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Genital And Anal Herpes

genital and anal herpes
Medically reviewed by Dr. Hina Razzaq


The herpes simplex virus is the culprit behind genital, anal, and oral herpes.

Many people have the virus without ever having symptoms of HSV, while others experience an outbreak of herpes. Symptoms of genital and anal herpes typically include small, fluid-filled blisters or sores that are usually painful. Although herpes infection is prevalent, it is poorly understood and highly stigmatized. This article will help remedy that and provide you with all the necessary information on genital and anal herpes. 

What Causes Genital and Anal Herpes?

Herpes simplex virus-2 or HSV-2 results in genital herpes and anal herpes. This virus is transmitted through sexual contact. The primary transmission mode is coming in touch with the genitals, semen, vaginal fluid, or skin sores of a person with HSV-2.

As the case with HSV-1, HSV-2 can be transmitted regardless of the fact if the person has active symptoms or the presence of sores or not. 

Difference Between Oral and Genital Herpes

It is often stated that HSV-1 causes oral herpes, while HSV-2 causes genital herpes and anal herpes. 

HSV-1 is a type of herpes virus that primarily causes oral herpes, commonly referred to as cold sores. Although, HSV-1 can also cause genital or anal blisters that may appear identical to the genital sores caused by the HSV-2 virus.

HSV-2 is another type of herpes virus that causes genital or anal sores. However, it is usually associated with other symptoms such as swollen lymph nodes, fever, and body aches.

Similarly, HSV-2 may rarely cause sores on the face or mouth. It is often impossible to look at the sore ad determine if the infection is caused by HSV-1 or HSV-2. 

Mode of transmission

HSV-1 can spread through contact with an infected person’s cold sores, oral secretions (like saliva) or genital secretions (like semen).

Commonly the virus is transmitted by:

  • kissing someone on the mouth
  • performing oral intercourse
  • sharing eating utensils or straws
  • sharing lip balms 

The virus usually affects the area where it initially comes in contact with the body. So, for instance, a person with herpes performing oral sex on their partner can transmit it to their partner, who could, as a result, develop genital sores.

On the other hand, HSV-2 is usually transmitted through sexual contact. This includes genital-to-genital contact or contact with genital secretions such as semen or vaginal fluids. 

 HSV-2 can be transmitted through:

  • vaginal intercourse 
  • oral intercourse
  • anal intercourse

How long after exposure do symptoms appear?

Once exposed to the herpes virus, the virus travels through the body, residing in the nerve cells, specifically in a dorsal root ganglion(part of the spinal cord).

For some people, the virus stays dormant and never causes any symptoms, while others may experience sores periodically once the virus activates. However, the symptoms don’t appear immediately after exposure.

There is currently limited information on the exact mechanism or the cause of why the virus activates and results in symptoms. 

However, some factors that trigger the herpes infection have been identified:

  • severe stress
  • exposure to sunlight or cold weather
  • undergoing a surgical procedure or tooth extractions
  • hormone fluctuations, such as during pregnancy or menstruation
  • fever
  • presence of other infections 

Although sometimes the triggers are random, it is hard to identify the possible cause. 

Do you have an outbreak of herpes? Talk with a doctor to get a prescription

Symptoms of Herpes

HSV does not always produce symptoms. The symptoms and severity usually depend on whether you’re experiencing your first episode of an outbreak or a recurrent infection.

Primary HSV symptoms

Symptoms of a first episode can appear anywhere from a few days to a few weeks after exposure to the herpes virus.

An initial episode can present with the following symptoms:

  • fever
  • pain at the site of the infection
  • swollen lymph nodes
  • body aches and pains
  • fatigue
  • lack of appetite

Itching or tingling can occur at the site of the infection. Following that, small, painful blisters can appear. A single blister may form a cluster. These fluid-filled blisters eventually burst and crust over before healing begins. The herpetic sores that develop during the first episode of the viral infection may take up to 6 weeks to heal completely. Sores may cause itching, and genital sores may cause a sting or pain while urinating. 

Genital herpes symptoms

HSV-2 causes genital and anal herpes. The virus is contracted through sexual contact with an individual who has the infection.

