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2.1
Genital Herpes in Women
Herpes Genitalis in Women

Presentation

While skin symptoms are present, a person is very contagious, as herpes viruses are present in the blister fluid and over the entire infected area (5). [helloclue.com]

If sores are present, a sample of fluid is taken from a sore. The sample is tested to see if it contains the virus and, if so, what type of HSV it is. Blood tests also can be helpful if no sores are present. [acog.org]

The population-averaged ORs that were derived from both the univariate and multivariable GEE models are presented along with the 95% CIs and P values. [academic.oup.com]

No herpes antibodies are present in the blood. Abnormal: Abnormal results that show HSV are called positive. HSV grows in the viral culture. HSV antigens or DNA are found. Antibodies to the herpes virus are present in the blood. [northshore.org]

According to a study presented at the 2002 National STD Prevention Conference, there is a 40% risk of reduction by using condoms. [americanpregnancy.org]

Immune System

  • Inguinal Lymphadenopathy

    Inguinal lymphadenopathy as the consequence of virus replication in the site of lymph drainage is seen frequently. Symptoms of viremia - malaise, myalgias and fever, are most commonly seen in primary herpetic infections. [womenshealthsection.com]

Entire Body System

  • Pain

    Sit in a bathtub of warm water 2 or 3 times a day to help soothe the pain. Take aspirin, acetaminophen, or ibuprofen to reduce pain or fever. [summitmedicalgroup.com]

    For instance, pain may be referred to as a symptom, while a rash may be referred to as a sign. [herpesalliance.org]

    Genital herpes is suspected when multiple painful blisters occur in a sexually exposed area. [emedicinehealth.com]

  • Fever

    The symptoms of genital herpes in women are: high temperature or fever skin irritation, burning or itching in the genital area nausea pain when urinating muscle aches and pains blisters Fever, nausea and muscle pain typically occur during the first herpes [onlinedoctor.superdrug.com]

    Take aspirin, acetaminophen, or ibuprofen to reduce pain or fever. Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. [summitmedicalgroup.com]

    Fever. The initial outbreak of genital herpes might also come with a fever, swollen lymph nodes in the groin, achy muscles, or flu-like symptoms. [loudounphysiciansforwomen.com]

    With the initial infection, some people also experience fever, flu-like symptoms, headaches, body aches or swollen lymph nodes, especially near the groin. [herpesalliance.org]

  • Asymptomatic

    Asymptomatic Pregnant Women The U.S. [uspreventiveservicestaskforce.org]

    Two-thirds of genital herpes cases are asymptomatic. Getting tested for both HSV-1 and HSV-2 is the only sure way to know if you have genital herpes. [stdcheck.com]

    Asymptomatic viral shedding Asymptomatic viral shedding is episodic and brief, usually lasting 24-48 hours. One to 2% of pregnant women with a history of recurrent HSV infection have asymptomatic shedding at the time of delivery. [emedicine.medscape.com]

    In paired specimens from HSV-2 positive women, genital HIV viral shedding was similar during symptomatic and asymptomatic visits. [journals.plos.org]

    Acyclovir need not be started as long as the infant remains asymptomatic (BIII). [pediatrics.aappublications.org]

  • Inflammation

    Instead, they suggest that neurodevelopmental outcomes are due to primary or reactivation of infection in mothers with inflammation in close proximity to the womb. [sciencedaily.com]

    In rare instances, HSV infection leads to inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord. Rectal inflammation (proctitis). [mayoclinic.org]

    Besides itching, other symptoms that come with bacterial vaginosis are inflammation, burning, discharge, and a fishy-smelling odor. Sexually transmitted disease ( STDs ). [webmd.com]

    […] of the male reproductive system with mcc 728 Inflammation of the male reproductive system without mcc 742 Uterine and adnexa procedures for non-malignancy with cc/mcc 743 Uterine and adnexa procedures for non-malignancy without cc/mcc 757 Infections, [icd10data.com]

    Our work suggests that inflammation and immune activation may contribute to risk. Herpes simplex virus-2 could be one of any number of infectious agents involved." [medicaldaily.com]

  • Weakness

    The herpes virus enters the body through the: Lining of the mouth Labia Vagina Regular skin that has small cracks or cuts People with a weak immune system can get a herpes infection more easily. [publichealth.va.gov]

