What Is a Genital Rash?
A genital rash is the development of bumps, lesions, patches, or skin discolorations on the genitals and surrounding areas. A systemic rash that includes the genital area is not a true genital rash, and has different causes and treatments.
Many genital rashes are caused by infections, but this may not be the case for all patients. It’s also important to know that not all genital rashes are sexually transmitted. Please discuss with a physician before making any major decisions within your relationship based solely on the presence of a genital rash.
What Is Causing the Itch Between My Legs?
Large population-based studies have shown that the two most common causes of genital rashes are:
- Herpes: The herpes virus initially infects skin cells during the acute phase. Later, it can spread to sensory nerves and enter a lifelong latency phase with occasional flare ups on the skin. These rashes are typically associated with pain and itching because of their involvement with sensory nerves.
- Syphilis: Syphilis is caused by bacteria that spread through the body in various phases over several years. It starts as a genital rash but becomes dormant if not treated, and can stay that way for a while. It can also show up as an itchy rash affecting the whole body — but the skin is not the only place syphilis shows up. It can infect the cardiovascular, central nervous, and musculoskeletal systems, presenting in numerous ways.
However, these are not the only causes of genital rashes. Below is a thorough, albeit not exhaustive, list of causes:
- Herpes simplex
- Mulluscom contagiosum
- Pubic lice
- Genital warts
- Tinea cruris (jock itch)
- Drug reactions
- Razor burn
- Autoimmune disorders such as Behcet’s syndrome
How Do I Get Rid of a Genital Rash?
The first step in eradicating a genital rash is to receive a proper diagnosis. After determining the cause of your genital rash, your physician can help you devise a treatment plan. Following are the steps we take to help patients get rid of genital rashes.
Step One: Run the Proper Tests
Every patient with a genital rash, regardless of its appearance, should receive the following lab tests:
- HSV PCR (test for herpes)
- Syphilis serologies
- HIV test
- Gonorrhea/chlamydia test
Physicians recommend these tests because genital rashes have various presentations and because the above conditions are so common. While you are waiting on test results, proceed to step two.
Step Two: Determine Your Exposure
If you know you’ve been exposed to a sexually transmitted infection in the last 90 days, you’ll need empiric treatment (see below for a description of empiric treatment) and further testing based on the known exposure.
If you haven’t had a known exposure then you should ask the following questions.
Is the Rash Painful?
A painful rash could point to genital herpes, cellulitis, or chancroid.
- Genital herpes is common and is known to cause genital lesions and painful rashes. The characteristic appearance of genital herpes is grouped 2-5mm vesicles (think pimple-like appearance) with surrounding skin redness. Be careful not to mistake this for razor burn if you recently shaved — razor burn is not often grouped together as herpes lesions are.
Often, but not always, genital herpes symptoms include pain with urination, fever, and painful lymph nodes in the inguinal region. Keep in mind that herpes is a lifelong virus that switches between active and dormant states. If you’ve previously received treatment for genital herpes, there’s a good chance this is a re-activation of the initial infection. Talk to your doctor if you have numerous re-activations throughout the year, as you might be a candidate for suppressive therapy that prevents virus reactivation.
- Cellulitis rashes are red, hot to the touch, painful, and can lead to significant swelling in the genital region, especially testicular swelling. If you are immunosuppressed or diabetic, cellulitis can be serious. Do not hesitate to reach out to your physician if you’ve noticed an enlarging rash that fits this description.
- Chancroid: While chancroid infections are considered to be rare, there are likely some reporting biases given that many labs aren’t equipped to test for this infection. The typical appearance of chancroid is a 1-2 cm (in diameter) ulcer that is painful, red, and inflamed. Ulcers can easily bleed if scraped or bumped and are usually covered with gray or yellow pus that drains.
Does the Rash Itch?
If your rash isn’t painful, it might be itchy. Most of the other causes of genital rashes have some degree of itching. Two notable exceptions that don’t often cause itching are genital warts and molluscum contagiosium.
- Genital warts come in a wide variety of shapes (flat, dome-shaped, cauliflower-shaped, etc.) and colors (white, skin-colored, red, brown, or black). Patients may have one or multiple lesions, and sizes can range from 1 mm to several centimeters in diameter. They can be found in the vaginal canal, urethra, and anal canal, interfering with natural function.
