Let’s see – a patient presents with itching, burning, cracking and irritation of the genitals. Is it herpes? Is it yeast? It is a bacterial infection? It could be any of those things, but the herpes option strikes the most fear into patients. That’s probably because of the stigma and the lack of knowlege about the subject. But indeed, many things can mimic herpes symptoms in the genital.
Herpes itches but so do lots of things, primarily yeast. Herpes can cause blisters in the genitals, but so can staph infections. Herpes can cause a discharge, but so can gonorrhea and chlamydia and bacterial vaginosis and trich. My point is, if genital symptoms are present, they aren’t always herpes, and that’s true even with the person who has a diagnosis of herpes. That’s why is is important for people who have herpes who have symptoms that are constant, are unresponsive to antivirals or that are outside of the “normal” pattern of herpes to have those symptoms evaluated by a clinician rather than assuming that they are herpes.
Of course, the reverse is also true, and probably happens more often. A person has symptoms like pain with urination. They present to the clinician’s office where urine is dipped for white cells (pus). White cells are found, so the person is put on antibiotics. But when the urine sample is sent to the lab to grow bacteria, none is found. That’s because what the person really had was herpetic urethritis, herpes lesions in or at the urethra. These lesions cause pain with urination because urine, which is acidic, is passing over open sores, which hurts. And there are pus cells in the urine because the lesions have pus in them. But the symptoms get better, so the patient and the clinician believe it was a bacterial UTI. Really, time just passed and the lesions resolved.
There are a few problems with that, as you might imagine. The first is that people are taking medicine for things they don’t have. That’s an issue because they might have allergies to those medicines or the medicines might cause side effects, like antibiotics cause yeast infections. As if having first episode herpes wasn’t bad enough, now that same person has a yeast infection or more serious complications from the antibiotics. It’s a vicious circle, for sure.
Here’s the bottom line: Symptoms need careful evaluation by a clinician who knows genital herpes and takes a good history and does good lab work. Nothing should be assumed.