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Syphilis vs Herpes: How to tell them apart
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.
Syphilis has multiple stages. Here, we are comparing a primary syphilis sore to herpes.
This infographic provides a summary of the comparison between genital herpes and syphilis.
History
What caused the rash?
The cause of the skin lesion is not a differentiating factor because both conditions are caused by infection transmitted by skin-to-skin contact.
How soon do symptoms appear?
Unlike herpes’s incubation period, which is very short (2–4 days on average), syphilis’s incubation period is much longer and can be from 10 to 90 days (the average is 3 weeks). [6] Syphilis https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/syphilis
How are symptoms evolving?
A prodrome period, significant skin pain, and the fact that lesions change over time differentiate herpes from syphilis.
✓ Both conditions can present with sores. But the primary syphilis sore (chancre) is not preceded by any signs or symptoms, unlike a herpes skin flare-up, which is preceded by prodrome symptoms and “nerve pain.” [1] Genital Herpes – CDC Detailed Fact Sheet https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm
✓ Unlike herpes skin lesions , which change from one stage to another (bumps, blisters, and sores), syphilis lesions stay in one stage (ulcer) for a prolonged time (4–6 weeks).
✓ Herpes lesions, unlike syphilis, are very painful during all stages (bumps, blisters, and sores). The syphilis sore is painless and, for that reason, is often missed. [2] Genital Herpes Symptoms, Pictures, and Treatment https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes
✓ Both conditions cause localized groin lymph node enlargement (lymphadenopathy). But with herpes, lymphadenopathy is painful; with syphilis, it is not.
✓ Syphilis sores take a long time to heal (6 weeks), unlike a herpes flare-up, which, on average, resolves in 7–10 days. [4] Syphilis – CDC Detailed Fact Sheet https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm
✓ Unlike herpes sores, which heal without scarring, syphilis sores commonly leave a scar. The scar formation depends on how deeply the lesion penetrates the skin.
These pictures show the differences between herpes and primary syphilis lesions.
Warning
Contains sensitive content
View Photos
Herpes
Syphilis Infection
Visual exam
What do the lesions look like?
Usually, there are multiple herpes lesions clustered on the same red base. However, with syphilis, a patient will typically have only one syphilis sore. [5] Syphilis Images https://www.cdc.gov/std/syphilis/images.htm
How deeply do the lesions penetrate the skin?
Unlike herpes lesions, which don’t penetrate the entire skin thickness, a syphilis sore is deep and does penetrate the entire skin thickness. Due to this deeper skin involvement, a syphilis sore has firm, well-defined borders.
What is the discharge like?
A syphilis sore is dry, unlike a herpes lesion, which can have a discharge for a very short time.
Source
-
Genital Herpes – CDC Detailed Fact Sheet
https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm -
Genital Herpes Symptoms, Pictures, and Treatment
https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes -
Genital herpes: Overview
https://www.ncbi.nlm.nih.gov/books/NBK525769/ -
Syphilis – CDC Detailed Fact Sheet
https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm -
Syphilis Images
https://www.cdc.gov/std/syphilis/images.htm -
Syphilis
https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/syphilis
