Highlights from this article:
- Herpes is a viral infection transmitted primarily through sex, either through skin-to-skin contact or secretions from a sore.
- Yeast infections are fungal infections that can be spread through sex, but can also develop when the vagina experiences a change in pH such as after wearing tight clothing for a long time or taking a course of antibiotics.
- Both yeast infections and genital herpes can cause pain during sex and while you pee as well as itchiness, which is why they’re sometimes confused for one another.
- There is a lot of stigma around herpes, but it’s actually a very manageable condition. While it can’t be completely cured, doctors can prescribe antivirals that help the virus remain undetectable and minimize outbreaks.
- Yeast infections can be treated with antifungals, and in some cases, boric acid. An Evvy test can help determine the presence and strain of Candida (yeast) in your vaginal microbiome so you can work with your doctor to find the most effective treatment.
Some things become very clear when you’re experiencing itchiness, pain, and discomfort around your vulva or in your vagina: how close the nearest bathroom is, whether the people around you can see you itching your vagina in public, the sacrifices you would make to get some, ANY relief, and that the scratching you’re doing is not a great antidote for itchiness in sensitive areas (ouch).
But sometimes, one thing remains unclear: the cause of all of that discomfort. Unfortunately, there are a lot of yeast infection symptoms that overlap with other conditions, including herpes.
What is genital herpes?
Genital herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV). There are two virus strains that can cause genital herpes: HSV-1 and HSV-2. These are the same viruses that cause oral herpes, aka cold sores.
How is genital herpes diagnosed?
Doctor’s office: Detection of HSV virus genetic material (PCR) from a swab of the genital area. Herpes can also be diagnosed with a blood test. Finally, herpes can be diagnosed clinically, without a PCR swab, especially for patients with a prior history of HSV who has a recurrent outbreak.
At home: You can purchase kits online to prepare and mail in your own sample, which a lab will receive and perform the same method done in a doctor’s office.
Note: When you ask to get tested for “all STIs,” herpes may or may not be included, depending on your risk for having a possible infection. Be sure to talk with your doctor specifically about herpes if you’re interested in being tested.
What is a yeast infection?
A yeast infection is a vaginal infection caused by an overgrowth of Candida, a type of fungi. A small amount of Candida is common in a healthy vaginal microbiome, but too much can cause unpleasant symptoms.
How is a yeast infection diagnosed?
Doctor’s office: A swab of vaginal discharge is examined under the microscope for visible signs of yeast. A PCR test that looks for the presence of yeast will be the most accurate test available at the doctor’s office.
At home: You can purchase mail-in kits online to assess your vaginal pH, and the presence of yeast which is not an official diagnosis, but can help you figure out if you are on the right track.
An Evvy test will not only tell you if yeast are present, but the exact type of yeast present in your sample and their abundance relative to other microbes, which you can then bring to your doctor. (An Evvy test cannot diagnose you with a yeast infection, nor can it diagnose you with herpes).
Need the Cliff Notes version? Check out this table to learn more about herpes and yeast infections, and how they might overlap:
What does genital herpes feel like for people with vaginas?
In a 2013 study monitoring over 3,000 women for genital herpes, most of the women who tested positive for herpes exposure never experienced any symptoms. Believe it or not, having no symptoms or mild symptoms is common in many STIs, not just herpes!
Those who did have symptoms experienced lesions on the skin, pain, burning or itching, redness, and pain with urination (71-62%). People with genital herpes usually experience these symptoms on and off. Most people report their first outbreak (aka when someone is experiencing symptoms) as the longest and most severe, with future outbreaks being shorter and having milder symptoms. Stress and infections can sometimes trigger outbreaks.
Herpes infections can also cause symptoms in other parts of the body, such as headaches, fever, and swollen glands. There were no significant differences in the symptoms experienced by people with genital HSV-1 or HSV-2 infections.
And how is that different from a yeast infection?
Yeast infections can cause vaginal and vulvar itching, redness, and soreness; white vaginal discharge with a curd-like consistency (think cottage cheese); and pain during sex and/or when you pee. Some people with yeast infections have a red and/or scaly rash.
The skin irritation can sometimes be confused for herpes sores, which is why these two conditions are confused for one another.
If abnormal vaginal discharge or a smell are on the list of your vaginal complaints, you’re probably dealing with a vaginal infection and not herpes. Some people with yeast infections do not experience any smell, but when they do it usually resembles bread or beer (remember, yeast!)
Yeast infections generally do not cause red bumps, blisters, or other lesions on the skin. A fever or swollen glands also aren’t usual parts of the (ahem, delightful) yeast infection package.
If what you are experiencing is mainly limited to the skin on the vulva, and you’ve ruled out herpes, you might want to talk to your doctor about dermatological conditions like vulvar lichen planus and vulvar lichen sclerosus.
One way to know if something is vulvar vs vaginal is by taking a vaginal microbiome test, like Evvy. If your results come back showing an overgrowth of pathogens in your vaginal microbiome, it’s likely that the origin of your discomfort is in your vagina rather than the vulva.
Are herpes and yeast infections transmitted the same way?
Herpes viruses are spread by close skin-to-skin contact and/or secretions from an infected person, which can happen during penetrative and oral sex. So, for genital herpes to be a likely suspect, at some point your genital area would have come into contact with skin and/or secretions from another person who was shedding the virus.
Even more important to remember: you can’t tell whether or not someone has an STI based on what they look like, who their sexual partners have been, or the number of partners they’ve had!
