After invading the skin or mucous membranes, the virus that causes genital herpes travels to the sensory nerves at the end of the spinal cord. Even after the skin lesions have disappeared, the virus remains inside the nerve cells in a latent state. In most people, the virus reactivates from time to time. When this happens, the virus travels along the nerves to the skin, where it multiplies on the surface at or near the site of the original herpes sores, causing new lesions to erupt.
It also can reactivate without any visible sores. At these times, small amounts of the virus may be shed at, or near, sites of the original infection, in genital or oral secretions, or from inapparent lesions. This shedding is infrequent, but it is sufficient to infect a sex partner.
The symptoms of recurrent episodes are usually milder than those of the first episode and typically last about a week. A recurrent outbreak may be signaled by a tingling sensation or itching in the genital area or pain in the buttocks or down the leg. These are called prodromal symptoms and, for some people, they can be the most painful and annoying part of a recurrent episode. Sometimes no visible sores develop. At other times, blisters appear that may be very small and barely noticeable or may break into open sores that crust over and then disappear. The frequency and severity of the recurrent episodes vary greatly. While some people recognize only one or two recurrences in a lifetime, others may experience several outbreaks a year.
The number and pattern of recurrences often change over time for an individual. Scientists do not know what causes the virus to reactivate. Although some people with herpes report that their recurrences are brought on by other illness, stress exposure to sunlight or menstruation, recurrences often are not predictable.
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Herpes