Herpes and hidradenitis suppurativa (HS) may look and feel similar, but these two skin conditions have some key differences, including their causes and treatments. Neither condition can be cured, so the symptoms need to be managed for life. That means getting the right diagnosis so you get the right treatment plan.

Because herpes is caused by a virus (herpes simplex virus 1 or 2), it can be spread from one person to another. HS, on the other hand, can’t be caught or spread through sexual activity or any other form of physical contact. The cause of HS is less clear-cut, but some people are more susceptible.

Although it’s possible to have HS and herpes at the same time, they have several distinct differences. Here’s what you should know.

Symptoms of Herpes vs. Hidradenitis Suppurativa

Herpes and hidradenitis suppurativa can have some similar symptoms, making it easy to confuse the two.

Type 1 herpes mainly occurs in and around the mouth, and type 2 typically affects the genitals. However, it’s also possible to develop herpes symptoms in other areas of the body.

A first outbreak of oral herpes can take between a week and 10 days to heal. A first outbreak of genital herpes can take two to four weeks to resolve. Outbreaks after that first outbreak are usually shorter and less severe.

Along with blisters that break open, ooze, and crust over, people with herpes may experience:

• Fever
• Swollen lymph nodes
• Muscle aches

HS symptoms develop in areas where skin rubs against skin, including the armpits, buttocks, breasts, and genitals. Lesions (areas of damaged or inflamed skin) can progress into more severe wounds and tunneling (connections under the skin, also called sinus tracts).

HS also can cause painful pea-sized lumps and pus-filled bumps that get larger and eventually break open. Complications from HS include:

• Limited mobility
• Chronic and severe pain
• Scars
• Swollen lymph nodes
• Psychological distress

What Causes Herpes and Hidradenitis Suppurativa?

The herpes virus can affect people of all races and ages. Infection depends on exposure to the virus.

There are ways to help prevent transmission, such as practicing safe sex. Oral herpes can also be transmitted through kissing.

Although it’s less common, herpes can spread when symptoms aren’t visible. Many people have herpes with minimal or no signs of infection, so exposure can be difficult to avoid.

The cause of hidradenitis suppurativa is less clear, but certain groups are affected more than others.

According to Mayo Clinic, women are three times more likely to have the condition, and Black people have higher rates compared with other racial groups. Usually, people with HS begin showing signs in young adulthood, between puberty and age 40.

Health experts believe that genetics probably play a role in who gets HS, but there’s still a lot to be discovered about the disease. Along with having a family history of HS, those with a history of smoking and medical conditions like severe acne, diabetes, arthritis, inflammatory bowel disease, and metabolic syndrome are more likely to have HS.

How Are Herpes and Hidradenitis Suppurativa Diagnosed?

Herpes is a relatively common condition. Worldwide, type 1 (associated with oral herpes) affects 64 percent of people under age 50. Hidradenitis suppurativa isn’t nearly as prevalent — researchers estimate that less than 1 percent of the world’s population has HS — so some doctors aren’t as familiar with it.

Members of myHSteam have reported being misdiagnosed with herpes before learning about HS. “I was told I had herpes back in the ‘80s, even though I was practicing safe sexual measures, then later found it was the symptoms of HS,” one member said.

Diagnosing Herpes

Your healthcare provider can assess whether you have herpes by taking a swab of the sore and sending it to a lab. They can also do a blood test to see if you’ve been exposed to the virus in the past, even if you don’t have a current outbreak.

Diagnosing Hidradenitis Suppurativa

Unfortunately, diagnosing HS isn’t as straightforward. An experienced dermatologist can evaluate your symptoms and medical history and do testing to rule out similar conditions.

Since it’s possible to have herpes and HS at the same time, it’s important to continue searching for answers if your skin symptoms are significantly affecting your life. If herpes treatment isn’t enough or skin problems progress to more significant and painful lesions, another underlying issue — like HS — may need medical attention.

Another member described their long path to diagnosis: “I had no clue that HS was a thing and that there was a community of people who suffer as well. I’ve been dealing with HS since I was 13 years old. I am now 25. I have lived in secret ALL OF THIS TIME,” they wrote.

The member continued, “I’ve spoken to care physicians in the past, and they all automatically question if it’s herpes. I’ve been tested numerous times for herpes, and it’ll come back negative. But they insist on continuously retesting as if nothing else could be the answer. This, of course, has made me very frustrated!”

How Are Herpes and Hidradenitis Suppurativa Treated?

Your dermatologist can offer a range of treatment options to help control the symptoms of herpes or hidradenitis suppurativa. Both herpes and HS can have periods of flare-ups and remission.

Maintaining a healthy lifestyle and seeking treatment as soon as flare-ups begin can help you avoid complications like infections and scarring.

Herpes Treatment

Herpes symptoms range in severity. Some people show few signs of the disease and don’t require treatment. Prescription ointments or antiviral creams such as acyclovir (Zovirax) can help kill the virus and speed healing when applied to the skin during outbreaks. Some people take daily oral antiviral medication to avoid flare-ups of genital herpes.

You can also use at-home remedies to address herpes outbreaks. Treatments include:

• Applying over-the-counter creams
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
• Placing ice (covered by a cloth) on the affected area
• Wearing breathable cotton underwear
• Soaking in a warm bath

HS Treatment

If you have HS, your doctor may suggest various treatment options. Examples include:

• Topical or oral antibiotics
• Steroid injections to ease swelling and inflammation
• Retinoids to reduce acnelike symptoms
• Over-the-counter or prescription painkillers to manage pain
• Surgery to uncover tunnels or remove inflamed bumps
• Laser hair removal to treat affected skin
• Biologics, a class of medications that regulate the immune system for longer-term management of HS

Living With Herpes and Hidradenitis Suppurativa

Both herpes and hidradenitis suppurativa can significantly affect your quality of life, intimate relationships, and self-esteem. Taking time to care for your overall health and well-being is important for lowering stress and preventing flare-ups.

You can get helpful ideas, insight, and support by connecting with others who can relate to your experience.

Join the Conversation

On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.

Have you ever had a healthcare provider mistake HS lesions for herpes? Let others know in the comments below.