Sex can be a risk factor for yeast and other vaginal infections, but not always. During penetrative and oral sex, your microbiome is exposed to another person’s, which can introduce new pathogens and change your vaginal pH to a level that makes a happy home for bacteria and fungi. But sex isn’t always part of the story for yeast infections. Tight clothing, antibiotics, and exposures to chemicals or fragrances can also cause Candida (yeast) overgrowth.
What is the treatment like for herpes vs a yeast infection?
Because herpes is caused by a virus, and yeast infections are caused by a fungus, you will need completely different treatments depending on which microbe you are dealing with, and unfortunately one won’t work for the other. (Because why would anything in our vaginal healthcare be convenient!)
There is no cure for genital herpes, as the virus can hang around in nerve cells for long periods of time. Before you panic, “not curable” does not mean “not treatable.”
Treatment options are prescribed by a doctor and are identical for both genital HSV-1 and HSV-2 infections. The treatments are typically either acyclovir, famciclovir (Famvir), or valacyclovir (Valtrex) for 7-10 days. From there you can work with your doctor to decide if suppressive (aka continuous) or episodic (in other words, only taking medication as needed) treatment is right for you.
Yeast infection treatment
Yeast infections are usually treated with antifungals, such as miconazole and terconazole. While you can buy these at a grocery store or order online without a prescription, it’s best to get your yeast infection symptoms examined by a doctor before grabbing something off the shelf. This is because yeast infection symptoms can be easily confused with other vaginal health conditions (like herpes or bacterial vaginosis!) and sometimes, over-the-counter yeast medications can cause further irritation.
But, there are some cases in which antifungals don’t work for a yeast infection, or they work temporarily but the infection bounces back. (These recurrent episodes are yet another one of the reasons yeast infections and herpes are sometimes confused for one another.)
For yeast infections it’s possible that the type of yeast causing the infection isn’t effectively targeted by the antifungal, or the yeast causing the infection has evolved to resist the antifungal you are using (while we love a rebel, we would prefer they not be the disruptive pathogens in our vagina!). In these cases, boric acid can sometimes more effectively treat the infection. This is when ordering an Evvy test is super helpful, to see the exact type of yeast present in your vagina. You can bring the results of your test to your doctor, who can help you to navigate the best course of treatment.
Sex and masturbation with herpes or a yeast infection
Can I have sex with herpes or a yeast infection?
If you think you might be dealing with herpes, it’s a good idea to hold off on sexual activity with a partner until you’ve confirmed your diagnosis and/or received antiviral treatment to avoid transmitting the virus to a partner.
Remember, despite the stigma surrounding it, herpes is common and many people with herpes have happy and healthy sex lives!
As for yeast infections, if you’re having unprotected sex it is possible for you to transmit it to a sexual partner. It’s best to lay off sexual activity for the time being while you finish antifungal treatment.
If you are feeling up to sex when you have a yeast infection, be sure to use condoms or dental dams. If your partner has a penis, they have a relatively low risk of infection––about 15% develop an itchy rash and will need treatment. If your partner has a vulva, doctors recommend getting proactively tested and to be on the lookout for symptoms.
Can I masturbate with herpes or a yeast infection?
In either the case of herpes or a yeast infection, masturbation is still an option. Just be sure to wash your hands after to avoid spreading secretions from a possible herpes outbreak. Masturbating next to a partner can be a great alternative while you’re waiting for results or treatment.
How do I tell someone I have herpes?
If you are diagnosed with herpes and need to notify an ex and you really, really don’t want to open that door again (we’ve all been there), you can still do your public health duty without the awkward coffee date. STDcheck.com lets anyone enter a phone number or e-mail anonymously, and a text or e-mail will be sent letting them know they should get tested. This helps to ensure that your former partners are not unknowingly transmitting an STI to future partners (remember, many people are asymptomatic!)
Alternatively, if you’re feeling nervous about talking with your partner about any of this, we’ve got you! We dedicated a post to how to talk to a partner about vaginal infections.
Why is there so much stigma around herpes?
We’ll also take a moment here to get up on our soapbox and say that having a vaginal infection, including herpes, is nothing to be ashamed or embarrassed about. When you look at the numbers, genital herpes infections are actually pretty common. About 16 million (1 in 5!) American women have been exposed to HSV-2 at some point.
Researchers estimate that there are nearly 600,000 new incidences of HSV-2 infections per year, and tens of thousands of genital HSV-1 infections. Unsurprisingly, it’s twice as common for women to have genital herpes than men. (Yes, the gender health gap shows up here too. Ugh.)
There is a long, storied history as to why our culture has come to treat herpes as a catastrophic health diagnosis, when in fact it’s more uncomfortable and inconvenient than life-threatening.
While not curable, in 2022 there are many treatment tools to help manage herpes. Psychologists believe that herpes stigma leads women to be especially reluctant to seek a diagnosis or to get treatment, which makes them even more likely to continue suffering from recurrent episodes.
This is especially true for Black women, who experience a higher rate of HSV-2 infections, largely due to the fact that Black women face harsh stigmatization for STIs and often inadequate care and counseling on sexual health.
Although it is totally normal to feel worried, upset, and angry about a potential genital herpes diagnosis, we encourage you to seek out a definitive answer so you can receive the proper care and treatment that you deserve.
If you believe you have a yeast infection, our recent #AskEvvy post on what to do next is a great place to go from here. If you believe you could have herpes, pause sexual activity and getting tested ASAP either at a doctors office or with a mail-in kit.
If you are dealing with discomfort and problems with the skin on the vulva in particular, check out this article on vaginal vs vulvar irritation.
And remember, no matter what the cause of your vaginal discomfort is, you are an awesome person with a vagina who deserves to feel better. Evvy is here to make sure you have all of the info to get the help you need!