Genital herpes vs. Balanitis
In this section, we’ll help you tell the difference between genital herpes and balanitis (a penile head fungal infection).
Balanitis is not an infection in itself but rather a fungal overgrowth caused by moisture that can be a result of sweating, being uncircumcised, or discharge from another infection that keeps the area wet.
Balanitis and herpes skin lesions can look alike and be easily confused.
It is important to distinguish these two conditions:
- Unlike genital herpes, balanitis can be easily cured.
- Unlike genital herpes, balanitis is usually not transmitted to a sexual partner and not considered a sexually tranmitted infection (STI).
In this chapter, as in previous chapters, we will present tables of important facts followed by frequently asked questions answered by an expert STD doctor.
Table 1. Similarities of and differences between these conditions’ common symptoms (what the patient feels)
In the table below, we summarize common symptoms (what’s felt by the infected person) of balanitis and herpes simplex virus.(for both herpes simplex virus types: HSV-1 and HSV-2)
It’s important to consider symptoms within the right context. The right context is the history of the condition: how soon it happened, what preceded the signs and symptoms, how it’s evolving over time, etc.
Similarities of herpes simplex virus and
balanitis symptoms | Differences between herpes simplex virus
and balanitis symptoms |
|---|
Symptoms
- Both conditions may cause pain and itching of the head of the penis.
- Both conditions might cause painful urination (if the urethra is involved).
| Pain
Balanitis does not cause shooting pain in the hips, thighs and legs.
Genital herpes symptoms might be preceded by shooting pain locally.
Systemic symptoms
Balanitis does not have systemic symptoms.
Genital herpes usually has prodrome symptoms of fever, fatigue, flu-like symptoms, or others |
Table 2. Similarities of and differences between these conditions’ common signs
In the table below, we summarize the common signs of herpes simplex virus (for both herpes simplex virus types: HSV-1 and HSV-2) and balanitis (that is, what can be seen by both the infected person and their doctor). In comparison to symptoms, signs are more reliable when it comes to establishing a diagnosis because they are objective and can be seen by the patient and the doctor.
Similarities of genital herpes
and balanitis signs | Differences between genital herpes
and balanitis signs |
|---|
Location
- Both conditions may cause a rash on the head of the penis.
Incubation period
- In both conditions, signs may appear two to three days after sex.
Lesions
- Both conditions affect a very superficial layer of the skin.
| Lesion (rash) appearance
Balanitis lesions are
- not filled with fluid,
- tiny red bumps with occasional shallow ulcers, and
- bright red in color.
Herpes lesions are
- flesh colored,
- fluid-filled blisters or crusted sores, and
- much bigger (2-3 mm)
Grouped vs. widespread lesions
- Balanitis skin spots are widely spread around the head of the penis.
- Genital herpes lesions are usually together on a red base.
Local lymph node enlargement (or lymphadenopathy)
- Herpetic lesions have local (mostly, inguinal or groin) lymph node enlargement.
- Balanitis has no lymph node enlargement.
Discharge
*Balanitis causes significant thick white discharge under the foreskin.
- Genital herpes discharge is insignificant and comes from the blisters.
|
Side-by-side photos of herpes and balanitis
These pictures show the differences between herpes and balanitis sores.
Pay specific attention to the following:
- Genital herpes ulcers are skin-colored on a red base while balanitis are tiny bright red bumps.
- Genital herpes ulcers are bigger lesions than the tiny red spots of balanitis.
- Genital herpes ulcers are clustered whereas balanitis lesions are widespread in a small area with each sore on its own red base.
- Genital herpes ulcer is a fluid-filled sac in this photo (at a later stage, it’s superficial crusted sores), unlike balanitis.
Frequently Asked Questions
In this frequently asked questions section, Dr. Fuzayloff answers questions in more detail about important points that differentiate between genital herpes and balanitis.
How can a doctor tell the difference between genital herpes and balanitis? 
When a doctor examines a person with suspected herpes or balanitis, they try to put the signs and symptoms into the right context.
What is the right context? It’s the history of the disease: what preceded it, when it began appearing, how it’s evolving, and whether there are associated symptoms.
The activities preceding the appearance of lesions
Though balanitis may be caused by sex, it’s more likely to be the result of activities that make the penile head wet and thus contribute to fungal overgrowth. The list of those activities includes but is not limited to the following:
- Falling asleep after having sex (vaginal discharge keeps the area moist)
- Exercise: biking, running, and other exercise that results in sweating
- Wearing tight synthetic clothes and underwear, which causes sweating)
- Recent use of antibiotics, which kill beneficial bacteria that are usually n our bodies and that suppress fungal growth
The presence of systemic symptoms and signs
Unlike genital herpes, balanitis does not cause systemic symptoms and signs (overall weakness, flu-like signs, lymph node enlargement).
The appearance of the skin lesions
- Herpes causes fluid-filled blisters that are usually clustered on the same red base.
- Balanitis lesions look like superficial bright red spots and don’t contain any fluid. They’re not clustered but rather mainly spread in the area that stays wet (the penile head).
The presence of pain
- Unlike herpes lesions (which are pretty painful), balanitis is itchy.
The discharge
- Balanitis cause a very thick white discharge that usually appears on the penile head and under the foreskin.
- Herpes discharge is scanty and usually clear.
YouTube video by expert STD (sexually transmitted diseases) health care provider (Dr.Slava Fuzayloff)
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