    The virus can be more serious in newborn babies or in people with weak immune systems. Repeat outbreaks are common, especially during the first year. Over time, you get them less often and the symptoms become milder. [medlineplus.gov]

    Examples: Journal articles of individual studies Published intervention research Published pilot studies 1 out of 4 These resources are based on weak evidence. [healthypeople.gov]

    However, in persons with weak immune systems, the genital herpes outbreaks can be unusually severe and long lasting. A pregnant woman diagnosed with genital herpes can pass the infection to her baby. [allhealthsite.com]

    Herpes episodes are more likely to happen when your immune system is weak. Illness, tiredness, stress, periods or sexual activity can trigger them, but they can occur for no obvious reason. [healthywa.wa.gov.au]

Respiratoric

  • Sneezing

    Because the virus dies quickly outside the body, you can’t get herpes from hugging, holding hands, coughing, sneezing, or sitting on toilet seats. [plannedparenthood.org]

Gastrointestinal

  • Perianal Ulcer

    Sexually Transmitted Disease Treatment Guidelines: Diseases Characterized by Genital, Anal, or Perianal Ulcers. Available online at http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#hsv. Page last reviewed January 28, 2011. [labtestsonline.it]

Skin

  • Blister

    After the prodromal symptoms occur the blisters develop into painful red spots, which then evolve into yellowish, clear fluid-filled blisters after a day or two. These blisters burst or break and leave ulcers that usually heal in about 10 days. [stdcheck.com]

    Usually there are groups of several blisters, but sometimes there may be just 1 blister. The blisters usually lose their tops quickly. Then they look like small (1/8 inch to 1/4 inch wide) pink or red shallow sores. [summitmedicalgroup.com]

    Next, a blister forms. The blisters and subsequent ulcers that form when the blisters break are usually very painful to touch and may last from seven days to two weeks. [emedicinehealth.com]

    When signs and symptoms are present, they consist of: Typically painful fluid-filled blisters (that may appear like " pimples ") around the vaginal area Blisters around the vagina, anus, or buttocks Ulcer formation after the blisters break open Blisters [rxlist.com]

    Some women who have vaginal herpes only encounter one or two blisters while others suffer from multiple clusters of blisters on the vulva and inside the vagina. The blisters open up after a number of days and develop into open sores. [onlinedoctor.superdrug.com]

  • Ulcer

    Clothing that touches genital skin ulcers may transmit herpes simplex virus to others that wear the clothing. [rxlist.com]

    These classic ulcers resemble small pimples or blisters that crust over and scab like a small abrasion. It may take 14 days to 28 days for the sores to completely heal. [herpesalliance.org]

    Genital ulcer specimens. A single dry swab was taken from genital ulcers and multiplex PCR (M-PCR) was used for the detection of T pallidum, H ducreyi and HSV [29]. [journals.plos.org]

    It is important not to touch the eyes or mouth after touching the blisters or ulcers. Thorough hand washing is a must during outbreaks. Clothing that comes in contact with ulcers should not be shared with others. [emedicinehealth.com]

  • Vesicular Rash

    If, at any point during the evaluation outlined in the algorithm, an infant develops symptoms that could possibly indicate neonatal HSV disease (fever, hypothermia, lethargy, irritability, vesicular rash, seizures, etc), a full diagnostic evaluation should [pediatrics.aappublications.org]

  • Skin Disease

    Ulcer — A painful, pus-draining, depression in the skin caused by an infection. herpes [ her´pēz ] any inflammatory skin disease caused by a herpesvirus and characterized by formation of small vesicles in clusters. [medical-dictionary.thefreedictionary.com]

  • Eczema

    Fever Headache Tiredness Body aches Swollen lymph nodes Vaginal discharge Vaginal itch Painful urination Least common symptoms Sores, blisters, or ulcers inside or around the anus around the buttocks and thighs Trouble urinating Meningitis Encephalitis Eczema [stdcheck.com]

Neurologic

  • Headache

    With the initial infection, some people also experience fever, flu-like symptoms, headaches, body aches or swollen lymph nodes, especially near the groin. [herpesalliance.org]

    The first genital herpes outbreak may also sometimes be accompanied by flu-like symptoms, including muscle aches, fever, headache, and swollen lymph nodes in the groin area. [livestrong.com]

    The first signs may include: Itching, tingling, or burning feeling in the vaginal or anal area Flu-like symptoms, including fever Swollen glands Pain in the legs, buttocks, or vaginal area A change in vaginal discharge Headache Painful or difficult urination [publichealth.va.gov]