According to the statistics, World Health Organization estimates that 417 million people, or 11 percent of individuals aged 15–49 years worldwide, are currently infected with HSV-2.

Blisters or sores may appear on the:

  • penis
  • scrotum
  • vulva
  • buttocks 
  • around the anus

Anal herpes symptoms

Although many individuals do not experience symptoms immediately, they can remain symptomless for years. People who have no symptoms can still transmit the infection to others.

Some symptoms of anal herpes include:

  • Persistent pain around the anus

Herpes on the buttocks can affect the anal canal. Anal herpes in men can present as pain inside the rectum. Anal herpes pain can be persistent and feel like a stabbing/stinging pain. Anal herpes blisters can become anal ulcers due to erosion into the anal canal resulting from the passing stool. This increases the incidence of developing a secondary infection from the bacteria in the feces. Pimples may form, which often burst before the healing process commences. A foul odor is usually noticed when the fluid oozes from the open anal herpes sores.

  • Itching around the anus

Tingling or irritation around the anus can be associated with other causes, such as a fungal infection or irritation from a particular product. The symptoms may indicate mild anal herpes, or an anal herpes rash may appear. These symptoms can precede an initial anal herpes outbreak as well. Unfortunately, such symptoms are closely followed by anal ulcers, and the itching often indicates a flare-up. 

  • Red bumps or blisters, sores, or ulcers around the anus

Herpes in the anal area can begin as bumps that progress to yellow or white fluid-filled anal blisters. The most common signs of anal/genital herpes include anal herpes blisters. The anal sores begin forming clusters; over time, they scab over before healing begins.

  • Changes in bowel habits

Sores around the anus can lead to a burning sensation and continuous itching around the rectum. Constipation or diarrhea can be signs of anal herpes flare-up or an indication of internal anal herpes that can occur during a herpes outbreak. Anal herpes bleeding can occur if the ulcers form due to erosion into the anal canal. Anal herpes sores can last from 2 to 6 days or longer. 

However, if you have anal herpes sore that is not fading away, you need to consult with a doctor for an evaluation. 

Recurrent HSV symptoms

For those diagnosed with herpes, episodes can vary. Some people who live with HSV only have one episode, while others continue to have occasional outbreaks. 

After the body is exposed to the virus, it begins to produce antibodies for the virus. Therefore, recurrent episodes are less frequent and less severe.  

  • Blisters appearing during a recurrent episode tend to heal faster.
  • Blisters during a recurrent episode are less painful. 

If you’ve already experienced a few episodes, you may be aware of early signs at the site of the infection. The signs which show up a few hours or days before sores include:

  • burning
  • tingling
  • pain
  • itching

Diagnosis of Genital and Anal Herpes

HSV is not included in routine STI screenings or other lab work. According to the CDC, there isn’t sufficient evidence that diagnosing the condition even when symptoms aren’t present leads to changes in sexual behavior.

Additionally, the associated stigma may be more troublesome than the actual diagnosis. Also, there is always a possibility that an asymptomatic person could receive a false positive, resulting in unnecessary emotional unrest. 

Unless a person develops sores on the genitals or mouth or other symptoms such as burning, itching or tingling, you are unaware you have a herpes infection. However, you can talk to your doctor and get tested if you are worried about potential exposure. 

Your doctor can identify the condition by carrying out a physical examination. In addition, doctors may order a blood test to look for the herpes virus. Furthermore, a doctor may take a swab of the affected area and use the sample to run a DNA test called nucleic acid amplification testing (NAAT). Advanced tests provide fast and accurate results and help diagnose HSV-1 or HSV-2 infection.

Are you able to have sex if you have genital or anal herpes?

To prevent transmitting the infection to your partner, you should avoid intimate contact if you’re experiencing an active outbreak. For example, if you have a genital outbreak, you should avoid intercourse or genital contact or receiving oral intercourse. Even though the herpes virus is less likely to spread when no symptoms are present, the overall transmission risk can be reduced by practicing safe sex, such as using a condom or a dental dam.

Talk with a doctor to get a prescription and a lab test for herpes

Treatment for Genital and Anal Herpes

There’s currently no cure for herpes. One main reason is that the herpes virus has much more complicated DNA than other organisms causing other infections, which poses a real challenge for researchers. Potential vaccines are still being tested in clinical trials, but vaccination against herpes isn’t commercially available.

