms. Remember that the incidence of genital herpes caused by HSV-1, which normally causes herpes lesions on the lips and/or oral mucosa, is increasing. Couples in which one individual has active oral lesions should avoid oral sex or use a dental dam.

Additionally, all women who are considering pregnancy should be aware of their HSV status in order to prevent neonatal herpes, a potentially life-threatening condition.