What Does Herpes Look Like?

Genital herpes can look like small blisters, red or darker bumps, open sores or shallow ulcers around the genitals, anus, thighs or buttocks. The blisters may be filled with clear or cloudy fluid. They can burst and leave painful sores, which may sting when urine touches them.

On lighter skin, the area around the sores may look red or pink. On brown or black skin, the sores may look darker, purple, grey, brown or less red than expected.

Genital herpes symptoms can include:

• small blisters around the genitals, anus, thighs or bottom
• blisters that burst and become open sores
• tingling, burning or itching before spots appear
• pain when passing urine
• unusual vaginal or urethral discharge
• swollen glands in the groin
• flu-like symptoms during a first outbreak, such as fever, body aches or headache

At the beginning, herpes may not look like a blister straight away. You may first notice tingling, itching, burning, tenderness or soreness in one area. The skin may then become red, irritated, darker than usual or slightly swollen.

Within the next day or two, small bumps or blisters may appear. These can be easy to miss, especially if they are inside the vagina, under the foreskin, around the anus or hidden in pubic hair.

Early herpes can be mistaken for:

• shaving rash
• friction or irritation
• an ingrown hair
• a pimple
• thrush irritation
• an allergic reaction
• a small cut or graze

A herpes outbreak usually looks like a small cluster of fluid-filled blisters on sore or irritated skin. The blisters may appear around the genitals, anus, mouth or lips. They can burst and leave shallow, painful sores before drying, crusting or healing.

In some people, herpes does not look like obvious blisters. It may appear as small cuts, red or darker sore patches, ulcers, spots or a rash. The area may also tingle, burn, itch or feel painful before anything visible appears.

A herpes outbreak may look like:

• grouped fluid-filled blisters
• painful open sores or ulcers
• red, pink, brown, purple or irritated skin
• small cuts or cracks
• crusted or healing scabs
• a rash around the genitals, anus, mouth or lips

Pictures can help you compare symptoms, but they cannot confirm herpes. A swab test from a fresh blister or sore is usually the best way to check.

Herpes blisters usually look like small, round, fluid-filled bumps. They may appear alone, but they more commonly appear in a group or cluster. The fluid inside the blister may look clear, whitish or cloudy.

Herpes blisters often:

• appear in clusters
• feel painful, sore or tender
• burst and become open sores
• form a crust or scab as they heal
• come back in the same or nearby area

A herpes blister is usually different from a pimple because a pimple is often centred around a hair follicle and may contain thicker white or yellow pus. Herpes blisters tend to be more delicate, painful and fluid-filled.

A herpes rash usually looks like a small cluster of fluid-filled blisters on a sore, irritated patch of skin. The blisters may look clear, white, yellowish or cloudy. They can appear around the genitals, anus, mouth or lips, and may burst into painful open sores before drying, crusting or scabbing over.

A herpes rash may start before blisters are visible. Many people notice tingling, itching, burning, soreness or sensitivity in one area first. The skin may then become red, pink, darker, purple, brown or slightly swollen depending on skin tone.

A herpes rash is more likely if:

• the blisters appear in a small cluster
• the area tingles, burns or itches before the rash appears
• the blisters are painful or tender
• the blisters burst and become shallow sores
• the rash comes back in the same or nearby area
• symptoms appear around the genitals, anus, mouth or lips

However, a herpes rash can look similar to pimples, ingrown hairs, shaving rash, thrush, genital warts, syphilis or skin irritation. Pictures can help you compare symptoms, but they cannot confirm whether you have herpes. If you have a new rash, blister or sore around the genitals or mouth, speak to a sexual health clinic, pharmacist or doctor.

In men, genital herpes can appear as blisters, sores or ulcers on or around the:

• penis shaft
• head of the penis
• foreskin
• scrotum
• pubic area
• anus
• buttocks
• inner thighs

Herpes on the penis may start as small red, brown, purple or skin-coloured bumps before becoming fluid-filled blisters. These blisters may then burst, leaving shallow painful sores. If herpes affects the urethra or the tip of the penis, passing urine may sting or burn.

Men may mistake herpes for an ingrown hair, shaving rash, friction burn, balanitis, thrush or syphilis. A swab test from a fresh blister or sore is the best way to confirm whether it is herpes.

In women, genital herpes can appear as blisters, sores, ulcers or small cuts around the:

• vulva
• labia
• vaginal opening
• inside the vagina
• cervix
• pubic area
• anus
• buttocks
• inner thighs

Vaginal herpes can be harder to see because sores may be inside the vagina or on the cervix. Some women may notice pain, itching, burning, pain when passing urine or unusual discharge before they see any visible sores.

