No one wants to discover they have herpes, especially genital herpes. And believe it or not, many people never do: An astonishing 80% of people with herpes simplex virus (refresher: HSV-1 usually causes oral herpes, while HSV-2 is usually to blame for the genital kind) never have any symptoms. The remaining 20% of cases that do bring symptoms can be—and often are—mistaken for other things.
“There are lots of asymptomatic infections and the occasional person who has a really horrible outbreak,” says Jeanne Marrazzo, MD, member of the board of the Infectious Diseases Society of America and director of the Division of Infectious Diseases at the University of Alabama at Birmingham.
Of course, you’ll want to take the necessary steps to prevent herpes, regardless of whether or not you’re infected. Condoms can reduce the risk of herpes transmission, especially for men. “In men, condoms cover the relevant portion,” says Dr. Marrazzo. “For women, it’s harder to cover everything, so condoms reduce the risk by one-third to one-half.” If you know you have herpes, you can also take medications that reduce the risk of transmission.
If you think you could have genital herpes, here’s what else might be to blame.
Some 75% of women will be diagnosed with a yeast infection in their lifetime, and it may be mistaken for herpes. “For women, the most common confusion is recurrent yeast infections, particularly when they infect the outer labia,” says Dr. Marrazzo. Most of the time, though, a yeast infection is just a yeast infection—and one that can be treated easily with over-the-counter meds.
If you already know you’re prone to yeast infections, “that’s probably what it is,” Dr. Marrazzo says. Warning signs that something else might be up down there include anything out of the ordinary for you, particularly “a recurrent pattern, for example every three to six months, or around stress. That’s a little bit unusual for a yeast infection,” she says. Symptoms that appear after having sex with a new partner may also signal herpes.
Bacterial vaginosis is basically an imbalance of the normal bacteria universe in your vagina. It’s not considered a sexually transmitted infection (STI), but it is more common in sexually active women, and it can increase your risk of contracting an STI.
Douching, vaginal deodorants, and other vaginal products seem to up the risk of BV. Like herpes, BV often has no symptoms, but when it does, you might experience vaginal discharge, pain, itching or burning, and a fishy odor. The external skin itching and discomfort are what many people mistake for herpes. Bacterial vaginosis is treated with antibiotics.
Trichomoniasis is a sexually transmitted infection, one caused by a small parasite. Like both herpes and bacterial vaginosis, the infection often has no symptoms. When it does have symptoms, they can also be mistaken for herpes: itching, burning, and redness in the genital area; difficulty urinating; and vaginal discharge. It’s easily treated with medication.
But don’t assume that a discharge in particular is a sign of an STI like trichomoniasis or herpes. “The reality is most people having an increase in discharge are just experiencing cyclic changes with hormones,” says Dr. Marrazzo. “What’s not normal is an abnormal odor. That goes with bacterial vaginosis or trichomoniasis.”
Once practically a death sentence, today the STI syphilis is easily cured with antibiotics like penicillin. Initial symptoms of syphilis (called primary syphilis) are one or more sores in or near the genitals, anus, or rectum that might be mistaken for herpes. Generally, the sores are round and firm, but they don’t hurt.
Once syphilis has progressed to the next stage (secondary syphilis), symptoms can include a skin rash as well as swollen lymph nodes and a fever as your body tries to fight the infection. Sometimes there are no symptoms in these first two phases, or the symptoms are tame enough to go unnoticed. It’s important to get syphilis treated as early as possible.
Urinary tract infection
A UTI is less commonly mistaken for herpes, but it can cause significant pain in the genital region. Other symptoms should tip you off that it’s a UTI and not herpes though: Look for an urgent feeling that you need to urinate; only passing a small amount of urine at a time (even though it may feel like your bladder is full); and urine that is cloudy, discolored, red, pink, or smelly. If your UTI doesn’t go away, get treatment. Untreated infections can affect your bladder and kidneys