Genital Herpes in Women: Early Signs & Symptoms

Although genital herpes is a common STI, not everyone will get symptoms. This is known as being ‘asymptomatic’. The signs of genital herpes in females can vary from person to person, but tingling, burning, or itching around the vulva, vagina, thighs, or buttocks are common early signs that can suggest an outbreak is coming.

An HSV infection can also be mistaken for something else, including the flu, because the first infection can also cause symptoms, such as:

• fever
• headache
• backache
• chills
• swollen glands
• aches and pains
• tiredness

Other early signs can include:

• pain when going for a pee
• itching
• small, painful, cracked sores around the vulva or anus, known as fissures

Before any obvious physical symptoms, if you have been infected with genital herpes, you may get an itching or tingling sensation in the affected area. Often this is followed by small, raised bumps that develop into itchy, red, painful blisters.

Other common genital herpes symptoms in women include:

• abnormal vaginal discharge
• pain when you go for a pee
• spotting (irregular vaginal bleeding)
• pain around your genitals
• difficulty going for a pee because the sores can block the tube where pee leaves the body (the urethra)

These symptoms can last up to 3 weeks, and the sores will eventually scab over and heal. The first genital herpes outbreak is usually the most severe and longest-lasting.

Signs of herpes in females can appear:

• around the opening of the vagina (the vulva)
• inside the vagina
• on the opening of the womb (the cervix)
• on or around the anus
• on the buttocks
• on the thighs

When you first catch genital herpes, the first outbreak is usually the most severe. This is because it’s the first time your immune system has encountered it and does not yet have the tools it needs to deal with it, such as antibodies. This means the first outbreak can last 2 to 4 weeks and may be more painful and severe.

Once you have been infected with HSV, it stays in the body for the rest of your life, as there is no cure. It can lie inactive for long periods and reactivate later in the same area where the infection originally entered the body. If this happens, genital herpes sores and blisters can appear again, known as a recurrent outbreak.

Recurrent outbreaks are usually less severe and shorter than the first outbreak. Some people never have a repeat genital herpes outbreak.

Triggers for genital herpes in women

Once you have HSV, many different factors can trigger a genital herpes outbreak, such as:

• stress
• illness
• sunlight exposure
• sex
• skin irritation
• hormonal changes, including the menstrual cycle
• weakened immune system
• surgery

Genital herpes is diagnosed by a doctor or nurse, usually at a sexual health clinic, GP surgery, or via an at-home test kit from an online doctor service. Most cases of genital herpes are diagnosed using a viral swab test that’s taken from an open blister or sore.

The most common swab test is the polymerase chain reaction (PCR), which detects HSV genetic material. It is the most accurate way to diagnose genital herpes and can correctly identify the virus in 82% of people. You will need to have active sores for this test to work.

A PCR swab test can be used to diagnose genital herpes in:

STI clinics

Even if you visit your GP, they may refer you to a sexual health clinic for diagnosis. A doctor or nurse will examine the affected area and take a swab from an open sore using a tool that looks like a cotton bud. The sample will then be sent to a laboratory for analysis.

GP surgeries

You can make an appointment with your GP to discuss your symptoms. They will look at the infected area and either use a swab test to confirm a genital herpes outbreak or refer you to a sexual health clinic.

Home test kits

At-home genital herpes test kits use a similar swabbing method to collect a sample from a sore, which is then sent to a laboratory for analysis. At Superdrug Online Doctor, our genital herpes home test kit is easy to use, and you can collect the sample yourself from the comfort of your own home. Then send it to our partner lab for analysis. When ready, one of our doctors will review your results and advise you on what to do next, including genital herpes treatments and referrals if needed.

You can also get diagnosed using our photo diagnoses service where you submit photos for our doctors to check. They will confirm whether or not you’re having symptoms of a herpes outbreak, and if you are, they may be able to offer treatment.

Sometimes, a blood test may be used in some sexual health or maternity clinics if there are no visible genital herpes symptoms in women and you think you may have been exposed to the virus. A blood test detects antibodies, which your immune system produces to identify and fight infections.

Getting a genital herpes test is vital for an accurate diagnosis, especially as it can be misdiagnosed as other conditions, including:

• STIs – syphilis, chlamydia, trichomoniasis, and genital warts
• skin conditions – ingrown hairs, razor burn, eczema, yeast infections
• other conditions – urinary tract infections, bug bites

Genital herpes is most often spread by skin-to-skin contact with an infected area, particularly during vaginal, anal, or oral sex. It is contagious from the moment you get tingling or itching of a new outbreak until the sores have fully healed.

Genital herpes can also be spread by:

• a cold sore touching your genitals
• transferring the infection via someone else’s fingers who touches your genitals
• sharing sex toys with someone who has genital herpes

When it comes to genital herpes transmission women can pass the virus on even when they have no visible sores or blisters. This is called asymptomatic shedding.

You cannot catch genital herpes from:

• sharing towels
• sharing swimming pools or hot tubs
• saunas
• bedding
• cutlery

Genital herpes treatment for women is treated with a combination of antiviral medications and self-care measures to control your symptoms and limit the impact of the outbreak. There is no cure for genital herpes, so medications will only help to manage the symptoms. If you keep getting outbreaks, a doctor may prescribe antiviral tablets to prevent them, an approach called suppressive therapy.

