Conditions You Might Mistake For Genital Herpes

Genital herpes is a common sexually transmitted infection (STI). Most people with the condition get mild or no symptoms, so it's often undiagnosed or misdiagnosed.

Some herpes-like conditions are also STIs such as syphilis and genital warts. Others are skin diseases, including contact dermatitis and folliculitis. And some are simple allergies or irritations, like jock itch and molluscum contagiosum, that can go away with home care. 

At first glance, genital herpes signs are not unique. You may get similar-looking bumps from other STIs or skin diseases like eczema, but there are differences to note. Here are 11 conditions you may mistake for herpes.

Contact Dermatitis

Contact dermatitis causes skin inflammation and soreness after direct exposure to an irritant or allergen. While herpes lesions can happen anywhere around the genitals, a dermatitis rash develops where the triggering substance touches your skin.

Genital contact dermatitis can appear as swelling without distinct boundaries (unlike the pustules in genital herpes) with a loss of skin texture. Other symptoms of contact dermatitis include burning, itching, soreness, and pain.

You may get contact dermatitis from the following:

• Medications applied to the skin
• Toilet paper
• Menstrual products
• Soaps
• Condoms

Avoiding the irritant or allergen is the first step to resolving and preventing contact dermatitis. Your healthcare provider may prescribe a topical corticosteroid cream to reduce inflammation or an antihistamine medication to reduce itching.

Syphilis

Syphilis is a STI that has been called the ”great imitator” for its similarity to other infections.

About three weeks after infection you may feel swollen lymph nodes and notice one or more ulcers on genitals or other parts of the body exposed to the virus. Unlike herpes, syphilis ulcers are typically painless and go away on their own after three to six weeks.

Six to eight weeks later you may experience fever, headache, and a rash on the shoulders, arm, chest, or back, and often on your palms and soles.

Syphilis is easy to diagnose and curable when caught early and treated with antibiotics.

Yeast Infection

A yeast infection ( candidiasis) happens when a fungus called Candida, which can exist normally inside the body, grows too much. It can affect the vagina, the penis, and the throat.

Most people with a vagina get at least one yeast infection at some point in their lifetime. Symptoms may include:

• Vaginal: genital itching, burning, and white and clumpy discharge
• Penile: itchy red rash under the foreskin, small red spots on the head of the penis, discharge, and pain while urinating
• Less commonly: fever

Yeast infections do not produce herpes-like vulvar rashes. However, people with a vagina can get a yeast infection as a complication of genital herpes, especially during their first outbreak. So if you have herpes-related sores, medication for a yeast infection won’t clear them up.  

Yeast infections can be treated with prescription or over-the-counter antifungal medications. It’s common to have more than one yeast infection in your lifetime. Nearly 50% of people with a vagina experience two or more yeast infections in their lifetime.

Molluscum Contagiosum

Molluscum contagiosum is a viral infection. It presents as lesions that can appear anywhere on the body and resolve on their own. In adults, many molluscum contagiosum cases are transmitted sexually, but any physical contact with the lesions can pass on the virus. As long as you have bumps, you are infectious.

Molluscum contagiosum lesions have the following features:

• Small raised bumps 
• Usually white, pink, or matching your skin tone
• Often appear pearly
• Have a dimple or pit in the center
• Occur anywhere on the body, including the genitals

Bumps can resolve on their own, but if you want to speed up the healing process (especially if you don't want to transmit the disease), talk to your healthcare provider about creams, medications, or physical removal.

Genital Warts

Genital warts are one of the most common STI in the U.S. Almost 6% of sexually active adults between the ages of 18-59 in the U.S. have reported a genital wart diagnosis. Warts appear between three weeks and eight months after infection.

Genital warts typically appear:

• Clustered in a few small bumps, possibly shaped like a cauliflower, or only appearing as one bump
• Light and pearly, dark purple, gray, brown, or matching your skin tone
• Bumpy or flat
• Smooth or rough
• Generally not uncomfortable nor painful, but occasionally itchy
• Rarely ooze — unlike herpes blisters

Genital warts are caused by the human papillomavirus (HPV) — the HPV vaccine can protect you from contracting it.

Without treatment, the warts can go away, stay the same, grow, or multiply. You can talk to your healthcare provider about getting prescription medication or physical treatment for the bumps, However, the warts may return since HPV is not curable.

Jock Itch

Jock itch is a fungal infection that mostly affects the penis. It can happen because of friction or prolonged wetness in the groin area.

Jock itch involves a rash, but, unlike genital herpes, it doesn't spread to the scrotum or penis. Instead, it typically shows up in the creases of the upper thigh and may spread to the anus.

The rash presents as red, raised, scaly patches that may blister and ooze, often with visible edges. Jock itch can also cause abnormally light or dark skin.

