If you have blisters or sores on or around your genital region, rectum, or mouth, it could be a sign of genital herpes.
Genital herpes is a common and incurable sexually transmitted disease (STD). It’s so prevalent in the United States that about 1 in 6 people ages 14 to 49 have it. More American women than men have herpes, possibly because the disease is somewhat easier to pass from men to women than from women to men.
Herpes is caused by the herpes simplex virus (HSV). There are two types of herpes viruses: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). Both viruses are transmitted by close contact with an infected person. HSV-1 is usually associated with cold sores, or fever blisters, around the mouth and is often transmitted through nonsexual contact with infected saliva. HSV-2 most often affects the genital area.
However, an increasing number of genital herpes cases are being caused by HSV-1, not HSV-2. That is partly because a person who has oral herpes caused by HSV-1 can spread it to their partner’s genitals during oral sex. You can also get genital herpes by having vaginal or anal sex with someone who has the virus.
Most people who have herpes are asymptomatic, or they have symptoms that are so mild that they may not even notice them.
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What Does Genital Herpes Look Like?
When herpes symptoms occur, lesions usually appear as small, painful blisters on or around the genitals, rectum, or mouth. On average, the initial herpes outbreak will occur 2 to 12 days after exposure. The blisters break and leave painful ulcers or sores that may take two to four weeks to heal.
During the first outbreak, herpes lesions often last longer and are more contagious. Other symptoms may include a fever, body aches, swollen lymph nodes, and headaches. Additional symptoms of genital herpes include difficulty urinating, burning when you urinate, and itching.
Recurrent outbreaks of genital herpes are common. Many people can sense a recurrent outbreak coming on hours to days before the lesions appear, with symptoms that may include genital pain and tingling or shooting pains in the legs, hips, or buttocks. Recurrent outbreaks are usually shorter and less severe than the initial one, and they may decrease in frequency over time. They are much less frequent with a genital HSV-1 infection than a genital HSV-2 infection.
Sometimes people mistake herpes for a pimple, ingrown hair, or the flu. And since most of the time there are no symptoms, many people don’t know they have herpes. On the plus side, this underscores how mild herpes symptoms can be. On the minus side, it helps explain how and why the infection is so widespread: If you don’t know you have it, you are unlikely to take steps to avoid spreading it. Herpes can be transmitted from one person to another, even with no symptoms. Also, having herpes raises the risk of getting HIV.
Oral Herpes Can Cause Sores or Blisters Around the Mouth
HSV-1 is a common cause of oral herpes, which can lead to cold sores, or fever blisters, around the mouth. Most people with oral herpes do not have any symptoms. Children and young adults typically get the infection from nonsexual contact with saliva. Oral herpes caused by HSV-1 can also spread from the mouth to the genitals through oral sex, causing genital herpes.
In the United States, 50 to 80 percent of adults have oral herpes. Once infected with oral herpes, you will have the virus for the rest of your life. While some people never develop any symptoms, others will have recurrent outbreaks.
The first outbreak of oral herpes is usually the worst. In addition to sores on and around the lips and throughout the mouth, it may cause severe flu-like symptoms, including swollen lymph nodes and a headache. However, some people have no symptoms at all.
Some people with oral herpes never have any additional outbreaks after the initial one. If they do, the recurring infections are usually much milder, and the sores typically appear on the edges of the lips. Recurrent outbreaks are more common in the first year after the first outbreak of oral herpes.
These are the most common signs and symptoms of a recurring oral herpes infection:
- Redness, swelling, heat or pain, or itching in the area where the outbreak will occur
- Painful, fluid-filled blisters on the lips or under the nose, which then leak fluid and turn into sores
- Sores that crust over and heal after four to six days
Oral herpes typically spreads during an active outbreak or sore. It can be transmitted during intimate contact (such as kissing and oral sex) with someone who has the virus. To protect yourself from getting oral herpes, avoid physical contact with a person’s sores during an outbreak.