Antiviral therapy only helps manage the symptoms but does not kill the herpes virus. However, antiviral treatment does help to prevent or shorten outbreaks. In addition, if you contract HSV, the medication may help treat the sores, and it also helps lower the risk of transmission to others. Oral antivirals are commonly prescribed, but formulations in creams and injectables are also available. 

Initial treatment

After your initial diagnosis and symptoms of an infection, your doctor may prescribe you a course of antiviral therapy. Typically antivirals are prescribed for 7-10days. This usually helps ease your symptoms and prevents them from worsening. However, if your symptoms do not improve, the duration of treatment is extended. 

Once you have completed the treatment, further treatment will depend on how frequently you experience a flare-up. The treatment options mainly include intermittent or suppressive therapy.

Intermittent treatment

Your health care provider may recommend intermittent therapy after your symptoms subside after the initial treatment. For this, you need to have the medication to manage a flare-up. It is necessary to consult with your doctor to see whether you are a candidate for intermittent therapy. The treatment protocol is different for every individual and can also depend on your doctor. 

Suppressive treatment

If you are prone to frequent outbreaks, you are probably a candidate for suppressive therapy. This involves taking antiviral medication daily. This is a preventive measure. Taking herpes medication daily may significantly lower the number of outbreaks. In addition, a daily pill has been associated with a lower risk of transmission of herpes. Some studies have concluded that once-daily suppressive therapy with valacyclovir significantly reduces transmission among couples diagnosed with genital herpes.

There are several options for genital and anal herpes treatment. Over-the-counter medication, prescription medications, and home remedies help manage the symptoms. The specific treatment depends on the type and severity of the infection. Some treatment options include:

Acyclovir (Zovirax)

Acyclovir is a prescription antiviral medication. It can decrease the pain associated with outbreaks and help them heal more quicker. It can be taken orally or applied topically and helps treat the symptoms of genital herpes. In addition, in individuals with a weak immune system, acyclovir can help reduce the risk of the virus spreading to other parts of the body. In severe cases, your doctor can administer acyclovir as an IV. 

Valacyclovir (Valtrex)

Valacyclovir is taken orally in the form of a pill. It’s a prescription antiviral pill used to treat the symptoms and prevent flare-ups of genital herpes and oral herpes. People who experience frequent outbreaks are usually prescribed valacyclovir daily as part of the suppressive therapy. It helps prevent future episodes while simultaneously lowering the risk of transmission to sexual partners. 

Famciclovir (Famvir)

Famciclovir is also taken orally in the form of a tablet. It is a prescription medication for genital herpes and oral herpes both. This medicine is not the first line of treatment for people experiencing their first episode of genital herpes. This is generally recommended for people with robust immune systems. Due to limited data on the associated risks, pregnant females are not recommended this medication. Famciclovir is occasionally used to manage initial outbreaks in some patients. The drug also can be used for recurrent episodes.

The CDC discourages topical treatments for genital herpes.

Home remedies

Home remedies may not cure the virus, but they can relieve many symptoms caused by the herpes virus.

Some home remedies for herpes include:

  • applying a cold compress or a warm compress
  • applying essential oils
  • making dietary changes
  • taking supplements, like lysine and zinc

Prevention of the transmission of genial and anal herpes

Oral antiviral medications such as those discussed above help reduce the risk of transmission. These mainly include:

  • acyclovir (Zovirax)
  • famciclovir (Famvir)
  • valacyclovir (Valtrex)

In some cases, herpes may be transmitted during pregnancy or childbirth. Therefore, if you are pregnant or planning a pregnancy, it is a good idea to discuss everything with a doctor so that you know everything about herpes. 

Conditions Confused With Herpes

Symptoms of anal herpes outbreak are often confused with several other conditions such as hemorrhoids, syphilis or anal fissure. Genital herpes may be confused with folliculitis. 

Anal Herpes or Syphilis?

Herpes blisters around the anus may be mistaken for sexually transmitted infections such as syphilis. However, there are subtle differences between anal herpes and chancroid. Therefore, it is wise to consult with a doctor for an examination and a test for herpes to confirm the cause and start treatment. 

