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When you have sores on your genitals, some medical staff members may assume you’ve got herpes. However, herpes isn’t the only possible cause of itching, pain, and swelling in your genital area.
If you’ve been diagnosed with herpes, but you don’t think that’s what is going on or you want a second opinion, talk to another doctor. You may end up getting diagnosed with one of the conditions below, including hidradenitis suppurativa (HS).
Genital herpes is caused by the herpes simplex virus, which is usually spread during sexual or intimate contact. As a sexually transmitted infection (STI) or sexually transmitted disease (STD), herpes can also affect the area around your mouth after oral sex, though that won’t be discussed in this article.
Not everyone responds to the virus the same way. Some people have painful symptoms, and others may not experience any symptoms of genital herpes.
People who have symptoms may experience:
Some people with genital herpes may feel like they have the flu, with symptoms like body aches, fever, swollen lymph nodes, and a headache.
A range of conditions, including other STIs, skin conditions, and infections caused by bacteria, yeast, or a fungus, may be mistaken for genital herpes.
Syphilis, another disease that’s transmitted through sexual or intimate contact, can be mistaken for herpes. However, syphilis sores tend to be deeper than those from herpes. Sores from syphilis also have no discharge, don’t change, and aren’t painful, like herpes sores are. Any enlarged lymph nodes related to syphilis won’t cause pain either, but those associated with herpes will.
Genital warts are caused by a virus that can be spread via sexual or intimate contact. They can appear anywhere in the genital area and vary in how they look. Genital warts may be:
Unlike herpes, genital warts usually don’t produce a lot of pain or other discomfort, though some people may find them itchy.
Eczema produces a chronic, itchy rash. If you happen to have eczema on your genitals, it could be confused with herpes. In one study of 220 people living with atopic dermatitis (the most common form of eczema), 45 percent reported symptoms involving their genitals. Eczema can be distinguished from herpes because it does not produce sores. Also, most people who live with eczema experience it in other places on their bodies, too, not just their genitals.
Contact dermatitis is a type of eczema that occurs when you develop a skin reaction after touching a particular substance. If this happens in your genital area, it can cause severe itching, discoloration, and inflammation, which may be confused with the first symptoms of herpes. Like herpes, contact dermatitis can also produce bumps that become fluid-filled blisters and may become crusty. You may need to have a doctor perform tests to determine whether you’ve got herpes or contact dermatitis.
At least one-third of people who live with psoriasis, another chronic skin condition, will experience it on their genitals. Psoriasis also itches but usually involves scaly, thickened patches of skin instead of sores. Most people who experience genital psoriasis will also have the same symptoms elsewhere.
Irritating the skin of the genitals can cause folliculitis, or inflammation of the hair follicles (tubelike structures that surround the roots and strands of hair). These follicles can get irritated during daily life, such as when shaving the genital area, while sitting on a saddle or bicycle seat, or during sexual intercourse.
Folliculitis looks like a rash with small, discolored bumps that become infected with pus, unlike herpes. Another difference: The bumps are usually painful only when touched. Finally, folliculitis occurs around your hair follicles, but herpes can occur anywhere in an area exposed to the virus.
Yeast growth in the vaginal area can cause some symptoms that are also associated with herpes. The main overlap is that both conditions can start with itchiness. Beyond that, however, the symptoms are different.
With a yeast infection, the itch may intensify and take over the whole vulva and vaginal area, usually causing a thick, white discharge. With herpes, the itching occurs along with sores that progress into open ulcers and become crusty.
Bacterial vaginosis is similar to a yeast infection, but this type of infection is caused by bacteria. When the balance of bacteria inside the vagina gets thrown off and one type grows too fast, bacterial vaginosis can occur.
People with bacterial vaginosis may experience itching or burning, particularly when they urinate, a symptom that’s similar to herpes. However, most people with bacterial vaginosis have a thin vaginal discharge that smells strongly of fish. The discharge can be clear, white, gray, or green and may be foamy, which is different from any discharge associated with herpes.
Jock itch is caused by a fungus that tends to grow when you spend a lot of time in damp clothes, like after a workout. This fungal infection can cause a rash (red, purple, brown, or gray, depending on your skin tone), severe itching, and peeling and may produce small, blistered bumps. The rash distinguishes it from herpes, and so does the fact that the bumps don’t become crusty, painful sores.
As some members of myHSteam have experienced, hidradenitis suppurativa can also be misdiagnosed as herpes. “I got so frustrated, I left without waiting for discharge papers,” shared one member. “One doctor said I had herpes, when I haven’t had sex in over a year and was married for 10 before that.”
Although HS can produce painful genital bumps, they’re different from those caused by herpes. HS bumps take longer to heal, often produce scarring, and aren’t contagious, all of which are different from herpes.
To further complicate matters, HS can also be associated with yeast growth, which may cause yeast infections in some people. One myHSteam member described this as “an HS problem people don’t seem to be talking about ... the growth of yeast in those protein-rich exudates.”
If you have a genital rash, itching, or pain in your genital area — or if you think you’ve been misdiagnosed with genital herpes — talk to your health care provider right away. A doctor should be able to do some testing and accurately diagnose what’s going on with your body so you can get the treatment options you need.
It may take extra time with your doctor to figure out whether you’re dealing with herpes, hidradenitis suppurativa, a yeast infection, or some combination of conditions, but it’s worth the effort. If you have herpes or another sexually transmitted infection, having the right diagnosis also gives you a chance to tell your sexual partners to get checked too.
On myHSteam, the social network for people with hidradenitis suppurativa, and their loved ones, more than 41,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.
Are you wondering if you have genital herpes or hidradenitis suppurativa? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Raj Chovatiya, MD, PhD, MSCI
is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.
Learn more about him here.
Sarah Winfrey
is a writer at MyHealthTeam.
Learn more about her here.
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