Genital herpes vs. folliculitis (or ingrown hair)

Here we show you the differences between genital herpes (can be caused by both HSV-1 and HSV-2) and folliculitis (also known as pimple or ingrown hair).

These are two widespread skin conditions affecting people of all ages and both genders. The appearance of these conditions on the skin is easily confused.

It’s important to distinguish between these two conditions because folliculitis, unlike herpes(caused by herpes simplex virus), is easily cured and isn’t passed from one person to another.

Like other chapters, this chapter will present tables with important facts, followed by frequently asked questions answered by an STI (sexually transmitted infection) doctor.

How to differentiate Genital herpes from Folliculitis. STD (sexually transmitted disease) expert doctor explains.

Table 1. Similarities of and differences between these conditions’(herpes simplex virus and folliculitis) common symptoms (what the patient feels)

In the table below, we summarize the common symptoms (what is felt by the infected person) of herpes and folliculitis.

It’s important to consider symptoms in the right context: how soon they developed, what preceded them, how they’re evolving over time, etc.

Similarities of herpes (HSV-1 or HSV2) and folliculitis symptoms	Differences between herpes (HSV-1 or HSV-2) and folliculitis symptoms
Both conditions can cause an itchy sensation around the area of outbreak.	1. Pain Folliculitis lesions (pimples) are not painful unless you press them Herpes lesions are painful all the time, and they have more pain with irritation. 2. Shooting (nerve) pain Folliculitis does not cause shooting (nerve) pain in the hips, thighs, and legs. Herpes skin lesions can be preceded by shooting nerve pain. 3. Systemic symptoms Folliculitis does not cause systemic symptoms like fatigue, flu-like symptoms, fever, and swollen lymph nodes. Herpes can be preceded or accompanied by systemic symptoms. 4. Causes Folliculitis lesions (pimples) appear after mechanical irritation of the area (shaving, cycling, tight clothing, etc.) that occurred (usually) the day before. Herpes symptoms begin within 48 hours (after an incubation period) and occur after sexual contact.

Similarities of herpes (HSV-1 or HSV2) and folliculitis symptoms

Differences between herpes (HSV-1 or HSV-2) and folliculitis symptoms

Both conditions can cause an itchy sensation around the area of outbreak.

1. Pain

Folliculitis lesions (pimples) are not painful unless you press them

Herpes lesions are painful all the time, and they have more pain with irritation.

2. Shooting (nerve) pain

Folliculitis does not cause shooting (nerve) pain in the hips, thighs, and legs.

Herpes skin lesions can be preceded by shooting nerve pain.

3. Systemic symptoms

Folliculitis does not cause systemic symptoms like fatigue, flu-like symptoms, fever, and swollen lymph nodes.

Herpes can be preceded or accompanied by systemic symptoms.

4. Causes

Folliculitis lesions (pimples) appear after mechanical irritation of the area (shaving, cycling, tight clothing, etc.) that occurred (usually) the day before.

Herpes symptoms begin within 48 hours (after an incubation period) and occur after sexual contact.

Table 2. Similarities of and differences between these conditions’(herpes simplex virus and folliculitis) common signs (what the patient and physician see)

In the table below, we summarize the common signs of herpes and folliculitis. Signs are more reliable than symptoms when it comes to establishing a diagnosis because they are more objective and can be seen by both the patient and the doctor.

Similarities of herpes and folliculitis symptoms	Differences between herpes and folliculitis symptoms
Both conditions can affect the face and the genitals.	1. Widespread vs. grouped Folliculitis lesions are widespread, covering a bigger local area, usually in a hairy part of the body. Herpes lesions are usually clustered together on one side of the body. 2. Bumps vs. Blisters Folliculitis lesions are dome-shaped pustules: firm red bumps with pus at the top. They’re almost perfectly round. They extend deeper into the skin (affecting the pores). The pus, when squeezed, has a thicker consistency and white to yellow color. They might bleed. Herpes lesions are irregularly shaped vesicles (fluid-filled sacs). They’re very superficial (meaning on top of the skin). The fluid inside the sac is clear and watery with a thin consistency. 3. Recovery time Folliculitis blisters disappear in a few days. Herpes lesions may need weeks to heal and disappear. 4. Preferred location Folliculitis lesions appear only around hair follicles. Herpes sores prefer areas where the mucosa is transitioning into skin. 5. Other distinctions With folliculitis, hair might be growing in the middle of the pus-filled lesion. Folliculitis does not cause penile or vaginal discharge. Folliculitis lesions (ulcers) might leave scars after healing, unlike herpes.

Similarities of herpes and folliculitis symptoms

Differences between herpes and folliculitis symptoms

Both conditions can affect the face and the genitals.

1. Widespread vs. grouped

Folliculitis lesions are widespread, covering a bigger local area, usually in a hairy part of the body.

Herpes lesions are usually clustered together on one side of the body.

