One in five American adults is infected with genital herpes, notes the Centers for Disease Control and Prevention (CDC). However, in some cases, genital herpes may also affect the anus. Anal herpes are most commonly experienced by people who engage in anal intercourse; however, some people with anal herpes report no such history. Symptoms of anal herpes can be divided into four categories.
The characteristic herpes lesions can be seen on and around the anus in many instances of anal herpes. According to a 2007 report in "Clinics in Colon and Rectal Surgery," perianal herpes lesions look like "dewdrops on rose petals," with small (1 to 2mm) fluid-filled blisters scattered over raised, red patches. the lesions are initially painful, and after a few days usually rupture, crust and become itchy.
Anal herpes lesions typically rupture a few days after they appear, leaving behind superficial erosions. These erosions are subject to mechanical trauma from passing stool, and secondary bacterial infections from bacteria present in stool. In a 2009 study published in the journal "Diseases of the Colon and Rectum," blood in the stools, anal drainage of blood, and pus and odor were the most common complaints in patients with anal herpes.
Pain was the second most common complaint of patients with anal herpes in the "Diseases of the Colon and Rectum" study. Pain was described variously as generalized anorectal pain, painful bowel movements, tingling or burning over the anorectal area or buttocks, and shooting pain down the back of the thighs. Some people with anal herpes also present with tender, pea- or marble-sized lumps in the groin. These constitute swollen inguinal lymph nodes.
Change in Bowel Habits
Change in bowel habits is a commonly overlooked symptom of anal herpes. People with anal herpes may complain of constipation, diarrhea or abnormal stool consistency, according to the CDC. In longstanding anal herpes, patients may even present with a history of weight loss due to voluntary food restriction in an effort to avoid exacerbation of symptoms.