context: Genital herpes is one of the most common sexually transmitted diseases in the U. S. It is caused by the herpes simplex virus ( HSV). Most cases of genital herpes are caused by infection by the herpes simplex virus type 2 ( HSV-2). Herpes simplex virus type 1 ( HSV-1) is more often the cause of cold sores or fever blisters. But it can also be a cause of genital herpes. Most people with genital herpes don't know they have it. That's because in most people it produces either no symptoms or very mild ones. Genital herpes virus is passed from one person to another through sexual contact. This happens even if the person with the virus doesn't have symptoms or signs of infection. Once the virus enters through the skin, it travels along nerve paths. It may become dormant (inactive) in the nerves and remain there indefinitely. From time to time, the virus may become active. When that happens, the virus travels back along the nerve path to the surface of the skin, where additional virus is shed. At this point the virus may cause an outbreak of symptoms. Or it may remain undetected. In either case, the active virus is easily passed from one partner to another through sexual contact. Even wearing a condom may not protect the uninfected partner. The virus can be present on skin that remains uncovered. The number of recurrences or outbreaks a person can have may vary. Even though you can still pass the infection, you may never notice that you have symptoms from an HSV infection. On the other hand, you might notice symptoms within a few days to a couple of weeks after the initial contact. Or, you might not have an initial outbreak of symptoms until months or even years after becoming infected. When symptoms occur soon after a person is infected, they tend to be severe. They may start as small blisters that eventually break open and produce raw, painful sores that scab and heal over within a few weeks. The blisters and sores may be accompanied by flu-like symptoms with fever and swollen lymph nodes. Any of the following symptoms of a genital HSV infection can occur in a man or a woman: Cracked, raw, or red areas around your genitals without pain, itching, or tingling Itching or tingling around your genitals or your anal region Small blisters that break open and cause painful sores. These may be on or around your genitals (penis or vagina) or on your buttocks, thighs, or rectal area. More rarely, blisters may occur inside the urethra -- the tube urine passes through on its way out of your body. Pain from urine passing over the sores -- this is especially a problem in women. Headaches Backaches Flu-like symptoms, including fever, swollen lymph nodes, and fatigue Genital herpes is not the only condition that can produce these symptoms. Sometimes, HSV is mistaken for vaginal yeast infections, bacterial infections, or bladder infections. The only way to know whether they are the result of HSV or another condition is to be checked by a health care provider. Genital herpes is diagnosed with a physical exam and typically confirmed with a swab test or a blood test. There is no cure for genital herpes. But the symptoms can be lessened and prevented with treatment. Treatment can also reduce the risk of infecting others. Your health care provider may prescribe antiviral medications to help prevent or reduce the pain and discomfort from an outbreak of symptoms. Medication taken on a daily basis to suppress the virus can reduce the number of outbreaks and reduce the risk of infecting others. People who have an initial outbreak following a genital HSV infection can expect to have four to five outbreaks within a year. As time goes on, your body builds up more immunity to the virus, and the outbreaks may become less frequent, even stopping altogether in some people. When symptoms recur, they usually come on during times of emotional stress or illness. That's because, during these times, your body's immune system may be less able to suppress the virus and keep it from becoming active. Symptom triggers can include: Fatigue Illness Sexual intercourse Menstruation Stress Surgery Trauma There are things you can do to relieve the discomfort and severity of the symptoms during an outbreak. Home treatments include: Take painkillers such as aspirin, acetaminophen, or ibuprofen. Bathe sore areas with a warm salt-water solution twice a day (1/2 teaspoon salt with 1/2 pint warm water). Let air circulate around the sores by wearing loose-fitting clothes. Put an ice pack on the affected area. Wrap the ice pack in a towel or piece of cloth. Get plenty of rest. There are also things you can do to avoid passing the virus to other parts of your body, as well as to other people. Take these steps: Don't kiss when you or your partner has cold sores. Avoid oral sex when either partner has oral or genital sores. Don't have genital or anal contact when any sores are present. Wash your hands with soap and water after touching infected areas. Don't wet your contact lenses with saliva. For most people, genital herpes is not a serious threat to their health. Aside from the discomfort, an HSV infection is more of a psychological stressor. It can: Create anxiety Affect a person's self-esteem Interfere with a person's sense of security and intimacy In some cases, though, complications from genital herpes can be serious, even life-threatening. Although it's rare, pregnant women can pass on the herpes infection to their child. This can result in a serious and sometimes deadly infection in the baby. That's why taking steps to prevent an outbreak at time of delivery is recommended starting at 34 weeks into the pregnancy. If you have signs of an active viral infection when it's time to deliver, your doctor will likely recommend a cesarean section for delivery. People with genital herpes have a higher risk of an HIV infection. One reason is that cracks and breaks in the skin that result from an outbreak create openings through which HIV can enter the body. If you have any reason to believe you may have an HSV infection as the result of a sexual encounter -- either genital or oral -- contact your health care provider.