According to the Centers for Disease Control, genital herpes is more common among women than men, with approximately 1 in 4 women in the United States being infected with the herpes simplex virus type 2 (as opposed to 1 in 8 men). While some women never experience any symptoms at all, others may suffer from recurring outbreaks over the course of their lifetime. The common symptoms of genital herpes among women are described below.
Symptoms of Initial Outbreak
Most people with the herpes simplex virus-type 2 (HSV-2) never develop an outbreak or have mild symptoms that they don't notice or attribute to other minor health conditions. For many women, however, the initial outbreak of genital herpes may be severe and can last for two to four weeks. It usually occurs within two to three weeks of coming into contact with an infected partner. Initially, small red bumps may appear. These raw, painful, or itchy sores can develop in the woman's vaginal area, cervix, external genitals, buttocks or anus. The bumps quickly turn into blisters or open sores that can be extremely painful, particularly during urination, which can cause severe burning. The ulcers ooze and bleed for a period of days or weeks until they eventually dry up, scab over and heal. Pain and tenderness may persist in the region of the outbreak until it is fully healed. Women experiencing their first outbreak may have flu-like symptoms, including muscle aches, fever, headache and swollen lymph nodes in the groin area. In some cases, a second crop of sores may appear along with continued flu-like symptoms. Women may also experience swelling in the affected area, along with vaginal discharge.
Symptoms of Recurring Outbreaks
While the number of recurring outbreaks varies widely from person to person, the average number of recurrences is four to five per year. A number of factors may contribute to recurring outbreaks, including stress, menstruation, friction or trauma in the genital or anal area, or surgery. Women whose immune systems are compromised due to illness or serious conditions such as HIV are particularly susceptible to recurrent outbreaks.
Like the initial outbreak, recurring outbreaks will occur in stages, starting with redness, itchiness, tingling or pain in the genital or anal area, and progressing to swelling and blistering of the herpes sores. The sores then turn into wet ulcers that are raw and painful, until finally a dry crust or scab forms over the blister and it begins to heal. Most recurring outbreaks are shorter and less severe in intensity than the initial outbreak, and it has been observed that the frequency and severity of outbreaks decrease even further over time.
Absence of Symptoms and Viral Shedding
Some women experience outbreaks for which there are no symptoms, and up to 70 percent of people diagnosed with HSV-2 show no signs of the virus at all. They may, however, still be contagious through a mechanism called asymptomatic viral shedding. HSV-2 lies dormant in our nerve cells when it is not actively causing an outbreak. Sometimes, it may travel up the nerve cell to just beneath the skin's surface and begin "shedding" the virus at the site of infection. Women may or may not experience noticeable symptoms, but they can still pass the virus to their partner while the shedding is occurring. It is estimated that viral shedding occurs between 20 and 40 percent of the days during the first 60 days after initial exposure to the virus. Among women who are symptomatic and do experience outbreaks, half of all shedding occurs in the seven days before and seven days after an outbreak.