Genital warts are caused by human papillomavirus (HPV). However, the genital wart variation is not the same strain of HPV known to cause anogenital cancers like cervical cancer. Studies have shown there are often coinfections of high-risk HPV strains. To diagnose the patient, a doctor will evaluate symptoms and the rash’s appearance. Rarely, a skin biopsy is required.
- Molluscum contagiosium is a virtual genital rash less diverse in appearance than genital warts. Molluscum contagiosium are firm, dome-shaped lesions between 2-5 mm in size. These lesions often have a shiny surface and central indentation, and can sometimes be itchy but are most often not. The area surrounding these lesions may also become inflamed (molluscum dermatitis).
Below are genital rashes that itch but are not painful: syphilis, chlamydia and gonorrhea, public lice, tinea cruris (jock itch), razor burn, and autoimmune diseases such as Behcet’s syndrome.
- Syphilis is a sexually transmitted infection that, if detected early, responds well to penicillin. It presents in various ways depending on the length of infection. This is the second most common cause of genital lesions, after genital herpes. Because of the wide variety of presentations, patients should be tested regardless of their symptoms. Anyone experiencing a new genital rash after having unprotected sex within the past 90 days should be tested for syphilis.
- Chlamydia and gonorrhea sometimes present with genital rashes, but they are not universally present. Vaginal or penile discharge may also be associated with the rash. Anyone experiencing a new genital rash after having unprotected sex within the past 90 days should be tested for chlamydia and gonorrhea.
- Pubic lice, often called “crabs,” is spread through sexual contact or through clothing, bedsheets, towels, and other shared items. Lice feed on blood in the pubic region and grasp tightly to pubic hair with their crab-like claws. Pubic lice are often very small and difficult to see except after a recent feeding when they are filled with blood. While itching is the predominant pubic lice symptom, patients can also develop small blue bumps if there have been multiple feedings in the same area. A pubic lice diagnosis is typically made by a medical professional after combing the pubic hair. If a patient is diagnosed with pubic lice, they should be promptly tested for sexually transmitted infections including HIV, syphilis, chlamydia, and gonorrhea, since these infections often do not present symptoms and are commonly found with pubic lice. Treatment consists of a cream, and many patients need only a single treatment. Some require a second treatment 9 to 10 days after the first treatment.
- Tinea cruris (jock itch) is a fungal infection that typically spreads directly from athletes’ feet. It is not a sexually transmitted infection and is found more commonly in men than women. Patients at risk for jock itch experience excessive sweating, obesity, diabetes, or immunodeficiency. Jock itch appears as a red patch extending from the highest part of the thigh to the genital region. The rash’s borders are sharply demarcated and are often red with tiny, pimple-like vesicles. It’s uncommon for the rash to spread to the scrotum/testicles, but it can spread to the buttocks and anal area. Treatment is similar to that of athlete’s foot — a topical antifungal usually does the trick.
- Razor burn is a common genital rash that occurs 24-48 hours after shaving. Symptoms include small, tender, pimple-like bumps 1-2 mm in size. These bumps can become infected from strep or staph bacteria transmitted from the razor blade to underlying dermis tissue. Regardless, these bumps don’t usually require direct intervention besides keeping the area clean. There may be exceptions for those who are immunocompromised or diabetic, as infections occasionally become serious and develop into cellulitis, requiring a doctor’s visit and oral antibiotics.
- Behcet’s syndrome is a rare autoimmune disorder. Few autoimmune disorders cause solely a genital rash and are accompanied by joint pains, fever, night sweats, fatigue, or other systemic symptoms. However, Behcet’s syndrome can present with only a genital lesion in some cases. It is best not to consider this diagnosis until more common disorders have been ruled out. Autoimmune disorders are often diagnosed after several visits to a primary care doctor or an evaluation from a rheumatologist.
When Should I See a Doctor for My Genital Rash?
It is recommended that ALL people visit a doctor if they have a genital rash, unless you are absolutely certain your rash is due to a razor burn. Every patient with a genital rash needs to be tested, and most genital rash treatments require prescriptions of one kind or another. Your doctor can help you decide which one you need. Schedule an appointment with a physician at The Kingsley Clinic to begin your genital rash treatment.