Oral herpes can be mistaken for many other infections, including allergic reactions. Your healthcare provider may diagnose oral herpes based on the location and appearance of your blisters and confirm the diagnosis with lab tests.
Treatments for oral herpes include the following:
- Antiviral oral medications, such as acyclovir, famciclovir, and valacyclovir
- Antiviral topical ointments, such as acyclovir and penciclovir
- Over-the-counter topical anesthetics and anti-inflammatory agents
How to Treat and Prevent Herpes
Once you have herpes, you’ll always have it. There’s no cure for herpes. However, medicines can prevent or shorten outbreaks and make it less likely that you will pass herpes on to intimate partners. Still, if you have herpes, whether you take medication or not, you should tell anyone you have sex with, so they know the risk.
Using latex condoms correctly every time you have sex can reduce your risk of transmitting or becoming infected with genital herpes, but condoms do not offer 100 percent protection. If you have herpes, you should avoid having sex while you have lesions or other symptoms of the virus (though you can still spread the infection even if you’re asymptomatic).
Symptoms of herpes can be mild or severe. Your doctor or healthcare provider may diagnose herpes by looking at sores you have or by testing a sample from a sore. If you are pregnant, you can pass on herpes to your fetus during pregnancy and to your infant during childbirth or just after birth. Herpes in newborns is a serious, sometimes fatal condition. If you are pregnant or planning to become pregnant, it’s important to tell your doctor if you have a history of genital herpes.
Are Canker Sores Caused by the Herpes Virus?
Canker sores, also called aphthous ulcers, are not caused by the herpes virus or any other virus. Canker sores typically appear as small, shallow lesions on the soft tissues in your mouth or at the base of your gums. They usually have a white or yellow center and a red border, and they typically occur on and under the tongue, inside the cheeks and lips, on the gums, and on the roof of the mouth. Unlike cold sores, canker sores occur only inside the mouth, and they are not contagious.
Simple canker sores, which are the most common kind, are usually small and oval shaped with a red edge, and they heal in a week or less, without leaving scars. Complex canker sores, which are less common, are larger than minor ones. They can be very painful and may take up to six weeks to heal. They may leave scars. Herpetiform canker sores are uncommon. They are very small, painful ulcers that frequently merge into bigger, irregularly shaped ones, and they heal without scarring in one to two weeks.
Canker sores may be triggered by a variety of factors:
- A minor injury to your mouth
- Acidic food like citrus fruit
- Nonsteroidal anti-inflammatory drugs like ibuprofen
- Emotional stress
- Dental appliances like ill-fitting dentures and braces
Some conditions and diseases may also cause canker sores:
- Celiac disease
- Crohn’s disease
- Behcet’s disease
- AIDS
- Ulcerative colitis
- Lupus
Anyone can develop canker sores, but they’re more common in teens, young adults, and women.
Your doctor or dentist can diagnose canker sores just by looking at them. Treatment usually isn’t necessary for minor ones, but a canker sore that is large or particularly painful can make it hard to eat and talk. Your doctor may suggest using a mouth rinse containing hydrogen peroxide, chlorhexidine, or dexamethasone, or a topical anesthetic or corticosteroid ointment. Particularly severe cases of canker sores may be treated by burning the affected tissue, called cauterization.
Contact Dermatitis Can Be Mistaken for Herpes
Contact dermatitis is a skin condition that can cause an itchy rash; cracked, dry, or scaly skin; bumps and blisters; leathery patches; and swelling, burning, or tenderness. It’s not an STD, but when it appears in the mouth or genital area, it may be mistaken for herpes. Unlike herpes, contact dermatitis can happen anywhere on the skin and is caused by direct contact with an irritant or an allergen. It is not caused by a virus.
Contact dermatitis usually occurs within days of exposure to an irritant or allergen. Common causes include poison ivy and reactions to medication, cosmetics, detergents, and jewelry. The skin rash from contact dermatitis usually disappears in two to four weeks. The best way to prevent contact dermatitis is to identify what’s causing it and avoid touching that item or substance again. Allergy testing can help determine the cause.
