What does herpes on vulva look like

Pictures and details about cold sores and genital herpes

Herpes is a type of viral infection caused by the herpes simplex virus (HSV). There are two types known as herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2), both of which can cause the outbreak of blisters and painful sores.

HSV-1 is the type most commonly associated with cold sores (oral herpes), while HSV-2 accounts for the majority of genital herpes infections. However, HSV-1 can also be spread to the genitals and HSV-2 can be spread to the mouth through oral sex.

This gallery of images describes the signs and symptoms of a herpes infection, including what a herpes sore looks like. It also differentiates herpes from similar conditions with similar features so that you can seek appropriate treatment.

Note: Some of the following images are of genital areas.

Early Herpes Symptoms

Once infected, herpes viruses stay with you forever. There is no cure. When the virus is inactive, it will imbed itself in nerve cells near the spinal cord (called the spinal nerve root).

When herpes reactivates, the virus will travel up the string of nerves to the surface of the skin where it will cause an outbreak of tiny blisters called vesicles. The vesicles will then erupt, causing painful open ulcers commonly referred to as herpes sores.

This photo shows an example of the early stages of a herpes rash, the blisters of which are clustered in a red patch. In addition to pain, there may be itchiness or a pins-and-needles sensation.

Prodromal Symptoms of Herpes

Prior to a herpes outbreak, people will often have prodromal symptoms (meaning non-specific signs that precede major symptoms). With herpes, this may include localized genital pain, or tingling or shooting pains in the legs, hips, or buttocks. This may occur hours or days before the actual outbreak.

The outbreak may also be preceded by flu-like symptoms like fever, fatigue, and swollen lymph nodes, particularly during the first outbreak.

Herpes Vesicles

There are three stages of a herpes outbreak:

• Prodromal: This is when the virus reactivates and migrates to the surface of the skin, causing non-specific nerve pain or sensations.
• Vesicular: This is when blisters (vesicles) develop.
• Ulcerative: This is when the blisters break open to form skin ulcers.

This picture illustrates the formation of vesicles. Note the cluster of vesicles on a red base. These fluid-filled blisters are delicate and break open easily, creating open, oozing sores. Eventually, the sore will stop oozing and crust over.

How Herpes Is Treated

Both HSV-1 and HSV-2 are treated with antiviral drugs. They are most effective when started within 48 to 72 hours of the first signs of an outbreak. They do not cure herpes but may reduce the severity and duration of an outbreak. Recommended options include:

• Zovirax (acyclovir)
• Famvir (famciclovir)
• Valtrex (valacyclovir)
  

Typical Herpes Outbreak of the Penis

This picture illustrates a typical herpes outbreak of the penis. Note how some of the tiny blisters have converged into larger ones.

Severe cases like this tend to occur during a first outbreak (called primary herpes). Thereafter, the body will have produced immune proteins, called antibodies, that are not able to neutralize the virus but can help control the infection.

As a result, subsequent outbreaks tend to be far less severe.

Atypical Herpes Outbreak of the Penis

Because the genital area is warm and moist, herpes can sometimes have an atypical appearance in places like the penis, vagina, and anus.

In this picture, the lesions look more like erosions (where only part of the top layer of skin is damaged). If you look closely, however, you can see that each red area has a cluster of small sores.

Herpes Outbreaks in Females

This picture shows a herpes ulcer on the vulva. The vulva is the external part of the female genitalia.

Females are four times more likely to get an HSV-2 infection than males. In addition, females may have symptoms that are not readily recognized as herpes.

For instance, a female may feel pelvic pain if the rash is located inside the vagina or on the cervix. This could lead to a misdiagnosis of pelvic inflammatory disease (PID).

Also, many females experience burning with urination during a genital herpes outbreak. The burning may be misdiagnosed as a urinary tract infection (UTI). 

Typical Healing of Genital Herpes Sores

Note the crusting that has occurred near the head of the penis in this photo. The crust forms as fluids from the blisters evaporate and leave behind whitish or yellowish crystals.

In addition to pain, the oozing sores will often have a "fishy" smell in both females and males. The smell can increase after sex due to the abrasion of skin on skin.

The timeline of a genital herpes outbreak can vary. With primary herpes, the outbreak will usually occur within four days of exposure to the virus (although it can occur anywhere from two to 12 days after exposure).

A genital herpes outbreak may last up to seven to 10 days, particularly with the first outbreak. After crusting, healing usually occurs within two to four weeks, typically with no scarring.

Atypical Healing of Genital Herpes Sores

This picture shows herpes lesions after some of the blisters have broken open. Typically, you will see a whitish or yellowish crust forming on the ulcers.

With that said, crusting may not be all that apparent. Because the skin of the penis and vagina is moist, there may be minimal crusting. Instead, there may be a whitish film covering or surrounding the open sores.

Cold Sores (Oral Herpes)

Cold sores (also called fever blisters, oral herpes, or orolabial herpes) are more often caused by herpes simplex type 1 (HSV-1) than herpes simplex type 2 (HSV-2).