In most cases, jock itch can be cured with antifungal medications.

Bacterial Vaginosis (BV)

BV happens because of changes in the amounts of certain bacteria in your vagina. About 29% of women in the U.S. may get BV, though only about half of them experience any symptoms.

Unlike herpes, BV doesn't present with bumps. Symptoms of BV include:

• Unusual vaginal discharge
• Burning while urinating
• Itching around the outside of the vagina
• Vaginal irritation

The exact causes of BV are unknown, but having sex without condoms or douching can raise your risk of getting the condition. 

It's generally treatable with antibiotics like Metronidazole and Clindamycin, but in most cases comes back some time after treatment.

Skin Irritation

The following causes of skin irritation can mimic genital herpes:

• Shaving or razor burn
• Hair removal products
• Bicycle seat friction
• Wearing thongs or tight jeans
• Friction from frequent sexual intercourse
• Not enough lubrication during sexual intercourse

If you experience irritation around your genitals, pay attention to your daily activities and clothing. Avoid tight or wet clothing and use lube during sex.

If the irritation doesn't go away on its own, or if it comes back regularly without a known trigger, talk to your healthcare provider about your symptoms and recommended STI testing.

Folliculitis

Folliculitis happens when a hair follicle — the tissue around the hair root — becomes inflamed. This inflammation can be caused by friction or shaving, as well as a staphylococci (staph) bacterial infection. 

Symptoms of folliculitis include:

• Rash
• Itching
• Pustules or pimples near a hair follicle that can crust over

Although people frequently mistake folliculitis bumps for genital herpes, they're different. Folliculitis pustules are associated with a hair follicle and can appear wherever you have hair. Herpes lesions may be preceded by fatigue, malaise, and tingling or prickling in the area. If a folliculitis pustule is popped (don't do this at home!), you will see thick and sometimes blood-stained pus, compared to the clear or straw-colored fluid inside herpes blisters.

You can take care of folliculitis at home by applying a hot, moist compress to the affected area and maintaining good genital hygiene. If you experience the condition often, if it gets worse, or if it lasts longer than three days, talk to your healthcare provider. They may prescribe antibiotics or antifungal medicine.

Genital Eczema

Eczema (atopic dermatitis) is a common skin condition that presents as an itchy rash. It may come and go throughout your life, but in many cases gets better over time, especially in children. Besides severe itchiness, symptoms of eczema include:

• Skin redness
• Sometimes, blisters that easily break and leak liquid

Dry, cracked, thick, or rough skin developed over time. There's not much research on how frequently eczema spreads to the genitals, but one 2021 study of more than 200 participants with eczema found that 45% of them had experienced genital symptoms.

Eczema doesn’t have a cure, but over-the-counter and prescription treatments topical corticosteroids, alitretinoin, and immunosuppressant tablets can help reduce symptoms.

Psoriasis

Psoriasis is another chronic skin condition that can affect the genitals and is often confused with eczema. About 63% of people with psoriasis develop genital lesions at least once in their lifetime, making the disease one of the most common genital skin conditions. Unlike genital herpes, psoriasis does not cause blisters. 

Psoriasis typically causes itchy raised and scaly patches known as plaques, however, genital psoriasis may appear smooth.  

There is no cure for psoriasis, but some prescription medications and creams can help reduce and treat flares.

What Does Herpes Look Like?

Before a herpes outbreak, you may experience flu-like symptoms such as:

• Fever
• Chills
• Muscle aches
• Fatigue
• Nausea
• Tingling or pricking in the area of future lesions

The development of a typical genital herpes lesion begins with redness, swelling, and the formation of a papule, a small, solid bump with easily visible edges. Then, a blister develops.

Blisters often cluster and may break open and leak fluid, resulting in ulcers (open sores). Eventually, they crust over and heal on their own without leaving scars.

Repeat outbreaks are common, but they typically get less frequent and milder over time. Your first outbreak may last two to four weeks, with sores more likely to appear on both sides of the genitals. If you experience repeat outbreaks, they resolve in three to seven days with sores more likely to cluster on one side.

Only about 10-25% of people with genital herpes develop typical blisters, sometimes years after they were infected. The rest may develop lesions that are unusual or go away fast, or no lesions at all. Other herpes symptoms include pain with urination and swelling or itching around lesions. 

Whether you have lesions or not, you can still transmit the virus through genital-to-genital contact or oral sex.

A Quick Review 

It can be scary to experience sores or bumps on or around your genitals, but herpes is both common and manageable. Most of the time, these bumps or sores can often be treated or cured. 

If you're worried or your symptoms bother you, there's no need to self-diagnose and wait it out. Talk to your healthcare provider right away, as they can recommend the right testing and treatment options. There's no cure for genital herpes, but antiviral medications can prevent or shorten outbreaks.