While contact dermatitis is generally not severe, it can be itchy and uncomfortable. When the rash is present, try using cool, wet compresses or anti-itch creams to soothe it. Antihistamine pills can help reduce the itchiness. Avoid scratching the area: Doing so can worsen symptoms and open the door to a bacterial or fungal infection. If your itching is severe, you should see your primary care provider or a dermatologist for topical steroid medication.
Is That Spot a Pimple or a Cold Sore?
Acne is most common in teens and young adults, but people of all ages can and do get it. Among teenagers, it is more common in boys. Among adults, it is more common in women. For most people, acne tends to clear up by the time they reach their thirties, but some people in their forties and fifties still have it.
Acne occurs when hair follicles under the skin become clogged with oil (sebum) or dead skin cells, causing lesions commonly known as pimples or zits. Acne usually occurs on the face but can also appear on the back, chest, and shoulders. It can cause inflammation, swelling, redness, heat, or pain.
There are different types of acne:
- Whiteheads Clogged follicles that stay beneath the skin and cause a white bump
- Blackheads Clogged follicles that appear black and reach the skin's surface
- Papules Lesions that are inflamed and usually appear as small, pink bumps on the skin
- Pustules (Pimples) Papules topped off by white or yellow pus-filled lesions that may be red at the base
- Nodules Large, painful solid lesions that are deep within the skin
- Severe Nodular Acne (Cystic Acne) Deep, painful lesions that are filled with pus
Hormones, stress, medications, and diet are among the factors that may trigger acne outbreaks or make them worse.
Acne is not contagious. Topical and oral medication can help heal pimples, stop new ones from forming, and prevent scars. To avoid scarring, don’t squeeze or pop pimples.
Scabies Rash Can Occur on the Genitals
Scabies is caused by tiny eight-legged bugs (human itch mites) that burrow into the skin to live, feed, and lay eggs. There are millions of cases of scabies worldwide each year.
Scabies can develop anywhere on the skin, but the mites most commonly burrow into the hands, the arms (particularly the elbows and wrists), and skin that’s usually covered by clothing or jewelry, including the buttocks, beltline, penis, and skin around the nipples.
If you’ve never had scabies, developing symptoms can take two to six weeks after the mites move in. The itching usually begins within one to four days if you've had scabies.
Signs and symptoms of scabies include the following:
- Itching, mostly at night
- A rash that causes small bumps that often form a line (The bumps can resemble hives, tiny bites, knots under the skin, or pimples.)
- Scaly patches that look like eczema
- Sores, caused by scratching the rash, which can become infected
- Thick crusts on the skin for a severe type of scabies called crusted scabies, or Norwegian scabies
People usually get scabies from direct skin-to-skin contact with an infected person. Adults can get scabies through sexual contact. You can also get scabies from infested items such as bedding, clothes, and furniture, but this is less common.
A dermatologist can often diagnose scabies just by looking at the rash, and they can confirm that diagnosis by removing some skin and looking at it under a microscope.
Scabies is easily treatable with prescription medication. In addition to the person diagnosed with scabies, everyone who has had close contact with that person must receive treatment. The skin should heal within four weeks. Any infested bedding, linens, towels, and clothing used during the three days before treatment should be washed in hot water and dried in a hot drier, or dry-cleaned, then sealed in a plastic bag for at least 72 hours.
How to Tell if It’s a Yeast Infection or Herpes
Vaginal yeast infections are very common — around 75 percent of women will experience this fungal infection in their lifetime, and many will have more than one.
Most vaginal yeast infections are caused by the fungus candida albicans. The vagina naturally contains a balanced mix of yeast, which includes candida, and bacteria. But an overgrowth of candida or penetration of the fungus into deeper vaginal cell layers can cause a yeast infection.
