Anal Herpes

What is anal herpes?

Anal herpes is a type of herpes simplex virus (HSV) infection that causes blister-like sores to develop on the skin surrounding your anus (butthole). Sores may also form inside your anus or rectum. An anal herpes infection can sometimes lead to HSV-associated proctitis, which is inflammation in your rectum that’s due to the herpes virus.

If you’re concerned you have anal herpes, reach out to a healthcare provider. They’ll do exams and testing to diagnose (or rule out) the condition. If you do have anal herpes, your provider can prescribe medications to treat it and help you feel better. They can also explain what you might expect in the future in terms of recurrent outbreaks and treatment options.

What are anal herpes symptoms?

The main symptom of anal herpes is a cluster of painful sores near your anus. If sores develop inside your anus (anal canal), you may not be able to see them, but you may notice pain or discomfort.

When HSV first infects your body, you may notice symptoms like:

• Fever
• Headache
• Pain or discomfort when you pee (dysuria)
• Swollen lymph nodes in your groin area that are tender to the touch

Not everyone gets symptoms. It’s possible to get infected with HSV and not even realize it.

Symptoms of a recurrent anal herpes outbreak

After HSV enters your body (possibly causing the symptoms listed above), it lies dormant in nearby nerves. Your provider might refer to this as the virus “going asleep.” But it never fully goes away. HSV can reactivate or “wake up” at various times throughout your life and cause new outbreaks.

Here’s what you can expect from a recurrent outbreak:

• Up to 48 hours before you develop visible sores, you may feel generally unwell. Possible symptoms include a fever, headache and swollen lymph nodes.
• You may also notice itching or tingling in the skin around your anus.
• Sores may develop on the skin around your anus. The sores will break open and ooze fluid before healing. Recurrent outbreaks usually last one to two weeks.

What does anal herpes look like?

Anal herpes sores look a lot like genital herpes. They start as small, blister-like bumps (discolored or white) that form in a cluster. They break open and ooze fluid before healing and scabbing over.

How do you get anal herpes?

Anal herpes is a sexually transmitted infection (STI). You can get anal herpes if you have anal-receptive sex with a partner who has genital herpes.

But you can also get an anal herpes infection without a history of anal sex. This can occur if you have genital herpes (an HSV infection that affects your genitals). In this case, after the initial infection, the virus goes to sleep in nerves near your genitals. These nerve cells also happen to be close to your anus. When the virus wakes up, it can shed from your anal area as well as your genital area. Even if you don’t notice sores, the virus can still spread to others through sexual contact until it goes back to sleep again.

Can you get herpes from anal sex?

Yes. You can get anal herpes through any form of sexual contact where an infected part of your partner’s body touches your anal area. For example:

• You can get anal herpes from anal sex if your partner has genital herpes. This is true even if your partner’s penis doesn’t fully enter your anus or they don’t cum (ejaculate).
• If your partner has oral herpes, HSV can spread from their mouth to your anal or genital area through sexual contact.

How is anal herpes diagnosed?

Your provider will diagnose anal herpes by talking to you about your symptoms and doing a physical exam. They may also do one or more of the following:

• Digital rectal exam. Your provider inserts a gloved, lubricated finger into your anus and rectum to check for abnormalities.
• Rectal culture. Your provider uses a cotton swab to collect fluid from the inside of your rectum. They send the sample to a lab where technicians check for the presence of HSV.
• Proctoscopy. Your provider gently inserts a device into your anus and rectum to check for signs of inflammation (proctitis) or other issues.
• STI testing. Your provider may recommend testing for other STIs besides herpes to rule out other causes of your symptoms and check your overall health.

The more information you can share with your provider, the more they can help you. For example, sharing your recent sexual history allows your provider to do appropriate testing and recommend treatment accordingly.

What is the treatment for anal herpes?

Providers prescribe antiviral medications to treat anal herpes. Your provider will tell you which specific medications you need and how long to take them. Taking your medications should clear up the outbreak and help you feel better. However, antivirals don’t get rid of HSV from your body. The virus will always remain in your body and may reactivate later on, causing other outbreaks.

If you get frequent outbreaks, your provider may recommend chronic suppressive therapy. This means you take antivirals on a regular basis even when you don’t have an outbreak. Doing so can help reduce how often you get outbreaks and lower the risk of spreading HSV to sexual partners. Your provider can tell you if this type of therapy is right for you.

How can I prevent an anal herpes infection?

HSV spreads through sexual contact, even when a person doesn’t have symptoms. The only ways to completely prevent anal herpes are to:

• Avoid sexual activity

OR

• Only have one sexual partner (who’s also only with you) and you’ve both tested negative for HSV

Otherwise, you can lower your risk of getting anal herpes by:

• Using protection (like condoms and dental dams)
• Avoiding sexual contact with a partner who has a herpes outbreak
• Asking partners to do STI testing before engaging in sexual activity (and doing the same to protect them)

What can I expect if I have anal herpes?

There’s no cure for anal herpes. You may have more outbreaks in the future. But antivirals can manage your outbreaks and help you feel better. Your provider can tell you more about what to expect and how to take care of yourself.

While it might be tough to do, you need to tell your sexual partner(s) about any STIs you have, including anal herpes. Ask them to be open and honest with you, too. Be sure to:

• Use protection for all sexual activity
• Avoid sexual contact (even protected) during an outbreak until the sores are fully healed

When should I see my healthcare provider?

Contact your provider if any of the following are true:

• You have symptoms of anal herpes or think you might be infected.
• Your sexual partner was diagnosed with anal herpes, genital herpes or any other STI (even if you don’t have symptoms).
• You want STI testing of any type.
• You have questions or concerns about your treatment plan.