Herpes Rash: Causes, Treatment, and More

Painful, red, bumpy skin can be caused by many conditions, but it can also be a sign of herpes.

Herpes is a common, lifelong condition that can cause blisters to form around your genitals, rectum, and mouth. There is no cure for herpes.

Once contracted, the virus will remain dormant in your body and can reactivate periodically throughout your life, usually from specific lifestyle triggers such as a weakened immune system, high sun exposure, surgery, hormonal changes, and physical or emotional stress.

There are two strains of the herpes simplex virus: HSV-1, which is an infection that spreads in the saliva and primarily affects the mouth and nose, and HSV-2, which typically affects the genitals and anus transmitted through sexual contact with an infected person.

HSV-1 can cause herpes gladiatorum (mat herpes), a herpes outbreak that causes a rash around your lips or on other areas of the body.

Herpes vs. Other Rashes

Since herpes causes a painful and possibly itchy rash, it can be difficult to tell the difference between a herpes outbreak and other rashes.

Taking a closer look at your symptoms can help you differentiate between other skin rashes and HSV. 

In many cases, people with herpes may be asymptomatic.

However, symptoms of an HSV-1 and HSV-2 outbreak typically include:

• Painful sores or tiny white blisters on and around the genital area, rectum, lips, and nose
• Ulcers that can be caused by ruptured blisters 
• Scabs that form from ruptured blisters
• Pain during urination due to ruptured ulcers

The first outbreak of genital herpes caused by HSV-2 is usually more severe, and symptoms (if any) will emerge within 2-12 days of exposure.

Along with the above symptoms, you may also experience the following: 

• Fatigue
• Feeling of pressure in the abdomen
• Flu-like symptoms
• Fever
• Itching or burning feeling in the genital or anal area
• Pain in the legs or buttocks
• Swollen glands
• Unusual vaginal discharge

Causes of Herpes Skin Rash

There are two types of herpes simplex viruses: HSV-1, or oral herpes, and HSV-2, or genital herpes.

HSV-1, or oral herpes

HSV-1, or oral herpes, is primarily contracted through saliva.

You can get oral herpes from kissing and sharing utensils, lipsticks, phones, toothbrushes, and other objects with an infected person.

HSV-1 is the more common of the two herpes virus types, with many people being exposed to it in childhood through non-sexual contact with saliva and growing up unaware that they have it.

Typical signs of oral herpes are cold sores that appear around the mouth and are painful to touch.

These sores are contagious, so be sure not to touch your mouth and then touch your eye or other parts of your body to avoid spreading the infection. 

HSV-1 can be transmitted to the genitals in rare cases via oral sex, so oral sex should be avoided if you have an active cold sore.

Another type of rash, Herpes gladiatorum, is caused by HSV-1, and can be spread through contact sports.

Because the virus is so contagious, it is important to notify your coach if you are showing symptoms of herpes, like an active cold sore.

Avoid sharing equipment or clothing with others—this can reduce the chances of contracting or spreading the virus. However, this is an uncommon way to contract HSV-1.

It is more commonly spread through contact with saliva.

HSV-2, or genital herpes

HSV-2 is the strain that affects the genitals and rectum, and is usually spread through vaginal sex, oral sex, or anal sex with an infected person through the exchange of genital fluids or direct contact with a herpes sore, the skin, or saliva of an infected person.

Could It Be Something Else?

There are several other rashes that may look similar to herpes and also cause itching, pain, blisters, or a red rash.

A healthcare provider can typically tell the difference by performing a thorough history and physical exam.

Shingles

Shingles (herpes zoster) are caused by the same virus that causes chickenpox (the varicella-zoster virus).

While this is a type of herpes virus, it is different from the herpes simplex virus that causes cold sores or genital herpes.

Shingles typically manifests as a rash of small blisters or red bumps on the skin, usually in a single, concentrated stripe along the left or right side of the body.

In some cases, the rash can appear on one side of the face or neck, and in rare cases (usually in people with weakened immune systems), the rash may resemble chickenpox rash and appear all over the body.  

Usually, the first symptom of shingles is a severe burning sensation or tingling on one side of the body, often around the waistline.

A few days to a week later, this may turn into a rash of fluid-filled blisters that is typically very painful.

Sometimes the pain will last even after the rash has gone away.

Other symptoms that can accompany shingles include:

• Chills
• Fever
• Headache
• Upset stomach

There is no cure for shingles.

Your doctor may prescribe antiviral drugs such as Acyclovir (Zovirax) or Valacyclovir (Valtrex), which are also used to treat herpes, to manage your symptoms and shorten healing time.

Other medications may be recommended for inflammation and pain.

Dermatitis

Contact dermatitis is an allergic reaction to an irritant that can manifest as redness, swelling, and even blistering in the area it affects.

Common irritants that can cause contact dermatitis include topical creams, cosmetics, hair products, perfumes, plants like poison ivy, foods, and some fabrics.

Since this rash can cause pain and blistering, it can look a bit like herpes, but you can usually tell the difference by the location of the rash and any exposure to an irritant or allergen.

The blisters of contact dermatitis are often larger and more fluid-filled than those of herpes.

Jock itch

Jock itch is a fungal infection, a form of ringworm that tends to live in warm, moist places on your body.

It appears like a red, round rash often on the inner thighs and groin, with a few small red bumps near the edge of the rash.

It can easily be mistaken for herpes because of its close proximity to the genitals.

The rash from jock itch usually does not appear on the genitals themselves, and is mildly itchy rather than painful.  

Treatment 

There is no cure for herpes, but sores tend to clear upon their own in a few weeks after an outbreak.

Antiviral medications, such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), have been proven to be effective in managing the severity and frequency of the symptoms of HSV.

These medications can also shorten the duration of the outbreak, which makes it less likely to pass the virus on to others.  

In some cases, your provider may recommend taking a daily pill (a prophylaxis) if you experience frequent outbreaks. This works as a prevention method.

When to See a Medical Provider 

For most people with herpes, the sores can be painful and uncomfortable, but go away on their own.

Antiviral medications can help speed up the healing process and manage your symptoms. 

If you are unsure whether you have HSV and have developed symptoms that could suggest you have it, visit your healthcare provider to be formally diagnosed.

They will be able to do a physical examination to determine if you have herpes or another skin condition.

If you have HSV, you run a greater risk of contracting HIV.

This is because the open sores or breaks in the skin or lining of the mouth, vagina, and rectum caused by a herpes outbreak can make it easier for HIV to enter the body. 

To protect yourself and your partners from STDs, get regular sexual health checkups from your healthcare provider or an STD clinic, use barrier protection like condoms, and have your partner(s) be tested before sexual contact.

If you are diagnosed with herpes, always use a barrier method with partners, and make sure you tell them about your diagnosis before engaging in any sexual behavior, as you can spread herpes even when you do not have an active outbreak.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app? Clinicians are able to treat herpes with medication, but patients must be diagnosed already. If you’re worried that you might have genital herpes, your clinician can refer you to a physician for an in-person visit.

Download K Health to check your symptoms, explore conditions and treatments, and, if needed, text with a clinician in minutes. K Health’s AI-powered app is based on 20 years of clinical data.