Anal Herpes

Medically reviewed by Rex Mahnensmith, MD on January 30, 2015Written by Kimberly Holland on December 12, 2017

What is anal herpes?

Herpes is a family of viruses that cause infections in humans.

Anal herpes is an infection caused by the herpes virus that erupts as sores or blisters around the anus, the opening through which bowel movements pass. Anal herpes are caused by the herpes simplex virus (HSV) — in particular, a type of HSV called HSV type 2, or HSV-II.

Syphilis, chancroid, and donovanosis are infections that can cause different types of lesions around the anus.

All of these infections, including HSV-II, are acquired through sexual contact.

Symptoms of anal herpes include:

  • red bumps or white blisters
  • pain and itching around the anus
  • ulcers that develop at the site of original blisters
  • scabs that cover ulcers that have ruptured or bled
  • changes in bowel habits

How is herpes transmitted?

HSV-II is a sexually transmitted infection (STI). It’s passed from person to person through sexual contact or intercourse.

In a fact sheet published in 2013, the Centers for Disease Control and Prevention (CDC) stated that more than 24 million Americans had HSV-II, and that each year an additional 776,000 Americans were diagnosed.

In the United States, one in six people has genital herpes, according to the CDC. The same virus that causes genital herpes can cause lesions in the genitals, anus, or perianus. However, not everyone with genital herpes has anal herpes.

How is anal herpes diagnosed?

If you have obvious symptoms of anal herpes, your doctor may decide to treat you after a physical exam. However, some doctors will want to conduct additional testing to verify the diagnosis or make sure the symptoms aren’t the result of another type of infection or condition. Because several different sexually transmitted microorganisms can cause anal symptoms, your doctor may want to verify the precise cause of your infection with testing before starting treatment.

To do this, your doctor will draw a blood sample. That sample will be sent to a laboratory where tests will determine the cause of your symptoms. With that information, your doctor can discuss treatment options.

How is anal herpes treated?

Treatment for anal herpes helps reduce the duration of the outbreak and the intensity. Treatment may also reduce your risk for passing the infection to a sexual partner.

The primary treatment for anal herpes is antiviral therapy. HSV-II is a virus. Antiviral medications fight the virus. People with HSV-II are given antiviral medications to reduce the symptoms until the outbreak ends. In addition, a doctor may prescribe an antiviral medication to take regularly.

Long-term use of antiviral medication is also known as suppressive therapy. People who use suppressive therapy to manage HSV-II reduce their risk of passing the infection to a sexual partner.

In cases of severe anal herpes, your doctor may suggest intravenous antiviral therapy. This means the antiviral medicines will be injected directly into your bloodstream through a needle inserted into a vein.

Anal herpes recurrence

Antiviral medication will help reduce the frequency and severity of anal HSV-II recurrence. When HSV-II does erupt again, the ongoing antiviral treatment can help shorten the duration.

Over time, episodes of herpes outbreak around the anus will decrease. Ultimately, you and your doctor may decide to end suppressive therapy. If so, you’ll likely begin using antiviral medicines again when a new outbreak occurs.

Can HSV-II be cured?

HSV-II can’t be cured. It’s considered a lifelong infection. After the first outbreak, the virus will move to your nerve cells. The virus will stay in your nerve cells for the rest of your life.

Even though the virus is still present in your body, it may be dormant or inactive for long periods of time. Outbreaks are typically triggered by an external factor such as stress, illness, or sun exposure.

Is anal herpes contagious?

Anal herpes is contagious. It’s most likely to be transmitted to another person when lesions are present on skin in or around the anus. You can be infected with the virus if you have sexual contact with an infected person. In addition, you can pass the infection to a sexual partner if you are infected, even when the virus isn’t causing obvious symptoms.

It’s possible not to know you have HSV-II. Symptoms aren’t always obvious, so you might not realize you’re infected. In that case, you may pass the infection to others without knowing. The only way to know if you’re infected is to have an STI screening.

Reduce your risk

Because STIs like HSV-II are passed during sexual contact, you can lower your risk by practicing safe sex. Use these safe sex measures to reduce your risk:

  • Wear a condom or barrier protection during every sexual encounter, including anal or oral sex.
  • Reduce your number of sexual partners.
  • If you’re in a relationship, practice monogamy.
  • Abstain from sex altogether.

If you’re sexually active, ask your doctor to conduct regular STI screenings. Regular testing keeps you and your sexual partners safe.

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