Herpes vs. Hemorrhoids: Key Differences to Avoid Misdiagnosis

Both cause anal/perianal discomfort, but distinct features guide differentiation:

Feature	Herpes (HSV)	Hemorrhoids
Etiology	Viral (HSV‑1/2)	Vascular (dilated anal cushions)
Lesion	Clustered vesicles → painful ulcers	Swollen, bluish vascular cushions; may bleed
Pain	Severe, burning, neuralgic	Dull, pressure; sharp if thrombosed
Systemic	Fever, malaise, myalgia (primary)	None
Course	Recurrent, same dermatome	Chronic, fluctuates with straining
Diagnosis	PCR/swab, serology	Anoscopy, clinical exam

Clinical Pearl

Herpes ulcers are typically multiple, shallow, coalescing; thrombosed hemorrhoid is a single, tense, purple nodule. Co‑infection possible. Confirm with HSV NAAT.