Table of ContentsView AllTable of ContentsEarly Signs of HerpesWhat Does Herpes Look Like?3 Conditions That Look Like HerpesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Early Signs of Herpes
What Does Herpes Look Like?
3 Conditions That Look Like Herpes
Diagnosis
Treatment
Prevention
Herpes looks like a rash with blistering sores in its early stages. The cluster of sores can quickly merge and break open, oozing fluid and crusting. The rash can be different when found at the mouth, eyes, anus, or genitals. A herpes sore also can change with the stage of infection.
Warning: Some of the following images are of genital areas.
Both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) stay with you forever, once you’re infected. The inactive virus will embed itself in nerve cells near the spinal cord.
When herpes reactivates, the virus will travel up the string of nerves to the surface of the skin where it will cause an outbreak of tiny blisters calledvesicles. The vesicles will then erupt, causing painful open ulcers commonly referred to as herpes sores.
This photo shows an example of the early stages of a herpes rash, the blisters of which are clustered in a red patch. In addition to pain, there may be itchiness or a pins-and-needles sensation.
A genital herpes outbreak may last up to seven to 10 days, particularly with the first outbreak. Healing usually takes a week or more.A first episode may last longer.
Prior to a herpes outbreak, people will often haveprodromal symptoms(meaning non-specific signs that precede major symptoms) hours or days before the actual outbreak.
The prodromal symptoms may include:
This photo contains content that some people may find graphic or disturbing.See PhotoApple2000 / Getty Images
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Apple2000 / Getty Images
Herpes Vesicles
This picture illustrates the formation of vesicles. Note the cluster of vesicles on a red base. These fluid-filled blisters are delicate and break open easily, creating open, oozing sores. Eventually, the sore will stop oozing and crust over.
The ulcerative stage begins when the blisters break open to form skin ulcers.
This photo contains content that some people may find graphic or disturbing.See PhotoGetty Images / Amphawan Chanunpha
Getty Images / Amphawan Chanunpha
Genital Herpes Outbreak
This picture illustrates a typical herpes outbreak of the penis. Note how some of the tiny blisters have converged into larger ones.Herpes in malesalso can affect the foreskin, scrotum, and anus in people who have anal sex.
Severe cases like this tend to occur during a first outbreak (called primary herpes).Thereafter, the body will have produced immune proteins, calledantibodies, that are not able to neutralize the virus but can help control the infection.
As a result, subsequent outbreaks tend to be far less severe.
This photo contains content that some people may find graphic or disturbing.See PhotoCDC
CDC
Atypical Genital Herpes Outbreak
Because the genital area is warm and moist, herpes can sometimes have an atypical appearance in places like the penis, vagina, and anus.
In this picture, the lesions on the penis look more like erosions (where only part of the top layer of skin is damaged). If you look closely, however, you can see that each red area has a cluster of small sores.
Genital Herpes Outbreak in Females
This picture shows a herpes ulcer on the vulva. The vulva is the external part of the female genitalia.
Females are four times more likely to get anHSV-2 infectionthan males. In addition, females may have symptoms that are not readily recognized as herpes.
For instance, a female may feel pelvic pain if the rash is located inside the vagina or on the cervix. This could lead to a misdiagnosis ofpelvic inflammatory disease (PID).
Also, many females experience burning with urination during a genital herpes outbreak. The burning may be misdiagnosed as aurinary tract infection (UTI).
Healing of Genital Herpes Sores With Crusting
The timeline of a genital herpes outbreak can vary. With primary herpes, the outbreak will usually occur within four days of exposure to the virus (although symptoms can occur anywhere from two to 10 days after exposure).
In addition to pain, the oozing sores will often have a fishy smell in both females and males. The smell can increase after sex due to the abrasion of skin against skin.
Note the crusting that has occurred near the head of the penis in this photo. The crust forms as fluids from the blisters evaporate and leave behind whitish or yellowish crystals.
This photo contains content that some people may find graphic or disturbing.See PhotoDermNet / CC BY-NC-ND
DermNet / CC BY-NC-ND
Healing of Genital Herpes Sores Without Crusting
This picture shows herpes lesions after some of the blisters have broken open. Typically, you will see a whitish or yellowish crust forming on the ulcers.
With that said, crusting may not be all that apparent. Because the skin of the penis and vagina is moist, there may be minimal crusting. Instead, there may be a whitish film covering or surrounding the open sores. Symptoms of genital herpes do vary with the individual.
Cold Sores (Oral Herpes)
HSV-2 is often thought of as genital herpes but HSV-1 can also be passed to the genitals or anus via oral sex.HSV-1 that causes a genital herpes outbreak is less virulent and less likely to recur.
apichsn/Getty Images
Herpetic Whitlow
The finger is a common place for a herpes infection to spread. A herpes infection of the finger often is referred to asherpetic whitlow(a.k.a. whitlow finger).
This picture shows the early stage of a herpes whitlow infection. Since the skin on the fingers is thicker, the blisters aren’t as fragile and may not break open.
