Genital psoriasis and herpes are both skin conditions that can affect the genital area, and they’re sometimes mistaken for each other. You might wonder: Is psoriasis a form of herpes? The answer is no.

Genital psoriasis is a chronic (long-term) condition in which the immune system attacks healthy tissue, leading to a buildup of skin cells. Herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV).

One MyPsoriasisTeam member shared their experience of being misdiagnosed with herpes after a trip to the emergency room (ER): “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.”

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Although both genital psoriasis and herpes can cause painful, itchy lesions, 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.

9 Differences Between Genital Psoriasis and Herpes

Even though genital psoriasis and herpes can look similar, they are very different conditions.

1. Only Herpes Is Contagious

Genital psoriasis isn’t contagious. You can’t get it through sexual contact with another person. Genital psoriasis is an autoimmune condition in which 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.

Herpes is caused by the herpes simplex virus. HSV has several types, with HSV-1 and HSV-2 being the most common. Both can cause genital herpes, but HSV-2 is more often linked to infections in the genital area. HSV-1 can cause oral herpes, also known as cold sores or fever blisters.

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 visible symptoms. Symptoms — which include small, painful bumps or blisters — usually show up about two to 12 days after a person is 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. This rash usually looks smooth and shiny. On lighter skin, it can appear bright red. On darker skin, the rash may be darker than the surrounding skin or look purple or brown.

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

• On the 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 in contact with, symptoms usually appear on mucous membranes — the skin that lines the inside of your body.

In the genital region, mucous 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 rare type of psoriasis affects only about 3 percent of people with psoriasis. It usually occurs on the hands or feet, not the genitals.

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 flare-ups usually don’t involve flu-like symptoms.

4. Herpes Is More Common Than Psoriasis

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

The prevalence (number of people with a condition) of psoriasis is lower. About 2 percent to 3 percent of the world’s population has psoriasis. Up to 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. Can herpes cause psoriasis? Although there’s a known link between strep throat and psoriasis, it’s not clear whether HSV can trigger psoriasis.

5. Genital Psoriasis and Herpes Can Share Some Triggers

A trigger refers to anything that can start or worsen a health condition. While genital psoriasis and herpes have different underlying causes, some of their triggers can overlap. Factors that trigger flare-ups (or recurrences, in herpes) vary from person to person, but both conditions may be affected by:

• Stress or anxiety
• Injury
• Illness
• Sexual activity

6. Diagnosis Uses Different Tests and Clues

If you have skin symptoms in your genital area, you might wonder whether it’s psoriasis or something else, like genital herpes. The two can sometimes look similar and be hard to tell apart. It’s important to see a doctor if you have a rash or sores in your genital area. They can run the right tests to figure out what’s going on.

To diagnose genital psoriasis, the doctor will carefully examine the skin — not only in the genital area but also on other parts of the body. Psoriasis is often diagnosed based on how it looks. If the rash is unusual or doesn’t respond to treatment, the doctor may take a biopsy (small skin sample) to examine under a microscope.

To diagnose herpes, doctors often test a sample from sores or blisters. This polymerase chain reaction (PCR) test looks for the virus’s DNA. A Tzanck smear, which checks for changes in skin cells, is used less often.

If there are no sores at the time, a doctor may do a blood test to check whether your body has made antibodies to the herpes virus, which can show exposure. However, blood tests can’t always tell if the virus is active right now.

Doctors use these tests, along with your symptoms, to make the correct diagnosis and choose the right treatment.

7. Genital Psoriasis Treatment Focuses on Reducing Inflammation

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. Both conditions can affect your quality of life.

Treatment options for genital psoriasis aim to reduce inflammation and relieve symptoms. Topical medications (applied to the skin) can slow down cell production and decrease inflammation. Topical steroids or immunomodulators are the most common medications for psoriasis.

If topical medications aren’t enough to control genital psoriasis, or if you have psoriasis on other parts of your body, your healthcare provider may also prescribe a medication to target your overactive immune system, such as a biologic treatment or an oral therapy.

8. 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 replicating. Antivirals are usually taken orally (by mouth). These medicines suppress the virus but don’t eliminate HSV. Your doctor may also recommend treatments to help relieve pain and discomfort caused by herpes.

9. Some Genital Psoriasis Treatments Can Trigger Herpes Outbreaks

If you have an HSV infection, your immune system keeps herpes from coming back. If you have psoriasis and take medications that affect your immune system, herpes symptoms may be more likely to return or become more severe.

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

Talk With Others Who Understand

On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.

Do you have concerns about genital psoriasis being misdiagnosed? Let others know in the comments below.