Anal Herpes

Overview

Anal herpes is a viral infection caused by the herpes simplex virus (HSV). HSV is the same virus family that causes cold sores and genital herpes. In anal herpes, the virus causes painful blisters or sores around the anus. It is passed on through close skin-to-skin contact, often during anal or oral-anal sex. Once the virus is in your body, it stays there for life and may become active from time to time.

Anal herpes is less common than oral or genital herpes, but it is a recognised condition that general practitioners and sexual health clinics see regularly.

Anyone who has anal sex or oral-anal contact with someone who has herpes can get anal herpes. It can also be passed through direct skin-to-skin contact with the infected area, so it is not limited to people of a certain age, gender, or sexual orientation.

Symptoms

Common symptoms

• Small, painful blisters or sores around the anus
• Itching, burning, or a tingling feeling before blisters appear
• Pain during bowel movements
• Discharge from the anus or a feeling of moisture
• Swollen glands in the groin
• Flu-like symptoms such as fever, headache, and tiredness

Symptoms in children

• Anal pain, itching, or discomfort
• Blisters or sores around the anus
• Crying or restlessness during nappy changes or cleaning
• Unexplained fever or poor appetite

Symptoms in older adults

• The same symptoms as any adult, but outbreaks may last longer
• Older adults may have a weaker immune response, so sores may be slower to heal
• Skin changes may look different and can be mistaken for tears or other skin conditions

Causes

Main causes

• Herpes simplex virus type 1 (HSV-1), often passed from a cold sore during oral sex
• Herpes simplex virus type 2 (HSV-2), often passed from genital herpes during anal or vaginal sex
• Direct skin-to-skin contact with an infected person, including oral-anal contact

Risk factors

• Having anal sex or oral-anal contact with someone who has herpes
• Having multiple sexual partners
• Having sex without barrier protection such as condoms or dental dams
• A weakened immune system, which can make outbreaks more likely or more severe

When to see a doctor

See a doctor urgently if:

• If you cannot pass urine or feel severe low back pain and leg weakness, get same-day medical help.
• If you are pregnant and you think you may have herpes for the first time, see a doctor urgently.

Book a routine appointment if:

• If you notice blisters, sores, or unusual pain around the anus that do not heal within a few days.
• If you have repeated episodes of anal itching or burning.
• If you are worried about a possible exposure to herpes.

Diagnosis

A doctor or nurse can usually tell if you have anal herpes by looking at the area. They may gently wipe a swab over a sore to send to a laboratory.

Tests that may be done

• A viral swab test – a soft cotton bud is rubbed over a sore to collect fluid and cell samples.
• A blood test – this looks for antibodies to the herpes virus, but it is not used in every case.
• A physical examination – the doctor checks the area around your anus and possibly inside the lower rectum.

What to expect at your appointment

The examination may feel uncomfortable, but you can ask for a chaperone or a clinician of a gender you feel more comfortable with. You do not need a full sexual health screen unless you want one, but it is often offered at the same time.

Treatment

There is no cure for herpes, but treatment can reduce pain, shorten an outbreak, and reduce the chance of passing the virus. Your doctor or sexual health clinic will recommend a plan based on how severe or frequent your symptoms are.

Self-care at home

• Take a warm sitz bath (sitting in a few inches of warm water) for 10–15 minutes to help the area feel more comfortable.
• Keep the area clean and dry, and wear loose cotton underwear.
• Use a cool compress or a soft cloth to relieve itching.
• Apply plain petroleum jelly or a protective barrier before using the toilet to reduce stinging.
• Drink plenty of fluids to keep urine less concentrated and reduce pain when urinating.
• Avoid friction or sex until the sores have healed completely.

Medical treatments

Antiviral medication can be prescribed by a doctor to help sores heal faster and lower the risk of future outbreaks. These medicines work by stopping the virus from multiplying. For frequent or severe episodes, some doctors recommend taking antiviral medication every day as a preventive treatment. Your doctor or sexual health clinic will discuss which option fits your situation. Do not self-treat with creams made for other skin problems without medical advice.

When is surgery considered?

Surgery is not usually needed for anal herpes. Rarely, a doctor may need to drain a very large fluid-filled blister, but this is uncommon.

Living with this condition

Most people manage anal herpes with simple self-care. Learn the early warning signs of an outbreak, such as tingling or burning, so you can start treatment quickly.

Lifestyle tips

• Get enough sleep and find ways to manage stress, such as walking or gentle breathing exercises.
• Avoid alcohol and smoking, as they can make your immune system less effective.
• Talk openly with sexual partners about herpes and your protection strategy.

Diet and exercise

No specific diet treats herpes, but eating a balanced diet with vegetables, fruits, and whole foods supports your immune system. Regular exercise helps reduce stress and boosts your overall health.

Mental health and emotional wellbeing

A herpes diagnosis can feel shameful or worrying, especially because of stigma. These feelings are normal, and talking about them with your GP or a counsellor can help. For some people, a new diagnosis brings up anxiety about relationships or sex, and those feelings deserve attention. If you are struggling to cope or have thoughts of self-harm, please contact your local emergency number or a mental health crisis service immediately.

Prevention

You can reduce the risk of anal herpes by using condoms and dental dams, talking openly with partners, and avoiding skin-to-skin contact when you or they have active sores. It cannot be completely prevented, because the virus can be passed even when there are no visible symptoms.

Vaccines

There is no vaccine that prevents herpes at this time.

Screening programmes

There is no routine screening test for herpes. If you have symptoms, a clinic will test you then. You can also have a blood test if you have concerns about past exposure.

Complications

If left untreated

• More frequent or longer outbreaks in the future.
• Spreading the virus to a sexual partner.
• Rarely, a severe infection in people with weakened immune systems.
• In pregnancy, a first-time herpes infection can rarely cause problems for the baby, so early medical advice is important.

Long-term outlook

Herpes is not a dangerous condition for most people. Outbreaks usually become shorter and less frequent over time. With good treatment and self-care, you can manage anal herpes and have a healthy, active sex life. The hardest part is often the emotional worry, and support is available.

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