Genital psoriasis and herpes both cause rashes in the genital area — and sometimes, they’re misdiagnosed as one another. Genital psoriasis is a chronic (long-term) condition that happens when the body’s immune system attacks its own tissue. Herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV).

One MyPsorisiasTeam member shared their experiences being misdiagnosed with herpes. “I’ve had genital psoriasis since 1967. When I went to the ER to see what the problem was, they took a swab test and sent me home. The next day, a nurse called and said I’d better come in and bring my husband because I had herpes. I told her I wasn’t married, so she said bring your boyfriend. I replied that I don’t have sex. It took over a year to find a medication that worked.”

Although genital psoriasis and herpes can both cause a painful, itchy rash, they’re different conditions that require different treatments. Getting the right diagnosis is important to ensure you get the treatment you need.

This article will review several key symptoms and treatments to help you spot the difference between these two conditions.

10 Things To Know About Genital Psoriasis and Herpes

Even though genital psoriasis and herpes can occur in the same area of the body, there are many differences between the two conditions.

1. Only Herpes Is Contagious

Genital psoriasis is an autoimmune condition where the immune system mistakenly attacks healthy skin cells. Scientists aren’t sure exactly what causes psoriasis, but they think genetics and environmental factors both play roles. Genital psoriasis isn’t contagious, though — you can’t get it through contact with another person.

Herpes is caused by HSV. There are multiple types of HSV — HSV-1 and HSV-2 are the most common. Both can cause genital herpes, but HSV-2 is more common in the genital region. HSV-1 is associated with causing oral herpes, also known as cold sores or fever blisters.

Genetics don’t affect a person’s risk of developing herpes. HSV passes from person to person through physical contact, saliva, or genital fluids. Sexual partners infected with HSV can spread it through genital contact or oral sex.

A person can have and spread HSV even if they don’t have any visible symptoms. Symptoms — which include small painful bumps or blisters — usually start showing up about two to 12 days after a person’s infected.

2. Genital Psoriasis Rash Is Usually Smooth and Shiny

Among the various types of psoriasis, inverse and plaque psoriasis most commonly cause genital psoriasis. The rash from genital psoriasis usually looks smooth and shiny. On lighter skin, it can appear bright red. On darker skin, the rash may look darker than the surrounding skin, or it may appear purple or brown.

Genital psoriasis can appear in different areas of the genital region, including:

• On inner and upper thighs
• In the skin folds between the thigh and genital area
• On the vulva, penis, or scrotum
• Between the buttocks
• On the skin above the pubis (genital area)

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A herpes rash typically consists of clusters of painful, fluid-filled blisters or sores. As the rash heals, these blisters usually pop and scab over. Although herpes can infect any skin it comes into contact with, symptoms usually appear on mucus membranes — the skin that lines the inside of your body. In the genital region, mucus membranes include the:

• Glans penis (tip of the penis)
• Urethra
• Vulva
• Vagina
• Cervix
• Anus

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Pustular psoriasis can look like a herpes rash. However, this type of psoriasis is rare, affecting only about 3 percent of people with psoriasis. Additionally, it usually occurs on the hands or feet.

3. Herpes Can Cause Flu-Like Symptoms

In addition to a genital rash, herpes can cause flu-like symptoms, especially during the first outbreak. Common symptoms of a herpes outbreak include:

• Fever
• Swollen lymph nodes (glands)
• Body aches
• Headaches

Other herpes symptoms include painful urination and discharge from the vagina or urethra.

People with genital psoriasis often have psoriasis on other parts of the body and don’t usually get flu-like symptoms with a flare-up.

4. Herpes Is More Common Than Psoriasis

Almost 12 percent of people in the U.S. between the ages of 14 and 49 have an HSV-2 infection.

The prevalence (number of people with a condition) of psoriasis is less common. About 2 percent to 3 percent of the world’s population have psoriasis. Around two-thirds of people with psoriasis will develop genital psoriasis at some point in their lives.

It’s possible to have psoriasis and herpes at the same time. Although there is a link between strep throat and psoriasis, it’s unknown whether an HSV can cause psoriasis.

5. Genital Psoriasis and Herpes Have Similar Triggers

A trigger refers to anything that can start or worsen a health condition. Factors that trigger flare-ups in genital psoriasis and herpes differ from person to person. However, genital psoriasis flare-ups and herpes flare-ups (called a recurrence) share some common triggers. These include:

• Stress or anxiety
• Injury
• Illness
• Sexual activity

6. Diagnosis Relies on a Physical Exam

Genital psoriasis and herpes can have similar symptoms, which is why these two conditions are sometimes mistaken for one another. Both conditions are usually diagnosed by a doctor conducting a physical exam and asking questions about your medical history.

Diagnosing genital psoriasis usually involves a physical exam of the rash in the genital region as well as other parts of the body, including your skin, scalp, and nails. If a physical exam isn’t definitive, your doctor may conduct a skin biopsy, which entails removing a sample of skin to examine under a microscope.

A doctor may verify herpes diagnosis through a blood test, which can determine if your immune system has made antibodies to recognize HSV. Your doctor may also take a skin biopsy or a sample from a herpes ulcer to check for the herpes virus.

7. There Currently Are No Cures for Genital Psoriasis or Herpes

Both genital psoriasis and herpes are lifelong conditions. The severity and frequency of herpes outbreaks usually decrease over time. Psoriasis severity can improve or worsen over time.

8. Genital Psoriasis Treatment Focuses on Decreasing Inflammation

Treatment options for genital psoriasis are aimed at reducing inflammation caused by an overactive immune system and relieving symptoms. Topical medications (applied to the skin) can slow down cell production and decrease inflammation. Topical steroids or immunomodulators are the most common medication for psoriasis.

If topical medications aren’t enough to control genital psoriasis, or if you have psoriasis on other parts of your body, your health care provider may also prescribe a medication to target your overactive immune system, such as a biologic treatment or an oral therapy. These medications are known as disease-modifying antirheumatic drugs (DMARDs) because they can slow or stop the process of damage.

9. Genital Herpes Is Treated With Antiviral Medications

Genital herpes outbreaks are caused by a viral infection, so treatment involves antiviral medications that stop the virus from growing. Antivirals can be applied topically or taken orally so they work all over your body. These medicines suppress the virus but do not eliminate HSV. Your doctor may also prescribe a topical medication for the pain and discomfort caused by herpes.

10. Some Genital Psoriasis Treatments Can Trigger Herpes Outbreaks

If you have an HSV infection, your immune system keeps herpes from coming back. If you treat psoriasis with a medication that suppresses your immune system, you could be at risk of herpes recurrence or a more severe case of herpes.

When considering a new medication, always let your doctor know about any health conditions you have.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you experienced genital psoriasis or herpes? Do you have any tips for managing symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.