Cold sores progress in much the same way as genital herpes. HSV-1 can also affect the tongue, gums, or face.

HSV-1 can also be passed to the genitals or anus via oral sex. While it is often impossible to tell which type of HSV caused a genital herpes outbreak, those involving HSV-1 are less to recur.

Herpetic Whitlow

HSV-1 and HSV-2 can both be spread to other parts of the body by hand-to-skin contact, such as rubbing a sore and touching your face, eye, or anus.

This can occur between someone with herpes and someone without. You can even auto-inoculate by touching a sore on your body and then another part of your own body.

The finger is a common place to get a herpes infection to spread. In fact, it's common enough to have its own name: herpetic whitlow.

This picture shows the early stage of a herpes whitlow infection. Since the skin on the fingers is thicker, the blisters aren't as fragile and may not break open.

Herpetic whitlow can occur if you come in contact with herpes sores or blisters, either from HSV-1 or HSV-2. 

Herpetic Keratitis

HSV-1 and HSV-2 can also be transmitted to the eye by hand-to-skin contact, such as rubbing the eyes after touching a blister or sore.

This picture shows herpetic keratitis, a herpes infection that involves the cornea (the outside covering of the eye). Note the blisters around the eyelid and crusting ulcers near the eyes.

Symptoms of herpetic keratitis may include:

• Eye pain
• Sensitivity to light
• Watery discharge
• Blurry vision
  

Herpes of the eye is serious and requires immediate care by an eye specialist known as an ophthalmologist. If left untreated, herpetic keratitis can cause corneal scarring and vision loss.

Herpes Simplex vs. Chickenpox

Chickenpox is caused by a herpes virus called varicella-zoster virus (VSV). While chickenpox can cause blistering and crusting sores like HSV, there are certain tell-tale signs that differentiate them.

With the chickenpox, note that each blister in this photo has its own red base and is not clustered in a group like HSV.

As opposed to a localized outbreak, chickenpox usually starts on the torso, scalp, and face before spreading to the arms and legs. The rash can also cause sores in the eyes, mouth, and vagina, although this is uncommon.

And, unlike HSV, a chickenpox rash can leave behind scars after it heals.

Herpes Simplex vs. Aphthous Ulcers

This is a picture of aphthous ulcers, a type of oral sore that is often confused with cold sores. Aphthous ulcers can occur anywhere in the mouth, but do not involve the outside of the lip. They are not caused by the herpes virus.

Aphthous ulcers (also known as canker sores) are painful, non-contagious ulcers limited to the inside of the mouth. As opposed to herpes blisters, aphthous ulcers start as painful sores that are yellowish or whitish in color with a red border.

Aphthous ulcers can be caused by the following.

• Coxsackievirus
  
• Contact dermatitis
• Chemotherapy
• Autoimmune diseases (like Crohn's disease and ulcerative colitis)

Summary

Herpes is a viral infection caused by herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). Although HSV-1 mainly causes cold sores and HSV-2 mainly causes genital herpes, they can cause herpes outbreaks on other parts of the body due to oral sex or hand-to-skin contact. Many genital herpes infections today are due to HSV-1.

Herpes progresses in stages and causes the outbreak of blisters and painful ulcerative sores. This is followed by the crusting of the sores. Healing usually occurs within two to four weeks.

A Word From Verywell

Herpes infections are common. While they cannot be cured, they can be managed or prevented with antiviral drugs. If you have symptoms of herpes, see your healthcare provider as soon as possible. They can take a swab of the sore to confirm whether you have been infected.

Frequently Asked Questions

• What is herpetic whitlow?

  Herpetic whitlow is a viral infection that usually causes a red, blistering rash to appear on one finger. It is possible for multiple fingers to be affected, but this is rare. If complications occur, herpetic whitlow can also cause scarring, nail damage, numbness, and skin hypersensitivity.

• What causes a blister to form?

  Blisters, also known as vesicles or vesicular lesions, are formed when fluid becomes trapped beneath the outermost layer of the skin (epidermis) which causes a small bubble to appear. Causes can range from allergic reactions and minor trauma to herpes or chickenpox.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Modi S, Van L, Gewirtzman A, et al. Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology. Ther Clin Risk Manag. 2008;4(2):409-17.

2. Sauerbrei A. Herpes genitalis: Diagnosis, treatment and prevention. Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494

3. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007;79(3):193-6.

4. Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: A Review. J Clin Aesthet Dermatol. 2017;10(3):26-36.

Additional Reading

• American Academy of Dermatology. Herpes simplex: Signs and symptoms. 

• Bernstein DI, Bellamy AR, Hook EW, et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clinical Infectious Diseases. 2013;56(3):344-351. doi:10.1093/cid/cis891

• Centers for Disease Control and Prevention. Genital HSV infections. Updated January 25, 2021.

By Heather L. Brannon, MD
Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.

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