Antiviral medication

Antiviral medication can treat and shorten an outbreak by 1 to 2 days, making it less painful. At Superdrug Online Doctor, we offer the following genital herpes medications:

Pain management and symptom relief

Antiviral medication helps to shorten genital herpes outbreaks and reduce the severity of symptoms, but there are things you can do to help manage pain and symptoms. These include:

• keeping the sores clean with plain or salt water to stop them from getting infected
• applying an ice pack wrapped in a towel to soothe the pain
• applying petroleum jelly or painkilling cream to relieve any pain when going for a pea
• washing your hands before and after applying any cream to the affected area
• pouring water over your genitals to soothe pain when peeing
• avoiding wearing tight clothing
• not having vaginal, anal, or oral sex until the sores have healed and gone away

Suppressive therapy for frequent outbreaks

Suppression of herpes treatment for women can be given if you keep getting recurrent outbreaks. A doctor may suggest suppression therapy if you have had at least 6 outbreaks in a year.

Antiviral treatment can be taken for 6 to 12 months or longer to stop genital herpes symptoms from coming back. After a year, your doctor will review your treatment.

When to seek professional help

If you think you may have genital herpes symptoms, visit a sexual health clinic or request a genital herpes test to get a diagnosis. This will help you get fast and effective treatment.

If you have previously had a herpes outbreak and they keep coming back, speak to your doctor about suppressive therapy to improve your quality of life.

Most women with genital herpes live well with the condition and have no long-term health issues because of it. However, there are some genital herpes complications women should be aware of, especially during pregnancy or when symptoms keep coming back.

Increased risk of HIV transmission

Genital herpes can cause breaks in the skin, which can make it easier for HIV to enter the body. Women with herpes who have unprotected sex with an HIV-positive partner have a higher chance of infection.

Pregnancy considerations

Genital herpes does not usually impact fertility or the ability to have a healthy pregnancy. However, if you have an outbreak late on in pregnancy or during labour, there is a chance you could pass it on to your baby. In this case, doctors may recommend antiviral medication, and in some cases, a C-section if sores are present at the time of delivery.

Risk of pelvic inflammatory disease

Herpes is not a usual cause of pelvic inflammatory disease, but in women with weakened immune systems, genital herpes outbreaks can increase the chance of the infection spreading into the reproductive organs, especially if you also have a bacterial STI like chlamydia or gonorrhoea. Always seek an urgent review with a doctor if you have fever, pelvic pain or unexpected bleeding.

Increased risk of cervicitis

Genital herpes can cause cervical swelling, also known as cervicitis, in rare cases. Some people may not get any symptoms, but others may have abnormal vaginal discharge or bleeding after sex. Treating genital herpes usually clears cervicitis.

Emotional and psychological impact

A genital herpes diagnosis can be emotionally challenging. It is normal to feel anxious, moody, or worried about relationships and spreading the infection. Supportive care, clear information about managing outbreaks, and speaking openly with doctors and sexual partners can make a big difference.

There is no cure for genital herpes, but there are things you can do to make sure you have a good quality of life, even during outbreaks. Living with genital herpes includes managing symptoms, lowering the chance of passing it on to others, and focusing on honest, open communication with your sexual partners.

Managing outbreaks

Genital herpes symptoms in women can be managed by:

• keeping the area clean with plain or salt water and patting dry
• applying a wrapped ice pack to the area and taking over-the-counter painkillers to manage pain
• wearing loose-fitting, cotton underwear and clothing
• following a healthy lifestyle, like eating a nutritious diet, prioritising sleep, and managing stress to support your immune system
• seeing a doctor and getting antiviral medication

Communicating with partners

Having an open, honest conversation with your sexual partners about your diagnosis and symptoms can help to build trust and improve communication in your relationship. It also means your partner can get a herpes test and treatment if needed. They will also be able to support you better if they know when you may have an outbreak.

Reducing risk of transmission

To reduce genital herpes transmission women can:

✓ use a condom or dental dam each time they have vaginal, anal, or oral sex or share sex toys

✓ avoid having sex when you have an outbreak until the sores have healed and gone away

✓ finish the course of antiviral medication and take it exactly as prescribed

✓ be honest with your sexual partners about your diagnosis and symptoms

✓ tell your doctor or midwife you have genital herpes if you are pregnant or plan to get pregnant

Can women have herpes without symptoms?

Yes, women can have genital herpes without any symptoms. By the age of 25, 70% of people have already caught HSV, and 1 in 3 people are unaware they have it because they have no symptoms. This means you can pass the infection on without realising.

Can genital herpes in women clear up on their own?

Yes, genital herpes sores and blisters can heal and clear up on their own, but the virus will remain in the body, even in an inactive state. When it reactivates, it can cause another outbreak.

Can genital herpes make you infertile?

No, there is no evidence that genital herpes causes infertility in women. However, it could lower the quality of sperm and reduce their numbers in men.

Do female condoms protect against herpes?

Yes, female condoms can offer some protection against genital herpes type 1 and 2 in women, but they are internal condoms and do not cover all skin. That means there is a chance that you could get herpes from uncovered areas. Research shows that using condoms in more than 25% of sexual activities can help protect women from HSV-2 infection.

Does herpes affect your period?

No, genital herpes does not affect your menstrual cycle, but some people find that a period can trigger herpes symptoms because of the hormonal changes taking place in the body. If you get changes to your period, like a missed period or irregular bleeding, this will not be caused by genital herpes, and you should see a doctor for more advice.