On the vulva or labia, herpes may look like small grouped blisters or shallow ulcers. The area may be swollen, sore or very sensitive. Sores in moist areas may not crust over in the same way as sores on dry skin.

Vaginal herpes may look like small blisters, ulcers, cracks or sore patches around the vaginal opening, labia or vulva. If sores are inside the vagina, you may not be able to see them. Instead, you may notice pain, burning, itching, pain during sex, pain when passing urine or unusual discharge.

Because vaginal herpes can look similar to thrush, BV, friction, dermatitis or other STIs, it is important to get checked if symptoms are new, painful, recurrent or linked to sexual contact.

Mouth herpes usually appears as cold sores. These are small fluid-filled blisters that commonly develop on or around the lips. They may also appear around the nose, cheeks, chin or inside the mouth.

A cold sore often starts with tingling, itching or burning. Over the next 48 hours, one or more painful blisters may appear. The blisters can burst, crust over and usually start to heal within around 10 days.

Herpes on the lips usually looks like a cold sore. It may begin as tingling, itching or burning on one area of the lip. A small painful spot may then appear, followed by one or more fluid-filled blisters.

Lip herpes may look like:

• tiny grouped blisters on the lip border
• a painful red, pink, brown or darker patch
• a yellowish crust or scab as it heals
• a cracked sore at the edge of the mouth

Cold sores are contagious from the first tingling sensation until the sore has completely healed. Avoid kissing, oral sex and sharing items that touch the mouth, such as lip balm, cups or cutlery, while you have symptoms.

Several conditions can look similar to herpes. This is why testing is important if you are unsure.

Many ailments and conditions are similar in appearance to a herpes rash. While determining the difference between herpes, pimples, ingrown hairs, and other sexually transmitted infections (STIs) can be difficult, there are some subtle distinctions that can aid in detection.

Genital warts

As defined by the Centers for Disease Control and Prevention (CDC),  Human papillomavirus (HPV) is among the most common STIs in the world. Certain strains of HPV cause genital warts. Similar to herpes, genital warts can appear as a small cluster of bumps. The warts may vary in size and appearance but are often flesh-coloured, raised and cauliflower-shaped.

Genital warts may form on the penis, scrotum, thighs, and lips. Females may develop warts on the walls of the vagina and cervix and inside the mouth or throat. Warts are typically painless, although sex may irritate them, resulting in an itching sensation or light bleeding.

Genital warts may emerge between six weeks and six months after contracting HPV, although some individuals may be asymptomatic.

Syphilis

Unlike herpes which cannot be cured, syphilis can be easily cured if treated in time. However, unlike herpes, syphilis can have devastating long-term effects if left untreated. The CDC details the four stages of syphilis, and how the small bumps the condition first presents are similar to herpes blisters. Unlike herpes, syphilis lesions are painless. Both conditions can affect the penis, vagina, anus, and mouth. Syphilis sores are usually round and firm, and last three to six weeks. Secondary stage infections may result in rashes that show up on the palms of the hands or bottom of the feet.

Folliculitis

Folliculitis, a condition commonly distinguished by an infected ingrown hair, is often mistaken for herpes. As detailed by the Cleveland Clinic bacteria – frequently Staphylococcus Aureus – enters the hair follicle through a small pimple that has developed around it. Areas surrounding both the mouth and genitals may be irritated or affected by ingrown hairs as a result of shaving or grooming.

Bacterial vaginosis (BV)

BV is an imbalance of the normal bacteria universe in the vagina. The CDC indicates that while BV is not considered a sexually transmitted infection (STI), it can increase a woman’s risk of contracting one.

Whilst there is no cure, genital herpes treatment can be used in two ways:

• Outbreak treatment: To reduce the length and severity of an outbreak
• Suppression treatment: Taken long term to reduce the chances of experiencing an outbreak

The two main antiviral treatment used for herpes are aciclovir tablets and valaciclovir tablets.

Outbreak Treatment

Outbreak treatment is used at the start of an outbreak during the prodrome phase. It can help to heal sores faster, and reduce pain associated with an outbreak.

Aciclovir dose: One 400mg tablet taken three times a day for five days

Valaciclovir dose: One 500mg tablet taken twice a day for five days

Suppression Treatment

Aciclovir dose: One 400mg tablet to be taken twice daily long term

Valaciclovir dose: One 500mg tablet to be taken once daily long term