Symptoms of a yeast infection include the following:
- Itching and irritation in the vagina and vulva
- A burning sensation, particularly during intercourse or urination
- Redness and swelling of the vulva
- Vaginal pain and soreness
- Vaginal rash
- Thick, white, odorless vaginal discharge that looks like cottage cheese
- Watery vaginal discharge
While a vaginal yeast infection isn’t considered a sexually transmitted infection (STI) and is not contagious, there is an increased risk of getting a vaginal yeast infection when you first start having regular sex. Sexual contact can sometimes cause a yeast infection if you have a bad reaction to another person’s natural genital yeast and bacteria. Infections may be linked to oral sex.
Antibiotics, pregnancy, diabetes, an impaired immune system, certain oral contraceptives, and hormone therapy can also cause an overgrowth of fungus, which can lead to a yeast infection. In addition to performing a pelvic exam, your healthcare provider may send a sample of vaginal fluid for testing to determine the type of fungus causing the yeast infection. Antifungal medication is commonly prescribed, and the infection typically clears up within a week.
Yeast infections can occur in men, too, on the penis or scrotum, but this is uncommon, per Planned Parenthood.
Chlamydia Can Cause Burning During Urination
Chlamydia is the most commonly reported bacterial STI in the United States. You can get chlamydia by having vaginal, anal, or oral sex with someone who has the infection. Sexually active young people have a higher risk of getting chlamydia. Men who have sex with other men are at risk because the infection can be transmitted through oral and anal sex.
Chlamydia often has no symptoms, but if symptoms occur, they may not appear until several weeks after having sex with an infected partner.
Women who have symptoms of chlamydia may notice abnormal vaginal discharge, and as with herpes, they may experience a burning sensation when urinating. Men who have symptoms of chlamydia may notice discharge from their penis, a burning sensation when urinating, and pain and swelling in one or both testicles.
Both men and women can get chlamydia in their rectum, which can happen as a result of having anal sex with someone who has the infection or if the infection spreads from another infected site (such as the vagina). Chlamydia in the rectum often causes no symptoms, but it can lead to rectal pain, discharge, and bleeding.
In women, untreated chlamydia can cause pelvic inflammatory disease (PID), which can lead to infertility, ectopic pregnancy, and other complications. The infection may also be transmitted to an infant during childbirth. In men, chlamydia doesn’t usually cause chronic health problems, but it can cause a fever and pain in the tubes attached to the testicles, which can lead to infertility (in rare cases).
Untreated chlamydia may increase your chances of getting or giving someone else HIV.
Your healthcare provider can diagnose chlamydia with lab tests. Treatment with antibiotics can easily heal the infection and could reduce your chances of having complications later, but it won’t undo any permanent damage caused by the disease. Avoid having sex again until you and all your sexual partners complete treatment. Because it's common to have repeat infections with chlamydia, you should get tested about three months after receiving treatment, even if your sexual partners were also treated.
Sexually active women should get tested for chlamydia annually if they are younger than 25 years old or if they are age 25 or older and have risk factors, such as new or multiple sex partners, and a partner who has an STI. Men who have sex with men should be tested at least annually and potentially more frequently if they are at increased risk. Men who have sex with women should be screened based on risk factors. Pregnant women should also be tested for chlamydia.
Syphilis Can Cause Sores on the Genitals and Mouth
Like herpes, syphilis is an STI that can cause sores in the genital area and the mouth. Despite these similarities, the two infections differ in their causes: Bacteria cause syphilis, and a virus causes herpes. The health risks they pose are different, too.
You can get syphilis by direct contact with a syphilis sore during vaginal, anal, and oral sex. Syphilis sores in the vagina, anus, and mouth, and under the foreskin of the penis, can be challenging to see, so you may not notice that a sexual partner has the infection.
There are four stages of syphilis. During the first (primary) stage, you may notice a single sore or multiple sores that typically occur in, on, or around the penis, vagina, anus, rectum, lips, and mouth. The sores are usually firm, round, and painless, lasting three to six weeks. While the sores will heal with or without treatment, you must receive treatment to prevent the infection from moving to the secondary stage.