Herpetic Keratitis
This picture showsherpetic keratitis, a herpes infection that involves the cornea (the outside covering of the eye).Note the blisters around the eyelid and crusting ulcers near the eyes.
When to Seek Medical Care
Symptoms of herpetic keratitis may include vision loss, and it is the most common cause of infection-related blindness in the world.Symptoms can include:
Shingles
For reasons that are not entirely clear, VZV can suddenly reactivate in later life, traveling up the nerve root to cause an outbreak of painful blisters that can break open, ooze, and crust over.
Unlike HSV, a herpes rash can leave behind scars after it heals.
TopKatai/Shutterstock
Aphthous Ulcers
Anaphthousulceris a type of mouth sore that is often confused with cold sores but not herpes-related. Called canker sores, they can occur anywhere in the mouth but do not involve the lip.These painful, non-contagious ulcers occur inside the mouth.
As opposed to herpes blisters, aphthous ulcers start as shallow ulcers that are yellowish or whitish with an inflamed red border.Possible causes include:
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet dermnetnz.org 2023
Reproduced with permission from © DermNet dermnetnz.org 2023
Drug Eruption
A drug eruption is an adverse reaction to a medication that can cause an outbreak of rash on the body. There are different ways of describing them, including division into two types:
Drug eruptions differ from herpes in that the entire torso, arms, legs, and even face can be affected.
With a Type B reaction, the eruption of the blisters does not cause crusting but can instead lead to the peeling and shedding of skin, such as withStevens-Johnson syndrome (SJS)ortoxic epidermal necrolysis (TEN). Both SJS and TEN are considered medical emergencies.
Chemotherapy drugsandanticonvulsantsare among those that commonly cause drug eruptions.
DermNet NZ
The tests for herpes include:
There are rapid versions of both the HSV PCR and HSV ELISA that can deliver results in around 40 minutes and 10 minutes respectively.
Shidlovski/Getty Images
Both HSV-1 and HSV-2 are treated withantiviral drugs. They are most effective when started within 48 to 72 hours of the first signs of an outbreak. They do not cure herpes but may reduce the severity and duration of an outbreak.
Recommended options include:
If outbreaks recur frequently, you might even be placed on dailyprophylactic(preventive) antivirals to reduce the frequency or severity of outbreaks.
Themode of transmissionof HSV-1 and HSV-2 (meaning the ways that the viruses are passed) differ slightly:
It can be difficult to avoid HSV as nearly half of all people ages 11 to 49 have HSV-1 and roughly one in nine have HSV-2.Once you have HSV, you typically have it forever and can infect others during episodic outbreaks.
With that said, there are things you can do toreduce your riskof getting herpes:
Thianchai Sitthikongsak / Getty Images
Summary
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Planned Parenthood.What does genital herpes look like?Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi:10.1080/21505594.2021.1982373Centers for Disease Control and Prevention.About genital herpes.American College of Obstetricians and Gynecologists.Genital Herpes FAQ.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.Van Wagoner N, Qushair F, Johnston C.Genital Herpes Infection: Progress and Problems.Infect Dis Clin North Am. 2023 Jun;37(2):351-367. doi:10.1016/j.idc.2023.02.011Sauerbrei A.Herpes genitalis: Diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi: 10.1080/21505594.2021.1982373Miller AC, Jr AS, Adjei S, Temiz LA, Tyring SK.Herpes manuum: a new name for non-digit herpetic whitlow.Dermatol Online J. 2022 Oct 15;28(5). doi:10.5070/D328559242Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982Centers for Disease Control and Prevention.Shingles symptoms and complications.Edgar NR, Saleh D, Miller RA.Recurrent aphthous stomatitis: a review.J Clin Aesthet Dermatol. 2017;10(3):26-36.Del Pozzo-Magaña BR, Liy-Wong C.Drugs and the skin: A concise review of cutaneous adverse drug reactions.Br J Clin Pharmacol. 2024 Aug;90(8):1838-1855. doi:10.1111/bcp.15490Zhang J, Lei Z, Xu C, Zhao J, Kang X.Current Perspectives on Severe Drug Eruption.Clin Rev Allergy Immunol. 2021 Dec;61(3):282-298. doi:10.1007/s12016-021-08859-0Nath P, Kabir MA, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021 Jun;13(2):518–539. doi:10.3390/idr13020049World Health Organization.Herpes simplex virus.National Center for Healthcare Statistics.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.Additional ReadingAmerican Academy of Dermatology.Herpes simplex: diagnosis and treatment.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Planned Parenthood.What does genital herpes look like?Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi:10.1080/21505594.2021.1982373Centers for Disease Control and Prevention.About genital herpes.American College of Obstetricians and Gynecologists.Genital Herpes FAQ.