Herpes On The Penis

The herpes simplex virus (HSV) is a common global infection. The World Health Organisation (WHO) estimates that the form of the virus that causes genital herpes – HSV-2 – affects approximately 491 million people.

While some men may have HSV-2 and not experience symptoms, others experience flare-ups that present at a later date if the virus reactivates. Genital herpes in men can cause blister-like sores on the penis, scrotum and anus.

Herpes on the penis begins with a tingling or itchy sensation, typically associated with the prodrome, or initial stage of outbreak. At the initial onset of infection, HSV-2 symptoms may also present sensations of shooting pain, aches or numbness in the penis shaft, lower back, buttocks, or thighs. Symptoms of genital herpes on the penis may be mistaken for other conditions with similar symptoms, such as genital warts. At times, the prodrome stage of infection will also cause fever, headaches, and swollen lymph nodes. These secondary symptoms typically fade with subsequent outbreaks. 

Tenderness or redness in the affected area will eventually manifest as a cluster of vesicles or blisters on the penis, similar in nature to a rash. These lesions will eventually rupture to form lesions or sores, before scabbing over and healing.

Herpes in men can affect the following areas:

Penis head

During the blister stage, small red lesions begin to appear on the top of the penis, often in a honeycomb-like cluster. These sores may also affect the urethra, making urination painful. The time from the sensation of tenderness to the formation of blisters can occur relatively quickly. The formation of lesions often have an irregular shape, or present in a row. Individual blisters may vary in size, from the size of a pin head to a small pea.

Some men will only experience one blister, while others will have many. The tip of the penis is a very sensitive area of the body, and men suffering from an outbreak affecting this area, will usually experience pain and tenderness. Tight clothing may irritate or exacerbate the tenderness, so wearing loose-fitting clothing may be a necessary consideration during an HSV-2 outbreak.

Once the blisters burst, they will ooze a clear-white or yellowish liquid before eventually scabbing over and healing. The duration and severity of the outbreak may vary between individuals, and even between flare-ups. The first outbreak is usually the most severe, with subsequent outbreaks usually milder in nature, and shorter in duration.

Foreskin

Herpes on the foreskin can be particularly painful, due to the increased sensitivity of this area. The area of skin around this area is very thin. Herpes sores can also form under the foreskin. The early stages can often be confused with friction sores; however, herpes blisters will contain fluid, which eventually burst. Herpes blisters under the foreskin take slightly longer to heal, than other areas of the penis. This is due to restricted oxygen levels under the foreskin, which hinders the healing process. Herpes blisters on the foreskin can also make it painful to get an erection.

Scrotum 

The scrotum is another sensitive area that can be affected by a genital herpes outbreak. Herpes on the scrotum affect the skin of the sheath of the scrotum, and the seven layers that envelop them. Since the herpes simplex virus travels on the body’s neural pathways to the surface of the skin, each layer from the superficial fascia down to the Peritoneum of the scrotum may be affected.

HSV-2 outbreaks may cause uncomfortable ulcers on the scrotum in the latter stages of infection. As with anal herpes, blisters, and ulcers on the skin of the scrotum may be mistaken for other sexually transmitted diseases (STDs) that cause ulcers, such as syphilis and chancroid.

The Mayo Clinic details the similarities between herpes sores and chancres (syphilis sores). Syphilis generally has painless blisters, which is the major distinction between the two infections.

As reported by the Centers for Disease Control (CDC), chancroid is a disease caused by Haemophilus ducreyi bacteria. It is more commonly found in Africa and Southeast Asia, and causes larger and deeper ulcers than those attributed to herpes. Chancroid causes pain in the inguinal glands, while HSV-2 does not.

Testicles

Often disguised as jock itch or an ingrown hair during the prodromal phase, herpes on the testicles is a common symptom of HSV-2. While a genital herpes flare-up on the testicles could make sexual activity more difficult due to the sensitive nature of the affected area, genital herpes is not associated with causing infertility in men. This news may come as a source of relief for men worried about the infection presenting so close to the sperm-producing testicles.

Although The National Library of Medicine (NIH) has reported a study linking genital herpes to a reduction in sperm count, no concrete evidence of a direct correlation has been found.

How to know if you have herpes on the penis?

Men who suspect they have contracted the herpes simplex virus should seek the assistance of a healthcare provider, who can provide a herpes test. 