During the secondary stage, you may have rashes or sores in your mouth, vagina, or anus. The rash can appear when your primary sore is healing or several weeks after the sore has healed. It can be on the palms of your hands and bottoms of your feet, and may appear rough, red, or reddish-brown. The rash usually isn’t itchy, and you may not even notice it. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. These symptoms will go away with or without treatment, but you must receive treatment to prevent your infection from progressing to the latent and possibly tertiary stages of syphilis.
During the latent stage of syphilis, there are no visible signs or symptoms, but the infection can still be transmitted to others through sexual contact. Most people with untreated syphilis don't develop tertiary syphilis, but when this stage does occur, it can affect many organ systems and sometimes even result in death.
Healthcare providers typically use blood tests to diagnose syphilis. Syphilis is curable with antibiotics, but treatment might not undo some of the damage that the infection can cause. You may get syphilis again if infected sexual partners don't receive treatment.
You should get tested regularly for syphilis if you are a sexually active man who has sex with men, have HIV, are taking pre-exposure prophylaxis for HIV prevention, or have a partner who has tested positive for syphilis. You should also get tested for syphilis if you are pregnant.
How to Know if It’s Gonorrhea or Genital Herpes
Gonorrhea is a bacterial STI that can affect the genitals, rectum, and throat. The infection is very common, especially among young people ages 15 to 24.
You can get gonorrhea by having vaginal, anal, or oral sex with an infected partner. The infection often has no symptoms but can cause serious health problems, even if you are asymptomatic.
Most women with gonorrhea don't have any symptoms, and if they do, they are often mild and can be mistaken for a bladder or vaginal infection. Symptoms of gonorrhea in women may include the following:
- Pain or a burning sensation when urinating
- Increased vaginal discharge
- Vaginal bleeding between periods
Symptoms of gonorrhea in men may include the following:
- A burning sensation when urinating
- White, yellow, or green discharge from the penis
- Less commonly, painful or swollen testicles
Rectal infections in men and women may cause no symptoms or these cause symptoms:
- Discharge
- Anal itching
- Soreness
- Bleeding
- Painful bowel movements
In women, untreated gonorrhea can cause pelvic inflammatory disease, according to the Centers for Disease Control and Prevention (CDC). In men, gonorrhea can cause a painful condition in the tubes attached to the testicles and, in rare cases, lead to infertility. Untreated gonorrhea can spread to your blood or joints, which can be life-threatening, but this is also rare. Having untreated gonorrhea may also increase your chances of getting or giving HIV.
Healthcare providers typically collect a urine sample to diagnose gonorrhea. Your provider may also use swabs to collect samples from your throat or rectum. Treatment with antibiotics can cure gonorrhea, but drug-resistant strains of the infection are on the rise. You should return to your healthcare provider if your symptoms continue for more than a few days after you receive treatment.
Avoid resuming sexual activity until you and any partners have completed treatment and all symptoms have cleared. It’s important to get retested about three months after treatment of your first gonorrhea infection.
If you are a sexually active man who has sex with men, you should get tested for gonorrhea at least once a year. If you are a sexually active woman, you should get tested for gonorrhea annually if you are younger than 25 years old or if you are 25 years or older with risk factors, such as new or multiple sex partners, and a sex partner who has an STD. If you are pregnant, talk to your healthcare provider about getting tested for gonorrhea because the infection can cause serious health problems for your infant.
Mpox Can Cause a Rash on the Genitals
Mpox is a rare disease caused by the mpox virus. The mpox virus belongs to the same family of viruses that causes smallpox. While mpox symptoms are similar to smallpox symptoms, they are less severe, and mpox is rarely fatal.
Mpox can cause a rash that looks like pimples or blisters. The rash may be painful or itchy, and it may occur on or near the genitals or anus. It may also appear on other body parts, like the hands, feet, chest, face, and mouth.
Additional symptoms of mpox can include the following:
- Fever
- Headache
- Muscle aches and backache
- Swollen lymph nodes
- Chills
- Exhaustion
- Respiratory symptoms, such as coughing, nasal congestion, and sore throat
Mpox symptoms usually appear within three weeks of exposure to the virus. The illness typically lasts two to four weeks. Some people get a rash first, followed by other symptoms, while others get flu-like symptoms first and then develop a rash one to four days later. Still others get only a rash and no other symptoms.