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.Van Wagoner N, Qushair F, Johnston C.Genital Herpes Infection: Progress and Problems.Infect Dis Clin North Am. 2023 Jun;37(2):351-367. doi:10.1016/j.idc.2023.02.011Sauerbrei A.Herpes genitalis: Diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi: 10.1080/21505594.2021.1982373Miller AC, Jr AS, Adjei S, Temiz LA, Tyring SK.Herpes manuum: a new name for non-digit herpetic whitlow.Dermatol Online J. 2022 Oct 15;28(5). doi:10.5070/D328559242Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982Centers for Disease Control and Prevention.Shingles symptoms and complications.Edgar NR, Saleh D, Miller RA.Recurrent aphthous stomatitis: a review.J Clin Aesthet Dermatol. 2017;10(3):26-36.Del Pozzo-Magaña BR, Liy-Wong C.Drugs and the skin: A concise review of cutaneous adverse drug reactions.Br J Clin Pharmacol. 2024 Aug;90(8):1838-1855. doi:10.1111/bcp.15490Zhang J, Lei Z, Xu C, Zhao J, Kang X.Current Perspectives on Severe Drug Eruption.Clin Rev Allergy Immunol. 2021 Dec;61(3):282-298. doi:10.1007/s12016-021-08859-0Nath P, Kabir MA, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021 Jun;13(2):518–539. doi:10.3390/idr13020049World Health Organization.Herpes simplex virus.National Center for Healthcare Statistics.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.Additional ReadingAmerican Academy of Dermatology.Herpes simplex: diagnosis and treatment.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Planned Parenthood.What does genital herpes look like?Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi:10.1080/21505594.2021.1982373Centers for Disease Control and Prevention.About genital herpes.American College of Obstetricians and Gynecologists.Genital Herpes FAQ.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.Van Wagoner N, Qushair F, Johnston C.Genital Herpes Infection: Progress and Problems.Infect Dis Clin North Am. 2023 Jun;37(2):351-367. doi:10.1016/j.idc.2023.02.011Sauerbrei A.Herpes genitalis: Diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi: 10.1080/21505594.2021.1982373Miller AC, Jr AS, Adjei S, Temiz LA, Tyring SK.Herpes manuum: a new name for non-digit herpetic whitlow.Dermatol Online J. 2022 Oct 15;28(5). doi:10.5070/D328559242Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982Centers for Disease Control and Prevention.Shingles symptoms and complications.Edgar NR, Saleh D, Miller RA.Recurrent aphthous stomatitis: a review.J Clin Aesthet Dermatol. 2017;10(3):26-36.Del Pozzo-Magaña BR, Liy-Wong C.Drugs and the skin: A concise review of cutaneous adverse drug reactions.Br J Clin Pharmacol. 2024 Aug;90(8):1838-1855. doi:10.1111/bcp.15490Zhang J, Lei Z, Xu C, Zhao J, Kang X.Current Perspectives on Severe Drug Eruption.Clin Rev Allergy Immunol. 2021 Dec;61(3):282-298. doi:10.1007/s12016-021-08859-0Nath P, Kabir MA, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021 Jun;13(2):518–539. doi:10.3390/idr13020049World Health Organization.Herpes simplex virus.National Center for Healthcare Statistics.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.
Planned Parenthood.What does genital herpes look like?
Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi:10.1080/21505594.2021.1982373
Centers for Disease Control and Prevention.About genital herpes.
American College of Obstetricians and Gynecologists.Genital Herpes FAQ.
Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.
Van Wagoner N, Qushair F, Johnston C.Genital Herpes Infection: Progress and Problems.Infect Dis Clin North Am. 2023 Jun;37(2):351-367. doi:10.1016/j.idc.2023.02.011
Sauerbrei A.Herpes genitalis: Diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494
Zhu S, Viejo-Borbolla A.Pathogenesis and virulence of herpes simplex virus.Virulence. 2021 Dec;12(1):2670-2702. doi: 10.1080/21505594.2021.1982373
Miller AC, Jr AS, Adjei S, Temiz LA, Tyring SK.Herpes manuum: a new name for non-digit herpetic whitlow.Dermatol Online J. 2022 Oct 15;28(5). doi:10.5070/D328559242
Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982
Centers for Disease Control and Prevention.Shingles symptoms and complications.
Edgar NR, Saleh D, Miller RA.Recurrent aphthous stomatitis: a review.J Clin Aesthet Dermatol. 2017;10(3):26-36.
Del Pozzo-Magaña BR, Liy-Wong C.Drugs and the skin: A concise review of cutaneous adverse drug reactions.Br J Clin Pharmacol. 2024 Aug;90(8):1838-1855. doi:10.1111/bcp.15490
Zhang J, Lei Z, Xu C, Zhao J, Kang X.Current Perspectives on Severe Drug Eruption.Clin Rev Allergy Immunol. 2021 Dec;61(3):282-298. doi:10.1007/s12016-021-08859-0
Nath P, Kabir MA, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021 Jun;13(2):518–539. doi:10.3390/idr13020049
World Health Organization.Herpes simplex virus.
National Center for Healthcare Statistics.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.
American Academy of Dermatology.Herpes simplex: diagnosis and treatment.
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