Where genital herpes can differ is in the risk of transmission in men versus women. Due to the differences in genital and reproductive anatomy, certain complications can occur in males that don’t occur in females.
This article looks at the signs and symptoms of genital herpes in males, including sex-specific risk factors and complications you may not be aware of.
Genital Herpes Symptoms in Men
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 disease. (HSV-1 is the type commonly linked to cold sores that can be passed to the genitals or rectum through oral sex.)
Infection with HSV-1 and HSV-2 doesn’t always cause symptoms. When it does, it can lead to an outbreak of itchy or tingling blisters that quickly rupture to form painful ulcers. The open sores can ooze and bleed, eventually crusting over and healing within two to four weeks.
Other symptoms can accompany, particularly during the initial outbreak, including:
Fever Headache Body aches Swollen lymph nodes Pain or burning with urination
Subsequent genital herpes outbreaks tend to be less severe than the first outbreak.
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 Does Genital Herpes Look Like in Men?
Genital herpes looks no different in men than in people of any sex. The spontaneous outbreak of blisters accompanied by pain is the classic tell-tale sign of this common viral infection.
You can get genital herpes if you come into contact with:
A herpes soreSaliva from a partner with oral herpesGenital fluids from a partner with genital herpesSkin 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.
Even so, the symptoms can vary from one person to the next. An outbreak may involve only one sore or a dense cluster of sores. Some cases will be subclinical (meaning that the symptoms are vague and not readily recognized), while others can be severe and physically debilitating.
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 are sometimes needed to 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. 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: 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.
How Common Is Genital Herpes in Men?
Approximately 8 out of 100 males between the ages of 14 and 49 in the United States are living with HSV-2.
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, people with a vagina have larger areas of mucosal membranes in their genitals than people with a penis. 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).
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-1 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.
Treatment
There is no cure for herpes. Antiviral medications can only prevent or shorten outbreaks of the virus. Daily suppressive antiviral therapy for herpes can reduce the likelihood of transmission to partners. There is currently no vaccine that is protective against genital herpes infection.
The treatment of genital herpes involves one of three oral antiviral drugs:
Famvir (famciclovir) Valtrex (valacyclovir) Zovirax (acyclovir)
The drugs do not cure genital herpes but can reduce the severity and duration of an outbreak, especially if taken within 72 hours of the appearance of lesions.
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.
Possible Complications
Genital herpes complications include:
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)
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 people of any sex. Blisters accompanied by pain may be seen or felt in the genital area, including on the scrotum, penis, foreskin, and prepuce.
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.
A Word From Verywell
As distressing as it can be to be diagnosed with genital herpes, treatment can reduce the severity and duration of an outbreak if and when it occurs. Treatment can also reduce the risk of infecting a sexual partner, an especially important issue if you’re in a relationship.
If you have herpes, you can protect your partner by always wearing a condom and avoiding sex if you feel symptoms coming on. Outbreaks are often preceded by itching or tingling in the area where your outbreaks typically occur and/or pain running down the back of your leg or buttocks.
If you are prone to frequent attacks, ask your healthcare provider about suppressive antiviral therapy, which can further reduce your risk of transmission.
Genital herpes can also be mistaken for syphilis if the outbreak is limited and causes a single large sore on the penis.