Hemorrhoids or Herpes?

Hemorrhoids are swollen veins in the rectum. They can develop inside or outside the anal canal. The external hemorrhoids can resemble the blisters or sores caused by herpes viral infection.  

Anal Fissure or Herpes?

Anal fissures are defined as small tears in the mucosa/tissue lining the anus. The tears are caused by the passage of the complex while passing the stool. This can result in bleeding and discomfort and be mistaken for a genital herpes outbreak.

Folliculitis or Herpes?

Folliculitis is a bacterial skin infection that occurs when hair follicles become blocked/inflamed. As a result, tiny hairs in the genital region or near the buttocks can become irritated due to shaving. This can result in fluid-filled bumps in the genital area. Therefore, herpes can be confused with folliculitis.

Do other types of herpes viruses exist?

There are several other subtypes of herpes viruses from the same family as HSV-1 and HSV-2. This family is called Herpesviridae. HSV-1 and HSV-2 are also known as human herpesvirus 1 (HHV-1) and human herpesvirus 2 (HHV-2). 

Some other human herpesviruses include:

  • Human herpesvirus 3 (HHV-3): This causes chickenpox lesions and is known as the varicella-zoster virus.
  • Human herpesvirus 4 (HHV-4): This virus results in infectious mononucleosis and is called the Epstein-Barr virus. 
  • Human herpesvirus 5 (HHV-5): This virus causes symptoms such as muscle aches and fatigue and is commonly known as the cytomegalovirus. 
  • Human herpesvirus 6 (HHV-6): This type causes “the sixth disease,” or roseola infantum. This primarily affects infants causing a high fever and a rash.
  • Human herpesvirus 7 (HHV-7): This virus can also result in roseola.
  • Human herpesvirus 8 (HHV-8): This virus is found to cause Kaposi sarcoma, a form of cancer.

When to Consult a Doctor

Herpes is a life-long infection. It may cause recurrent outbreaks, and therefore individuals may require a prescription at any time. Your Doctors Online has got to be covered in every aspect. Our board-certified physicians can prescribe antivirals for it. Since our doctors are available 24/7, it is very easy to get a prescription quickly if you have herpes. If you think you have herpes, talk with our online doctor to discuss testing for herpes and treatment options.

Talk with a doctor to get treatment for herpes

FAQs About Genital and Anal Herpes Answered by Our Your Doctors Online Team

What does anal herpes look like?

Anal herpes usually presents with the following symptoms:
Persistent pain around the anus
Red bumps or blisters, sores, or ulcers around the anus
Itching around the anus
Changes in bowel habits 

How do you get anal herpes?

You can get anal herpes through anal intercourse, genital intercourse, or skin-to-skin contact with an infected individual. In addition, receiving oral intercourse from an infected person can result in the transmission of the virus as well.

How do you get genital herpes?

The virus is contracted through sexual contact with an individual who has the infection. However, skin-to-skin contact can result in transmission as well. For example, if you receive oral intercourse from a person with active oral lesions, you can also get HSV. 

What does anal herpes feel like?

Anal herpes can present as discomfort and itching around the anus. You may also notice bumps or blisters around the anus as well. 

Can you get herpes from anal sex?

Yes, anal sex can result in anal herpes. In addition, skin-to-skin contact or intercourse with an infected person can result in the transmission of herpes.

Does genital herpes hurt?

In case of symptoms, herpes is painful if there is the development of genital sores. 
Genital herpes symptoms mainly include vaginal sores or sores on/inside the cervix. The sores are usually very painful.

How do you know if you have anal herpes?

You may notice pain inside or around your anus or visible sores or blisters around your anus. You can experience tingling and itching at the site as well. If you experience such symptoms, it is best to consult a health care provider for a diagnosis. 

How to prevent genital herpes?

Avoiding intercourse during an outbreak reduces the risk of transmission to your partner. For example, if you have a current genital outbreak, you should avoid intercourse or genital contact or receiving oral intercourse. The overall transmission risk can be further reduced by practicing safe sex, such as using a condom or a dental dam.

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