Balanitis vs Herpes

Written and reviewed by Slava Fuzayloff | Published on June 1, 2024

When we (doctors) try to differentiate between two medical conditions, we compare two parts of those diseases: history and the visual exam. What does each part mean?

1. History is about:

✓ What caused the rash?

✓ How soon did the rash appear after exposure (the rash incubation period)?

✓ How are the rash and other symptoms changing over time?

2. Visual exam is when we:

✓ Look at the rash

✓ Notice the location of the rash

✓ Pay attention to any discharge from the lesion

✓ Skin depth affected by the lesion

In medical practice, 90% of diagnoses are based on a visual exam and 10% on the history of the rash. So, the history of the rash plays a confirmatory role.

This infographic provides a summary of the comparison between genital herpes and balanitis.

History

What caused the rash?

Unlike herpes, which is infectious and transmitted by skin-to-skin contact, balanitis is caused by fungal overgrowth caused by increased moisture production, prolonged wetness, and poor hygiene. [4] Balanitis https://www.nhs.uk/conditions/balanitis/ It is widespread in overweight, physically active, and uncircumcised people.

How soon did the rash appear?

The incubation period for both conditions is about the same, 1–3 days, so this is not a differentiating factor.

How are symptoms evolving?

This is a primary differentiating factor between herpes and balanitis.

Herpes rash is preceded by prodrome symptoms (flu-like symptoms and skin tingling), unlike balanitis.

The herpes rash is painful and goes through stages, from a red bump to a blister to a crusted sore, over one week. Balanitis skin lesions begin with red skin that itches, and the red area becomes swollen and develops a white discharge as the itch intensifies.

Unlike herpes, balanitis does not usually present with enlarged, painful groin lymph nodes. [5] Balanitis https://my.clevelandclinic.org/health/diseases/21186-balanitis

The healing time for both conditions is about the same: 5 days for mild balanitis vs. 7 to 10 days for herpes.

Balanitis vs herpes pictures

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Herpes

Balanitis

Visual exam

What do the lesions look like?

Herpes can present in different stages, such as blisters, sores, and eventually crusted sores. [2] Genital Herpes Symptoms, Pictures, and Treatment https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes

Balanitis rash presents as skin redness that might become swollen over time. Dark red pinpoint spots may be seen as the disease progresses. [5] Balanitis https://my.clevelandclinic.org/health/diseases/21186-balanitis

How much skin is affected?

Herpes lesions are usually clustered together and confined to one small area.

Balanitis rash is widespread, affecting the entire penile head area.

What is discharge from the lesions like?

Herpes has minimal, watery discharge for a short time (when the blister's roof comes off, forming a sore). [3] Genital herpes: Overview https://www.ncbi.nlm.nih.gov/books/NBK525769/

Balanitis discharge is significant and can be described as having the appearance of thick, white cottage cheese; it is always present, especially as the disease progresses.