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Herpes in women

What is Herpes?

  • Genital herpes is a sexually transmitted infection caused by the Herpes simplex viruses – either type 1(HSV-1) or type 2 (HSV-2)
  • This is the same family of viruses that causes cold sores on the lip.
  • The majority of women infected with herpes will have no symptoms or only very mild disease. Often the infection goes completely unrecognised.
  • Women with symptoms may typically notice one or more blisters on the vulva or around the bottom.
  • These quickly break open leaving tender ulcers (sores) that take 1-2 weeks to heal.
  • Herpes outbreaks may recur but they are always much milder and shorter than the first.
  • The number of outbreaks usually decreases over a period of years.
  • Herpes can increase the risk of catching HIV or passing it on to your partner.
  • If you have herpes we recommend that you should have a full STI screen including a HIV test.  

How common is herpes?

  • Genital herpes infection is very common – 1 in 10 women attending antenatal clinics have evidence of genital herpes.
  • Most women will be unaware of their infection.

How do you catch herpes?

  • From sexual contact with someone else that has herpes – but this person may not know they have herpes and may have never noticed anything wrong with themselves.
  • Herpes is usually caught through vaginal or anal sex or sometimes just close genital contact.
  • Herpes simplex type 1 may be caught through oral sex with someone that has cold sores – about 50% women catch genital herpes this way.

What would I notice if I had herpes?

Most women with genital herpes would not notice anything wrong.

First episode herpes

  • In some women the first episode of herpes can be quite pronounced.
  • A woman usually notices something within 2 weeks of catching the virus from her partner.
  • Symptoms may include:
    • tingling, pain, blisters and then sores at the site of infection
    • swelling and redness of the vulva
    • Pain on passing urine
    • flu like symptoms
    • swollen glands in the groin
    • The sores usually take 2 weeks to heal.

Recurrent episodes

  • Women diagnosed with a first episode of herpes may expect to get a couple of recurrences over the next year or so.
  • Recurrences:
    • are much milder – usually only one or two blisters
    • last a shorter time – usually less than a week
    • occur less frequently with the passage of time 

How do I get tested for herpes?

  • Herpes can often be diagnosed on clinical examination by an experienced clinician but can only be reliably diagnosed by taking a viral culture or PCR swab from a blister or sore – it is best to attend the clinic as soon as possible after noticing anything wrong.
  • Tests will be unable to detect the virus if the sores have crusted or already healed. 
  • The result will be available in 7 to 10 days 

How is herpes treated?

  • First episodeherpes is treated with:
    • ACICLOVIR tablets 200mg five times a day for 5 days
    • This is best started as soon as possible after the appearance of symptoms and preferably within 72 hours.
    • Treatment will shorten and reduce the severity of symptoms.
    • Recurrent episodes of herpes usually do not need treatment.
    • Other helpful tips:
      • Take regular pain killers e.g. paracetamol, ibuprofen
      • Bathe or soak in warm salty water – teaspoon to a pint or 3 tablespoons in a bath
      • Apply 5% lidocaine ointment to the sores (available over the counter from some pharmacies)
      • Drink plenty of water
      • All treatments from the Wolverton Centre are free and are given to you directly in the clinic.

What about my partner?

  • Herpes can be passed onto a partner through sexual contact – this is most likely to occur when you have a sore or break in the skin.
  • Sometimes you can pass herpes on to a partner even when there appears to be nothing wrong – this is called ‘asymptomatic shedding’ – active virus can be shed from normal looking skin intermittently during the year – so you can’t tell when it is happening.
  • For this reason it is always best to either discuss the problem with your partner or make sure you protect them by using a condom. Condoms help to prevent transmission.
  • Sometimes it can be difficult to know whether your partner has herpes or not – particularly if they have never noticed anything wrong. Tests can only be done reliably if they have signs or symptoms. This can be discussed with the doctor.
  • Some couples choose to minimise the risk of transmission by avoiding sex or using a condom when they have a recurrence but take a small risk by having unprotected sex the rest of the time.
  • If your partner has herpes too and it is the same type then you cannot re-infect them – if it is a different type then you could pass it on.
  • There are always choices but it is best to be open and honest with your partner so you can make the best choice for both of you – you can talk through the options with the doctor or nurse.

What problems can herpes lead to?

  • Once someone has caught herpes then it will stay in the body indefinitely.
  • The herpes viruses have a special property called ‘latency’ which enables them to become dormant in the sensory nerve cell roots – so for most of the time the infected person has no symptoms.
  • Occasionally the virus is reactivated and this will lead to a recurrence of symptoms (e.g. blisters and sores on the skin).
  • Some people never experience a recurrence – particularly if they are infected with herpes type 1.
  • A few people get frequent recurrences – but they always reduce in frequency with time.
  • Recurrences in some people may be triggered by sunlight (avoid sun beds), trauma (use lube during sex) or by stress or being rundown.
  • If you have troublesome recurrences then discuss with the doctor at the Wolverton as you may benefit from suppressive treatment with aciclovir for a while.
  • Herpes increase the risk of catching HIV or passing it on to a partner.
  • For many people the main problem with herpes is the psychological distress it may cause – the doctor or nurse at the Wolverton can help you with this.

Herpes in pregnancy

  • Herpes caught for the first time in late pregnancy (after 24 weeks gestation) may lead to a severe infection in the baby during vaginal delivery.
  • In the UK this is a very rare event – only 10 cases per year.
  • If you catch herpes for the first time in pregnancy it is important that you inform your doctor and seek specialist advice from a consultant at the Wolverton centre.
  • Women who have recurrences of herpes during pregnancy (and were first infected before pregnancy) are not at risk of infecting their baby – this is because they have protective antibodies that they pass onto their baby across the placenta.

Will herpes come back again after treatment?

  • Even if you are treated with aciclovir during your first episode of herpes it may still recur again at some point.
  • But for most women the symptoms are so mild that it does not bother them unduly.
  • Recurrences become less frequent and much milder with time.
  • Troublesome or frequent recurrences (e.g. every 6 to 8 weeks) may be managed with suppressive therapy using aciclovir – discuss this with one of the doctors at the Wolverton.

More information