Genital herpes is a sexually trans-mitted disease (STD) that affects approximately 50 million Americans. One in four US women has genital herpes, and up to 90% don’t know it. An outbreak of herpes sores is the most tell-tale sign of infection, but while some women will have several outbreaks a year, others will only have a few outbreaks in their lifetime, and many will have no symptoms at all.

The first outbreak usually occurs within 2–10 days of exposure to the herpes virus and is often longer and more severe than any that will follow. You may experience flu-like symptoms, such as swollen glands, fever, muscle aches, and chills. A painful cluster of small blisters—which turn into sores and heal without scarring—may form on the genitals, buttocks, or other areas, near the original place where the virus entered your body.

Herpes is most accurately diagnosed during an outbreak when a sample from a sore can be taken for lab analysis. If you notice herpes-related symptoms, contact your doctor right away. A blood test can also be used to detect the presence of herpes-fighting antibodies.

Outbreaks can be triggered by emotional or physical stress or when your immune system is worn down, such as after a cold or illness. Try to get plenty of rest, eat a balanced diet, and learn how to cope with stress to help you minimize flare-ups.

During an outbreak, try to keep sores clean and dry. A hair dryer on a low setting can dry sensitive or hard to reach areas. Wear loose-fitting cotton underwear and take aspirin or acetaminophen for pain.

Remember that you can spread herpes even when you’re not having an outbreak. Condoms may help prevent you from giving or getting herpes, but the virus can still be passed if a sore—or even a cold sore—comes in contact with skin on the genitals that is not covered by a condom.

Many people who have herpes experience a recurring group of symptoms, or a “prodrome,” a few hours before blisters appear. You may feel a tingling, itching, or burning sensation in the area where your outbreaks occur, or pain in your lower back, buttocks, and legs. It’s best to avoid sex if you notice prodromal symptoms.

Herpes infections in infants can cause serious problems, such as brain damage or eye problems. An infant can contract herpes if it is delivered vaginally while the mother is having an outbreak. Women may be prescribed medication to control outbreaks toward the end of pregnancy. Cesarean delivery may also be an option for women who have an active outbreak.

Genital herpes is a common and manageable disease, but there is no cure. Outbreaks and discomfort can be reduced with oral medications. Online or in-person support groups may help you cope with the disease.

April is STD Awareness Month. To learn more about herpes and other STDs, visit the American Social Health Association at http://www.ashastd.org.