One in 6 Americans aged 14 to 49 has genital herpes, reports the Centers for Disease Control and Prevention (CDC). This herpes simplex virus (HSV) infection can involve the genitals, anal area, or both. Anal involvement with herpes most commonly affects people who engage in anal intercourse. However, involvement of this area may be due to spread from the genital region. CDC points out that most people with herpes have mild symptoms or no symptoms at all. In those who experience symptoms, they are virtually identical in the genital and anal regions, with a few notable exceptions.
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Herpes lesions may occur around the anus at the time of an initial HSV infection or during a subsequent flareup. The rash initially appears as tiny fluid-filled blisters arising from a reddened skin base. The blisters soon rupture leaving small open ulcers, which then crust over and heal. Left untreated, the rash typically lasts 2 to 4 weeks, from outbreak to clearance. Because the anal region is not easily seen, many people may not realize they have an anal herpes rash.
Pain and Other Sensations
An anal herpes flareup is sometimes preceded by tingling, burning or shooting pain in the area around the anus where the rash will subsequently erupt. These sensations may occur hours to days before the skin rash appears. The herpes rash is painful. Anal lesions can be particularly uncomfortable due to friction from undergarments and clothing, and irritation of the skin related to bowel movements. An anal herpes rash can also become infected with bacteria, causing additional pain. Itchiness and burning can persist until the rash clears.
People with anal herpes often have unseen lesions inside the anus and rectum. As with the external skin rash, these lesions start as blisters and become ulcers. Internal anal and rectual herpes lesions can lead to significant erosions due to mechanical trauma from passing stool and secondary infection caused by bacteria in stool. Inflammation of the rectum and anus, known medically as proctitis, often leads to drainage of bloody or pus-like fluid from the anus accompanied by a foul odor. Passage of stool in people with herpes-related proctitis is typically very painful.
Change in Bowel Habits
Change in bowel habits is a frequently overlooked symptom of anal herpes. People with anal herpes may complain of constipation, diarrhea, abnormal stool consistency and foul odor. In people with longstanding anal herpes, weight loss can occur due to voluntary food restriction in an effort to avoid pain and other symptoms associated with bowel movements.
Warnings and Precautions
Seek medical care as soon as possible if you think you might have anal herpes. Antiviral medications can reduce the duration and severity of an outbreak, and ongoing treatment can reduce the frequency of recurrent episodes. CDC-recommended antiviral medicines for genital herpes include acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir). Medical evaluation and diagnosis are also important so you can be checked for other sexually transmitted infections.
Reviewed by: Tina M. St. John, M.D.