Excerpt from The Helper Newsletter published by ASHA, Ask the Expert column, Charles Ebel, Director, STD Resources Q: I recently learned that herpes lives in the nerve cells. If that is true, what does it do there? What damage does it do while it is there? Eventually, what is the end result? Would you please tell me in simple English, what is the outcome of herpes? A: When an individual has genital herpes, the virus sets up a sort of _base_ camp in nerve roots (called ganglia) near the spine. In the case of genital herpes, the ganglia infected are in the lower sections of the spine. Inside these nerve roots, the virus evades the efforts of the immune system to kill it, and it persists for life. For much of the time, herpes simplex virus is actually dormant inside the nerve roots and doesn't cause any damage there. From time to time however, the virus does have active phases in which it makes more copies of itself and travels the nerve pathways back to the surface of the skin in the genital area or to mucous membranes such as the cervix. The presence of the virus on these surfaces is called viral shedding. Sometimes people have symptoms that go along with this viral shedding, but sometimes they don't have symptoms. The nerve pathways that are affected by herpes travel to the genitals, anal area, upper thighs, buttocks, and even parts of the lower legs; therefore, a person can experience outbreaks and viral shedding in any of these areas. When a person has oral herpes, the virus lies dormant toward the top of the spine with symptoms or viral shedding occurring around the mouth or facial area. It's difficult to say how often the herpes virus will have active phases in any given individual. For one person, it may be 1% of days, for another 20%. Some people with herpes have symptoms (outbreaks) several times a year; others may rarely have an outbreak. Either way, those with latent virus will still probably have times when herpes is active and potentially contagious to sexual partners. To answer the question about long term consequences, it's rare for herpes to cause any serious complications. Preventing transmission to sexual partners can be an important issue in many couples. Preventing transmission from mother to baby is vital, because herpes can be devastating in newborns. But the mere presence of herpes simplex virus in the nerve cells alone causes no damage. Also, symptomatic recurrences decrease over time in a majority of people.