Nine reasons it's genital herpes-not something else

Introduction

Many genital skin rashes can look like herpes, but certain signs and symptoms can differentiate herpes from those skin conditions.

In this article, we'll go over the signs and symptoms that suggest a herpes outbreak more than anything else.

Why it is a herpes and nothing else. By expert STD doctor.

Reason #1. Prodrome period

Herpes rash can have a prodrome period. The prodrome period typically precedes the rash, but it can continue even after the rash has appeared.

The prodrome period is the time when you'll have nonspecific systemic symptoms before a rash appears, such as these:

fever
chills
muscle aches
fatigue.

Those symptoms are called nonspecific because they're not specific to herpes infection-people with other common viral conditions, such as flu, COVID-19, and sinusitis, can have similar symptoms.

In contrast to herpes, other genital skin conditions that have a similar appearance, such as folliculitis, balanitis, yeast infection, friction burn, syphilis, and yeast infection, do not have a prodrome period preceding the appearance of the rash.

Reason #2. Tingling of the skin and shooting nerve pain

Herpes rash can be preceded by a tingling sensation of the skin and localized shooting pain. This usually happens locally on the site of the skin rash.

When herpes virus enters the body through micro abrasions of damaged skin, it gets into nerve cells, where it permanently lives. Most of the time, the immune system keeps it suppressed and inactive

Tingling of the skin and shooting pain happens when the herpes virus is activated and travels along the nerve, inducing nerve firing.

All other genital skin rashes that need to be differentiated from herpes, such as syphilis, folliculitis, eczema, balanitis, friction burn, and yeast infection, do not have these nerve-related symptoms.

Reason #3. Herpes virus prefers thin, moist skin areas

Herpes rashes mostly affect the thin, moist skin areas of the genitals, such as the vulva and vagina for females and the penile head, scrotum, and shaft of the penis for males.

Why? Because it's easier to get microscopic cuts (micro abrasions) in those areas during sex, so the herpes virus can get through the skin more easily.

Herpes rashes can affect normal (thicker) skin areas, such as the pubic area, but that doesn't happen as often.

Unlike genital herpes, other genital rashes, such as folliculitis, fungal infection, and syphilis, can affect any skin type.

Folliculitis rash prefers hairy, relatively thick areas of the skin.
Fungal infection can affect any moist skin, regardless of skin thickness.
Syphilis sores have no skin type preference and can affect any skin surface that comes into contact with syphilis infection.

Reason #4. Pain

Pain is a very common symptom of a herpes outbreak

Herpes lesions (which be a bump, blister, or sore, depending on the stage of the disease) hurt all the time, but hurt even worse when they're touched.

The pain level is usually significant since the herpes sores in the genital area are irritated by walking and sitting.

Other skin rashes that need to be differentiated from herpes, such as folliculitis, balanitis, and syphilis, don't cause that much pain.

Folliculitis causes mild pain, mostly when it's touched.
Balanitis and yeast infection create itching with a bit of burning.
Syphilis sores are painless.

Reason #5. Herpes lesions are clustered

Herpes lesions are clustered-that is, located very close to each other, usually on the same red base.

One or two clusters of herpes bumps, blister, or sores can be seen, depending on the stage of the disease.

Other genital skin conditions that look similar, such as syphilis, folliculitis, and balanitis, show up as separate, individual lesions, with normal skin separating them.

Syphilis usually appears as a single sore. Rarely, there are multiple sores that are well demarcated (mean it's easy to see their individual borders).
Folliculitis presents as inflammation of the individual hair follicles, which are clearly separate. They can cover the entire pubic area, but each inflamed area is separate from others.
Balanitis appears as tiny red spots on the head of the penis that are separate from each other.

Reason #6 Herpes lesions are superficial

Herpes lesions are very superficial, meaning they affect the very top layer of skin. They don't penetrate the entire skin thickness. So, with herpes lesions, the skin thickness is normal.

The skin thickness, or level of skin penetration by the rash, can be assessed visually (by looking) or with a "skin pinch test."

When you look at the skin, you see skin that looks thicker or bumpier than neighboring skin.
Using a "skin pinch test," you pinch the skin in the area of a lesion and compare it to the skin next to it. When the skin is "thicker," unlike with herpes, you can feel the induration (hardness) under your fingers.

Other genital skin rashes, such as folliculitis and syphilis, can penetrate deeper skin layers:

Folliculitis can cause deep infection of the hair follicle. You can see and feel the thickness under the infected hair follicle.
Syphilis can cause a deep skin sore with a raised border.

Reason #7. Herpes lesions are usually one-sided

Herpes lesions ( are usually one-sided. This means that most of the time, the skin on only one side is involved: left or right. Occasionally, lesions are on both sides.

Other skin rashes that affect genital areas can be more widespread, affecting both sides at the same time.

Folliculitis can affect multiple hair follicles on different sides of the pubic area.
Balanitis affects the entire head of the penis.
Vaginal yeast infection affects the entire vaginal area and vulva.

Reason #8. Herpes skin lesions evolve (change appearance) over time

Herpes lesions usually evolve over time, going from one stage to another.

Herpes skin lesions don't stay in one stage for a long time; they evolve rapidly over a period of a week, on average (but this can take up to three weeks if it's a first outbreak).

The herpes rash starts as a redness. Then, bumps appear on the red skin; the bumps turn into blisters; the roofs of the blisters come off, forming sores; the sores become crusted; and the sores heal without leaving scars.

Unlike herpes, other genital skin conditions do not change in appearance once they've formed.

Syphilis forms a sore with a raised border that heals, leaving a scar, over a six-week period.
Friction burn is skin redness that slowly heals over time. If the skin burn was deep, a crust might form.
Balanitis presents with tiny red spots on the head of the penis.
Vaginal yeast infection appears as redness and swelling of the vagina and vulva. The areas might crack if they're not treated for a long time.

Reason #9. Localized lymph node enlargement

Herpes lesions usually cause lymph node enlargement on the site of the rash.

Lymph nodes are usually enlarged locally (in the groin area) and might be painful to the touch.

Other skin conditions affecting the area, such as friction burn, balanitis, folliculitis, and yeast infection, do not cause enlarged lymph nodes.

Similar to herpes, syphilis sore can be accompanied by lymph node enlargement.

Why it is a herpes and nothing else. By expert STD doctor.

Watch the video on the YouTube