2. Bumps vs. Blisters

Folliculitis lesions are dome-shaped pustules: firm red bumps with pus at the top. They’re almost perfectly round. They extend deeper into the skin (affecting the pores). The pus, when squeezed, has a thicker consistency and white to yellow color. They might bleed.

Herpes lesions are irregularly shaped vesicles (fluid-filled sacs). They’re very superficial (meaning on top of the skin). The fluid inside the sac is clear and watery with a thin consistency.

3. Recovery time

Folliculitis blisters disappear in a few days.

Herpes lesions may need weeks to heal and disappear.

4. Preferred location

Folliculitis lesions appear only around hair follicles.

Herpes sores prefer areas where the mucosa is transitioning into skin.

5. Other distinctions

With folliculitis, hair might be growing in the middle of the pus-filled lesion.
Folliculitis does not cause penile or vaginal discharge.
Folliculitis lesions (ulcers) might leave scars after healing, unlike herpes.

Side-by-side photos of herpes and folliculitis

These pictures show the main differences between the fluid-filled sacs of herpes blisters and the bumps of folliculitis.

Pay special attention to the following:

Folliculitis is in the hairy part of the skin while herpes is in areas with thin skin in places transitioning between mucosa and skin.
There’s a distinct difference between the thick yellow pus of folliculitis and the thin clear fluid of herpes outbreak. This difference is more obvious when the lesion is squeezed. (But please note that it’s not advisable to squeeze the lesions.)
Herpes lesions are clustered while folliculitis lesions are separate individual lesions that aren’t on the same red base.
Herpes skin lesions are very superficial (only the top of the skin is affected), unlike the lesions of folliculitis, which are dome-shaped, deeper, and firm at their base. When touched, herpes skin lesion have no underlying skin induration (firmness).

Folliculitis (ingrown hair or pimples)

Image source: https://www.acepnow.com/article/in-neonates-with-herpes-how-often-does-mom-have-genital-herpes/

Genital Herpes

Image source: Dermatology Atlas (http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=151).

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Frequently Asked Questions

In his answers to these FAQ, Dr. Fuzayloff discusses in more detail the important points that differentiate between herpes and folliculitis.

What do you mean when you say it’s important to put information in the right context?
When a doctor examines someone with suspected herpes or folliculitis, they try to put the patient’s signs and symptoms into the right context.

By context, we mean what preceded the event, other associated symptoms, the area involved, and how the skin lesions are evolving after their appearance.
The activity that preceded the appearance of skin lesions
Was the area shaved recently? Is it a commonly shaved area? Was it shaved against the direction of hair growth?
If you answer yes to any of these questions, the likelihood of folliculitis is high.
Have you had new a sexual partner?
Herpes can be contracted from sexual intercourse with a new partner.
The time that’s passed since a risky activity
Timing is a very important part of the “right context.”
- In the case of the herpes infection, it takes about two to four days from the time of the risky activity (sex) for blisters to develop.
- Folliculitis lesions may appear in a couple of hours, or more usually the next day, after a person has shaved the hairs in their genital area.
The area of the skin lesion
Both conditions mainly affect the genital area and the face, but they prefer different parts of those areas.
- Herpes lesions mostly appear on the part of the skin that is bordering the mucosa (thinner and moist skin areas).
- Folliculitis lesions appear in hair areas around hair follicles. (You may even notice hair coming out the lesions). It affects the thicker skin of the thigh, pubic area, and buttocks.
The presence of systemic signs and symptoms
The presence of systemic symptoms is another important “right context” issue that helps with differentiation of herpes and folliculitis.
- Herpes usually presents with systemic symptoms and signs (fever, lymph node enlargement, overall weakness, and flu-like symptoms).
- Folliculitis does not present with systemic symptoms and signs.
The initial skin appearance and how it changes over time
Folliculitis
- Lesions caused by folliculitis have an almost perfectly round dome shape and are filled with pus (white heads).
- They’re usually individual (on separate red bases).
- They cover a bigger area.
- They appear abruptly, as early as a few hours after the irritation but definitely by the next day.
Herpes
- Herpes lesions may have different shapes and are filled with clear or yellowish fluid.
- They’re clustered together and usually share the same red base.
- They affect a smaller area.
- They’re usually one-sided.
- They appear after a prodrome period when there is tingling of the skin and systemic symptoms. They take longer to appear: two to four days after contact.
*Note: the herpes symptoms and signs mentioned here are for newly acquired herpes, not recurrent outbreaks.

YouTube video by expert STD doctor (Dr.Slava Fuzayloff)

Herpes vs folliculitis (skin infection)

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Genital herpes vs. folliculitis (or ingrown hair)

Table 1. Similarities of and differences between these conditions’(herpes simplex virus and folliculitis) common symptoms (what the patient feels)

Table 2. Similarities of and differences between these conditions’(herpes simplex virus and folliculitis) common signs (what the patient and physician see)

Side-by-side photos of herpes and folliculitis

Frequently Asked Questions

What do you mean when you say it’s important to put information in the right context?

Have a question?