    If an individual has a high fever, severe headache, shortness of breath, or extreme fatigue, he or she should go to the hospital for evaluation. [emedicinehealth.com]

  • Seizure

    Certain medical and mental health issues frequently accompany autism including: gastrointestinal (GI) disorders, seizures, sleep disturbances, attention deficit and hyperactivity disorder (ADHD), anxiety and phobias. Source: Autism Speaks [dailymail.co.uk]

    If, at any point during the evaluation outlined in the algorithm, an infant develops symptoms that could possibly indicate neonatal HSV disease (fever, hypothermia, lethargy, irritability, vesicular rash, seizures, etc), a full diagnostic evaluation should [pediatrics.aappublications.org]

    Neonatal HSV Infection (Open Table in a new window) Disease Type Incidence, % Mortality, % Long-term Morbidity, %* Localized disease of skin, eye, mouth 45 0 5 CNS 35 15 65 Disseminated 20 60-80 40 *Morbidity includes mental retardation, chorioretinitis, seizures [emedicine.medscape.com]

    Potential Complications Genital herpes may be transmitted to the newborn during childbirth and may cause serious complications, including respiratory illnesses, retinal infection, liver infection, encephalitis, mental retardation, blindness, deafness, seizures [medical-dictionary.thefreedictionary.com]

  • Paresthesia

    […] crusts. [8] In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis ): pain, sensory loss, abnormal sensations ( paresthesia [en.wikipedia.org]

Urogenital

  • Vaginal Discharge

    Vaginitis is inflammation of the vagina that can cause itching, discomfort and discharge. [nhs.uk]

    […] nodes Vaginal discharge Vaginal itch Painful urination Least common symptoms Sores, blisters, or ulcers inside or around the anus around the buttocks and thighs Trouble urinating Meningitis Encephalitis Eczema herpetiform Eye infection How will I know [stdcheck.com]

    Symptoms of genital warts include increased vaginal discharge, vaginal bleeding during sex, itching, and dampness near the warts in the genital area. Genital warts can affect any person of any age or gender. Sex is the primary mode of transmission. [genitalherpestreatment.co]

    Redness, swelling, pain and tenderness in the area persist in the region of the outbreak while the sores are open, and women may also experience a vaginal discharge. [livestrong.com]

  • Vulvar Pain

    Mode of Delivery: Cesarean delivery is indicated in women with active genital lesions or symptoms of vulvar pain or burning, which may indicate an impending outbreak. [womenshealthsection.com]

    Cesarean delivery is indicated in women with active genital lesions or prodromal symptoms (eg, vulvar pain or burning) at the time of delivery, because these symptoms may indicate an impending outbreak. level C recommendations (based on consensus or expert [emedicine.medscape.com]

Workup

Once the maternal disease classification is determined (eg, first episode primary/nonprimary, recurrent), further management options include further diagnostic workup and/or neonatal empiric IV acyclovir or IV acyclovir for treatment of surface, CNS, [emedicine.medscape.com]

Microbiology

  • Herpes Simplex Virus Type 2

    Eis-HübingerAM, Nyankiye E, Bitoungui DM, Ndjomou J.Prevalence of herpes simplex virus type 2 antibody in cameroon. Sex Transm Dis.2002 ; (11):637-42 Weiss HA, Epidemiology of herpes simplex virus type 2 infection in the developping world. [hsd-fmsb.org]

    Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997; 337:1105-1111. 6. Fonnest G, de la Fuente Fonnest I, Weber T. Neonatal herpes in Denmark 1977-1991. Acta Obstet Gynecol Scand 1997; 76:355-358. 7. [clinicaltrials.gov]

    Wald A, Link K (2002) Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. J Infect Dis 185: 45–52. [journals.plos.org]

    Inhibitory activity of Melissa officinalis L. extract on Herpes simplex virus type 2 replication. Mazzanti G, Battinelli L, et al. Nat Prod Res. 2008;22(16):1433-40. 5. Vynograd N, Vynograd I, Sosnowski Z. [passeportsante.net]

    […] enzyme immunoassays for herpes simplex virus types 1 and 2 in women, J Clin Microbiol, 2003, vol. 41 (pg. 671 - 4 ) 12, Generalized estimating equations, 2003 Boca Raton Chapman & Hall/CRC 13 Frequent genital herpes simplex virus 2 shedding in immunocompetent [academic.oup.com]