• You will test positive for HSV. The most commonly administered test involves taking a sample from a sore, so in order to determine infection, you will need to wait until the blister stage of an infection to swab fluid. 
• Know the symptoms. It is not always possible to get fluid from a sore, depending on the nature of the outbreak. This means that performing a test is not always possible. Determining whether prodrome-like symptoms of an oncoming genital herpes outbreak are merely side effects of an itchy rash or other infection are difficult to discern. Herpes sores are unique in nature, so knowing the signs of a herpes outbreak can help you to determine whether you are experiencing an outbreak.
• Know what herpes on the penis looks like. Since the prodrome, or initial phase of HSV-2 infection can quickly progress to latter stages in the genital area, taking photographs of the penis and comparing them to outbreak images online can help determine similarities. 

If you’re concerned that you’re experiencing a genital herpes outbreak, it is important to visit a local sexual health service for a diagnosis. A healthcare provider can administer a test by swabbing a sore from the top of the penis.

How herpes affects the penis

Living with herpes is common. For men who are otherwise healthy, living with herpes shouldn’t cause any long-term medical complications. WHO estimates that the HSV-2 infection affects approximately 13% of the global population, which means that it’s probably more common than you think. Some people living with genital herpes are asymptomatic, which means that they don’t suffer from outbreaks; in fact, they may not even realise they carry the infection. If you have been diagnosed with genital herpes, you should take the following points into consideration.

Risk of passing it on

The HSV-2 virus is contagious during all stages of a herpes outbreak – and even if an individual is asymptomatic or not currently suffering from a flare-up. The risk of infecting another person is greatest when the viral load is at its highest, so sexual activity should be avoided during the stages of outbreak. Although taking herpes medication daily can reduce the viral load, making it less likely to pass the sexually transmitted infection onto a partner, the risk of infection remains.

Increased risk of HIV

As reported by the National Institute of Health (NIH), scientists have linked HSV-2 outbreaks with an increased risk of contracting HIV. The magnified risk – said to be 2-to-3-fold over non-HSV-2 infected individuals – is due to the ideal spreading mechanism open lesions present for the HIV virus. HIV targets the body’s CD4+T cells, which commonly appear at the site of healed genital herpes lesions at 2 to 37 times greater frequency than unaffected genital skin. 

Difficulty in having sex

Infected individuals should always notify their sexual partners if living with HSV, even if they are largely asymptomatic. Aside from the appearance of blisters on the penis that eventually rupture to cause ulcers, herpes doesn’t affect the sexual performance capabilities of the male genitalia. A general increase in sensitivity to the penis and surrounding area, can make it difficult to have sex during this time. Consideration for not wanting to pass the infection on may also contribute to reduced sexual activity during this time.

How to prevent herpes on the penis

Men should practise safe sex by utilising condoms during sexual encounters. While condoms do not prevent the spread of the HSV-2 virus, they are effective in reducing the chances of transmission. Avoid touching your infected areas if possible, and be sure to wash your hands with warm, soapy water immediately after coming into contact with a blister or sore. 

Tips to aid in avoiding herpes infection:

• Avoid sexual contact of any kind. An individual infected with the herpes simplex virus is contagious even when symptoms are not present. Abstaining from vaginal, oral, or anal sex when a sexual partner is experiencing blisters or sores associated with HSV-2 is the best way to avoid the risk of transmission.
• Use medication. Antiviral treatment such as aciclovir tablets and valaciclovir tablets can not only help to reduce the length and severity of an outbreak; they can also be taken daily as suppression therapy, to reduce the chances of experiencing an outbreak. Suppression therapy is usually only recommended for those who experience 6 or more outbreak a year.
• Use a condom every time when engaging in sexual intercourse of any kind, including vaginal, or anal sex. Whilst this doesn’t completely prevent transmission, it reduces the chances. Females can use a dam, which is a sheet placed over the genitals. This helps to reduce the chances of transmission, especially if the female has herpes.
• Avoid sharing sex toys or other items that have been in contact with an infected individual’s genitals.
• Refrain from sexual contact if a partner is experiencing itchy genitals or sensations that could be associated with the prodrome or initial stage of infection.
• Engaging in a long-term, mutually monogamous relationship with a partner who does not have herpes mitigates the risk of contracting HSV-2.

Men living with genital herpes can enjoy a healthy, normal, and productive life. Although recurrent outbreaks may be common, treatments designed to combat the effects of herpes on the penis have a significant impact on the severity, duration, and frequency of flare-ups. While the use of medications, combined with lifestyle adjustments as part of a preventative protocol can reduce the discomfort associated with the genital herpes virus, it is a lifelong infection once contracted.

Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.