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Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open to form painful ulcers. Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. Once infected further outbreaks may occur but are generally milder. The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected. This may occur during sex, including anal, oral, and manual sex. Sores are not required for transmission to occur. The risk of spread between a couple is about 7.5% over a year. HSV is classified into two types, HSV-1 and HSV-2. While historically HSV-2 was more common, genital HSV-1 has become more common in the developed world. Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies. Efforts to prevent infection include not having sex, using condoms, and only having sex with someone who is not infected. Once infected, there is no cure. Antiviral medications may, however, prevent outbreaks or shorten outbreaks if they occur. The long-term use of antivirals may also decrease the risk of further spread. In 2015, about 846 million people had genital herpes. In the United States, more than one in six people between the ages of 14 and 49 have the disease. Women are more commonly infected than men. Rates of disease caused by HSV-2 have decreased in the United States between 1990 and 2010. Complications may rarely include aseptic meningitis, an increased risk of HIV/AIDS if exposed to HIV-positive individuals, and spread to the baby during childbirth resulting in neonatal herpes.