Herpes on Penis and Other HSV Symptoms in Men

Herpes on the penis looks like clusters of small, fluid-filled blisters. After the initial outbreak, the sores can recur during moments of illness, stress, or fatigue.

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). The sores look similar in males and females, but the risk of transmission is different.

This article discusses the signs and symptoms of genital herpes in males, including sex-specific risk factors and complications you may not be aware of.

What Does Genital Herpes Look Like in Men?

Genital herpes looks like a cluster of blisters, though sometimes there is only one blister. When an outbreak first occurs, you will see:

• White, yellow, or red translucent bumps filled with a clear liquid that itch or tingle
• A clear or yellow liquid runs out when the blisters burst, causing small, shallow sores that quickly crust over
• Pain is the classic tell-tale sign of this common viral infection
  

Other symptoms can accompany the itching and tingling, particularly during the initial outbreak, including:

• Fever
• Headache
• Body aches
• Swollen lymph nodes
• Pain or burning with urination

Genital herpes is mainly caused by herpes simplex type 2 (HSV-2), although a related virus called herpes simplex virus type 1 (HSV-1) is increasingly linked to the condition. HSV-1 is the type commonly linked to cold sores that can be passed to the genitals or rectum through oral sex.

Herpes blisters typically heal within two to four weeks. Subsequent genital herpes outbreaks tend to be less severe than the first outbreak.

Symptoms can vary from one person to the next. Some cases will be subclinical (meaning there are no symptoms or the symptoms are vague and not readily recognized), while others can be severe and physically debilitating.

Where genital herpes can differ in males is in their location. In addition to the penis and scrotum, herpes sores can frequently develop on or under the foreskin (also known as the prepuce).

People of any sex who receive anal sex or oral-anal sex ("rimming") can also develop sores on the rectum.

What Triggers Herpes Outbreaks?

Herpes triggers can include illness, stress, and hormonal changes. After a person is first infected, the herpes virus travels to nerve cells near the spine and stays there. When the virus is reactivated, it causes a new outbreak of sores and blisters.

How Genital Herpes Is Spread

The herpes virus is found on the skin and in saliva. The virus is easily spread through intimate contact, usually during oral, anal, or vaginal sex.

You can get genital herpes if you come into contact with:

• A herpes sore
• Saliva from a partner with oral herpes
• Genital fluids from a partner with genital herpes
• Skin around the mouth or genitals of someone with a herpes infection

You can even get herpes from skin-to-skin contact with someone who has no symptoms and who may not even know they have herpes.

Risk Factors in Males and Females

One of the main differences between genital herpes in males and genital herpes in females is the frequency of infection. Compared to women, men are half as likely to get HSV-2 due to vulnerabilities in the female genital tract.

Simply put, vaginas have larger areas of mucosal membranes than penises. These mucus-secreting tissues are porous and vulnerable to tears and infection. In circumcised men, mucosal tissues are limited to the urethra (the tube through which urine exits the body).

How Common Is Genital Herpes in Men?

According to the Centers for Disease Control and Prevention (CDC), roughly 8.2% of males between the age of 14 and 49 were living with HSV-2 in the United States in 2016 compared to 15.9% of females.

Genital Herpes Diagnosis

Genital herpes can be diagnosed with a physical exam, a swab of a sore, and a review of your medical history (including recent sexual contacts).

The swab is used to obtain cells that a specialist known as a pathologist can evaluate using lab tests such as:

• Viral culture: This is a technique in which a sample of body fluid or tissue is added to host cells to see if the suspected virus grows and multiples.
• Nucleic acid amplification test (NAAT): A technique that can identify specific viruses like HSV-1 or HSV-2 by multiplying the virus's genetic material.

There are also blood tests, called enzyme-linked immunosorbent assays (ELISAs), that can detect immune proteins known as antibodies specific to HSV-1 and HSV-2. These tests are useful if you think you've been exposed to genital herpes through sexual contact but have no symptoms.

Differentiating HSV-1 from HSV-2 may help direct the treatment plan because genital herpes caused by HSV-2 is more likely to recur than genital herpes caused by HSV-1.

While it may seem reasonable to assume that the signs and symptoms of genital herpes are pretty obvious, the variations in symptoms can occasionally lead to misdiagnoses.