Treatment

What Is the Treatment for Genital Herpes in Women? Although there is no known cure for herpes, there are treatments for the outbreaks. [emedicinehealth.com]

Treatment Options for Recurrent Herpes Infection Treatment of recurrent herpes outbreaks in pregnancy are short lived and do not require treatment before 35 weeks of pregnancy. [womenshealthcaretopics.com]

Treatment if the blisters come back Go to your GP or a sexual health clinic if you've been diagnosed with genital herpes and need treatment for an outbreak. [nhs.uk]

Current treatment is based around viral suppression in order to decrease the length and severity of the episode. [cochrane.org]

Prognosis

The prognosis of genital herpes is variable: there is no cure, and the recurrent outbreaks may vary in frequency and severity. Genital herpes prevention is difficult. [rxlist.com]

For those of us who know we have herpes and become pregnant, our prognosis is generally good. [marieclaire.com]

What Is the Prognosis for Genital Herpes in Women? Recurrent outbreaks are common for people with genital herpes. About 90% of those infected report repeat outbreaks. [emedicinehealth.com]

Etiology

Etiology: Two types of HSV, herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2), can be identified on the basis of divergent biologic properties. Initial contact with HSV usually occurs early in childhood and involves HSV-1. [womenshealthsection.com]

[…] including a recurrent form) Disseminated herpes Encephalitis Hepatitis Neonatal infection Pelvic inflammatory disease Pneumonitis Diagnosis Although herpes is the most common ulcerative genital disease in the United States, the coexistence of multiple etiologies [aafp.org]

Currently, approximately 15% of genital HSV infections are caused by HSV-1, however, HSV-1 is increasingly recognized as the etiologic agent of genital herpes infection with a large proportion of new genital infections being caused by HSV-1 in young women [emedicine.medscape.com]

Epidemiology

Ian Lipkin, director of the Center for Infection and Immunity and the John Snow Professor of Epidemiology at Columbia's Mailman School. "But evidence suggests a role for both genetic and environmental factors. [sciencedaily.com]

Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol 2007;57:737-63; quiz 764-6 Brown ZA, Gardella C, Wald A, Morrow RA, Corey L. Genital herpes complicating pregnancy. [gpnotebook.co.uk]

Sex Transm Dis.2002 ; (11):637-42 Weiss HA, Epidemiology of herpes simplex virus type 2 infection in the developping world. Herpes. 2004; 11 (suppl. 1): 24A-35A. Spruance S, Tyring K, DeGregorio B, Miller C,Beutner K. [hsd-fmsb.org]

In many mouse studies and several human epidemiology studies—projects where researchers went back to look at available medical data for autistic children and their mothers to try to find some kind of pattern—scientists have found a link between infections [popsci.com]

Anna Wald, professor of medicine, epidemiology, and laboratory medicine at University of Washington, tells MarieClaire.com that newborns who contract herpes can get very ill and die, even with antiviral treatment, and some have brain damage and neurological [marieclaire.com]

Pathophysiology

Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York, NY: McGraw-Hill; 2014. 2. CDC. Genital herpes—CDC fact sheet. www.cdc.gov/std/herpes/stdfact-herpes.htm. Accessed October 28, 2015. 3. CDC. [uspharmacist.com]

22% ≥ 10 partners: 19% to 37% Oral-genital contact Increases risk of transmitting HSV-1 from latent or active infection at oral site to genital site of uninfected partner Presence of other sexually transmitted diseases Increases OR of shedding to 3.1 Pathophysiology [aafp.org]

Prevention

Therefore, public awareness and education about these infections and the methods of preventing them is important. There really is no such thing as "safe" sex. The only truly effective way to prevent STDs is abstinence. [emedicinehealth.com]

Examples: Recommendations of the Community Preventive Services Task Force Recommendations of the U.S. Preventive Services Task Force Systematic reviews published in peer-reviewed journals 3 out of 4 These resources are based on strong evidence. [healthypeople.gov]

Genital herpes prevention is difficult. Condoms may prevent the disease spread during sex, but not in areas of skin not covered by a condom or during oral to genital contact. [medicinenet.com]

Seeking to prevent and treat it effectively has been a priority for several decades. Determining which approach to a preventive vaccine is an ongoing process in many countries. [allhealthsite.com]

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