In 2022, there was an outbreak in several countries that don’t usually report mpox, including the United States.
Mpox can spread during close, personal, often skin-to-skin contact with a person who has the infection. This can happen during direct contact with the mpox rash, scabs, or body fluids, or contact with respiratory secretions. Direct contact can happen during intimate physical contact, including oral, anal, and vaginal sex and touching the genitals or anus of a person infected with mpox. It can also occur during hugging, massaging, kissing, and any type of face-to-face contact.
You can also get mpox by touching fabrics (such as clothing, bedding, and towels) that have been used by an infected person and touching objects used during sex that were used by any infected person, such as fetish gear or sex toys.
Additionally, you can get mpox from infected animals, either by being scratched or bitten by the animal, preparing or eating the meat, or using products from the infected animal. Pregnant women can spread mpox to their fetuses.
Mpox can spread from the onset of symptoms until the rash has fully healed and a new layer of skin has formed. This can take several weeks; sexual contact and intimacy should be avoided during this time. It is not known whether mpox can spread through semen or vaginal fluids.
The CDC recommends vaccination for people who have been exposed to mpox, as well as people who have an increased risk of being exposed to mpox:
- People who have been identified as a contact of a person who has mpox
- People who may have been exposed to mpox, such as people who have a sexual partner who has been diagnosed with mpox in the past two weeks or people who had multiple sexual partners in the past two weeks in an area with a known mpox outbreak
- People whose jobs may expose them to mpox
Antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat mpox infections.
How to Reduce Your Risk of Getting an STD
The only way to altogether avoid STDs, including herpes, is not to have vaginal, anal, or oral sex. If you are sexually active, you can reduce your risk by being in a long-term, mutually monogamous relationship with a partner who has been tested for STDs, and by using condoms correctly every time you have sex.
If you have any symptoms of genital herpes or any other STD, see your doctor or go to a sexual health clinic. Your doctor will know what tests to give you to detect any STDs you may have. And if you’re sexually active, get screened regularly and always practice safe sex.
The Takeaway
- Genital herpes is a sexually transmitted disease caused by the herpes simplex virus 1 or 2.
- Determining whether you have herpes or another disease that causes similar symptoms, such as syphilis and gonorrhea, depends on several factors, including the disease’s appearance and, most importantly, your healthcare provider’s diagnosis.
- Herpes is incurable, but it can be managed through medications and treatment. There are also multiple steps you can take to prevent infection.
Resources We Trust
- Mayo Clinic: Genital Herpes
- Cleveland Clinic: Genital Herpes
- Centers for Disease Control and Prevention: About Genital Herpes
- Johns Hopkins Medicine: Genital Herpes
- National Center for Biotechnology Information: Overview: Genital Herpes
Meet Our Experts
John Paul McHugh, MD
Medical Reviewer
Member of American College of Lifestyle Medicine
John Paul McHugh, MD, is an obstetrician-gynecologist and lifestyle medicine specialist in southern California. He has always placed wellness at the center of his work, in both delivering babies and improving practice standards. Dr. McHugh believes that bringing lifestyle medicine to the center of health and wellness empowers patients to make the change they seek and enjoy the benefits of true wellness.
He is a graduate of Harvard Medical School and the Massachusetts Institute of Technology and a fellow of the American College of Lifestyle Medicine. He served as a department chair at Scripps Mercy Hospital in San Diego and is now the chair-elect for the American College of Obstetricians and Gynecologists for California.
He has published several articles in the American Journal of Lifestyle Medicine and served as a peer reviewer for many articles. He contributed to the first textbook of lifestyle medicine in women's health: Improving Women's Health Across the Lifespan.
Chris Iliades, MD
Author
Chris Iliades, MD, is a full-time medical writer and journalist based in Boothbay Harbor, Maine. He practiced clinical medicine for 15 years before transitioning to medical writing in 2004.