Specialist evaluation and testing can differentiate genital herpes from conditions with similar symptoms, such as:

• Syphilis: This common STI, caused by the bacteria Treponema pallidum, usually involves a single, painless ulcer on the genitals or rectum.
• Shingles: This viral infection, caused by the reactivation of the chickenpox virus, triggers the outbreak of painful blisters similar to genital herpes. Even so, an outbreak of shingles on the genitals is exceptionally rare.
• Penile thrush: Also known as penile candidiasis , this fungal infection most commonly develops beneath the foreskin, where it can cause redness, blisters, and balanitis (pain and inflammation of the head of the penis).
• Chancroid: This rare STI, caused by the bacteria Hemophilus ducreyi, triggers the outbreak of painless lesions with crusting on or near the genitals. It is most common in parts of Africa and the Caribbean.
• Granuloma inguinale (donovanosis): This rare STI, caused by the bacteria Klebsiella granulomatis, manifests with a painless lump on or near the genitals that slowly enlarges and breaks open to form a sore. It is most common in tropical or subtropical regions like southeast India and Guyana.
  

Treatment of Genital Herpes

There is no cure for herpes. The treatment involves one of three oral antiviral drugs:

• Famvir (famciclovir)
• Valtrex (valacyclovir)
• Zovirax (acyclovir)

Antivirals can only prevent, shorten, or reduce the severity of an outbreak. They work best if taken within 72 hours of the appearance of lesions.

There is currently no vaccine that is protective against genital herpes infection.

Dosage and Duration

The dosage and duration of treatment for genital herpes can vary based on whether this is your first or subsequent outbreak.

• For the first outbreak: Antiviral medications are taken by mouth two to three times daily with or without food for seven to 10 days.
• For subsequent outbreaks: The antiviral dosage is generally less, while the duration of treatment can vary from one to five days.

If you have severe recurrent herpes, your healthcare provider may recommend suppressive therapy in which antivirals are taken at low doses every day to prevent outbreaks.

Studies have shown that suppressive HSV-2 therapy can reduce the frequency of genital herpes outbreaks by 70% to 80% while reducing the risk of transmission to sexual partners.

When to See a Healthcare Provider

While antivirals may have benefits if started within 72 hours of symptoms, many healthcare experts recommend that you wait no longer than 24 hours.

You can even start treatment during the so-called prodromal phase that often precedes the outbreak of lesions, the symptoms of which may include:

• Itching or tingling in the area when outbreaks usually occur
• Aching or shooting pains down the back of the legs or in the buttocks
• Headache and malaise (a general feeling of unwellness)

Possible Complications

Genital herpes complications include:

• Other sexually transmitted infections: People with open herpes sores have a higher chance of transmitting or contracting other STIs, like HIV.
• Meningitis: In rare cases, HSV infection can lead to inflammation of the fluid surrounding your brain and spinal cord.
• Proctitis: This is an inflammation of the rectal mucosa, commonly found in men who have sex with men.

Summary

The signs and symptoms of genital herpes are more or less the same in males as in females. Blisters accompanied by pain may be seen or felt in the genital area.

With the initial outbreak, there may be fever, headache, body aches, and swollen lymph nodes. Further outbreaks may be less severe.

Treatment with antiviral drugs at the start of an outbreak may reduce the duration and severity of symptoms. Daily suppressive treatment may reduce transmission.

Frequently Asked Questions

Genital herpes can sometimes be mistaken for penile thrush, particularly in people with an uncircumcised penis. The fungal infection can cause redness, swelling, and the formation of tiny blisters under the foreskin and on the head of the penis. Genital herpes can also be mistaken for syphilis if the outbreak is limited and causes a single large sore on the penis.

Genital herpes symptoms tend to occur within two to 12 days of exposure to the virus. The infection can cause an outbreak of blisters that break open into painful sores and quickly crust over. Healing usually occurs within two to four weeks, sometimes longer if the outbreak is severe.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By James Myhre & Dennis Sifris, MD
Dr. Sifris is an HIV specialist and Medical Director of LifeSense Disease Management. Myhre is a journalist and HIV educator.

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