Anal Herpes: Symptoms, Treatment, Appearance & More

What is anal herpes?

Anal herpes is a strain of the herpes simplex virus that manifests as white or red pus-filled sores, bumps or blisters around the anus. Transmission of this virus is facilitated through anal sex.

How can you get herpes on the bum?

The transmission of anal herpes is achieved in a variety of ways, including:

• Receiving anal sex from an infected individual
• Receiving oral-anal sex (mouth-to-anus) from a sexual partner infected with HSV-1/oral herpes
• Making direct contact with an infected individual’s anal sores
• An affected region of the body spreading to another, resulting in blisters on the anus

Anal herpes symptoms

The symptoms attributed to an anal herpes outbreak have similar characteristics to several other conditions, making them difficult to diagnose. Syphilis, as outlined by the Centres for Disease Control (CDC), is one example of a sexually transmitted infection (STI) that presents in the same areas of the body. 

When first contracting the herpes virus, signs of the preliminary outbreak typically present within two to ten days after the virus enters the body. The first outbreak is usually the most severe and may be accompanied by fever, chills, fatigue, muscle aches and nausea.

If you’re experiencing the symptoms that could be the result of an anal herpes outbreak, you should consult your doctor or pharmacist, in order to seek treatment.

Symptoms of anal herpes include:

Painful blisters or sores around the anus

Bumps that become irritated and filled with a yellow or white fluid are the most common signs of an anal herpes outbreak. Raised, red skin surrounding the anus precedes the appearance of these blisters, which follow a tingling or itching sensation in the affected area. 12 to 24 hours later, the anal sores begin to form in a cluster or honeycomb-like pattern, filling with fluid, before opening and becoming ulcers or blisters. These sores eventually scab over before healing. 

Itching around the anus

The tingling or irritation around the anus is often incorrectly attributed to other causes, due to the relative normality of the tissue preceding an initial anal herpes outbreak. Most likely caused by anal ulcers as they begin to emerge on the surface of the delicate tissue surrounding the rectum, this itching is an unfortunate indication of a flare-up.

Change in bowel habits 

Sores around the anus can lead to symptoms that, like the persistent itching or burning sensation surrounding the rectum, are often attributed to other causes. Constipation, diarrhoea or stool consistency differing from normal, are signs that a flare-up might be imminent, or symptoms that may present during a herpes blister outbreak. 

Pain around the anus

Herpes on the bum also affects the anal canal, and pain inside the rectum can represent another affectation of the HSV-2 virus. Blisters around the rectum eventually form anal ulcers, which can cause erosion in the anal canal as a result of the trauma from passing stool. Affected individuals also suffer the risk of secondary infection from the bacteria in faeces. This can be painful and cause pustules to form, which often burst prior to the healing process. A strong, foul odour often accompanies the fluid as it emerges from the open wound.

How long do anal herpes symptoms take to heal?

Herpes on the bum cheeks may heal significantly faster than herpes inside the anal canal or on the anus itself, as the virus thrives in moist areas. Most genital herpes outbreaks progress through stages. The healing process attributed to anal herpes is as follows:

• During the prodrome or initial stage, an individual is highly contagious. Before the formation of blisters, an infected person will experience sensitivity around the anus, which usually lasts 1 to 4 days.
• Lesions appear in the anal canal and surrounding the anus, resulting in pain and sensitivity as they fill with fluid. The sores typically last from 2 to 6 days.
• The lesions will continue to grow and fill with fluid, until they burst. The sores may remain open and fluid may be emitted for around 1 to 4 days.
• The affected area where the wounds are healing will scab and dry out, usually over the course of 3 to 7 days.

Anal herpes treatment

Anal sores are classified as a form of genital herpes, and so treatment protocols remain the same as other areas affected by the HSV-2 virus.

Genital herpes is treated using antiviral medications. Two of the most common treatments are Aciclovir (commonly sold under the brand name Zovirax) and Valaciclovir (also known as Valtrex). These medications can be effectively utilised to reduce the length and severity of an outbreak, and can also be used as a long-term treatment to prevent or reduce the chances of an outbreak. 
Suppressive therapy with medication is an effective treatment used to reduce outbreaks and lower the chances of passing the infection on. With this method, taking antiviral medication daily helps reduce the frequency and severity of symptomatic episodes.

Activities that boost immune system function, such as exercise, sunlight and a healthy balanced diet can also greatly reduce the frequency of anal herpes flare-ups.

How to prevent herpes sores around the anus

There is herpes suppression treatment for those that experience outbreaks 6 or more times a year. The dose for Aciclovir 400mg is 400mg (1 tablet), twice daily ongoing and for valaciclovir, the dose is 500mg one tablet daily. 

A strong immune system is also key to reducing the chances of an outbreak. You can keep your immune system in good order by:

• Eating healthily
• Avoiding alcohol
• Maintaining a good weight
• Quitting smoking
• Sleeping well
• Minimising stress

If you do not have genital herpes, you can prevent catching anal herpes by:

• Using a barrier form of contraception and ensuring sexual partners do the same. This can be in the form of a condom or a dam, which can be used to cover the anus, if engaging in anal sex, or oral-anal sex.
• Avoiding sexual activity with a partner if they are exhibiting symptoms. This is because herpes is most contagious during an outbreak

Is anal herpes contagious?

People with genital herpes sores should consider abstaining from sexual activity whilst experiencing symptoms, as the virus is most contagious at this stage. Although anal herpes can still be transmitted without an active, presenting episode, the chances of transmission increase exponentially if anal sores are visible on the skin. 

An infected individual should always use condoms or other barrier methods when engaging in sexual activity. If receiving anal or oral sex, best practises require the use of a condom or dental dam in order to prevent transmission of HSV-2.

Is there a cure for anal herpes?

There is currently no cure for anal herpes. Whilst doctors and experts are able to treat the infection via medications – and infected individuals can lower the frequency and duration of their outbreaks – an outright cure for HSV-1 and HSV-2 has yet to be discovered.

Researchers are actively searching for new treatments in order to combat herpes.

What else could it be?

Herpes blisters around the anus can be mistaken for other conditions and sexually transmitted infections. A recent STD Center report clarifies the sometimes subtle differences between anal herpes and conditions such as Chancroid. Sores around the anus can be difficult to self-identify, and as a result, it is always best to seek an examination, or taking a herpes test, before commencing treatment. Here are some of the other conditions and ailments that resemble an HSV-2 flare-up of anal herpes.

Folliculitis is a common skin reaction when hair follicles become inflamed. Tiny hairs surrounding the buttocks can become irritated as a result of grooming or wiping activities, and become raw and sore the way anal herpes symptoms present in the initial stages. Herpes on the bum cheeks can be confused with folliculitis as there is often hair follicles within this region.

Haemorrhoids, also known as piles, are swollen veins in the anus. Haemorrhoids can develop inside or outside the rectum, with external lesions somewhat resembling the blisters and ulcers caused as a result of the herpes simplex virus. 

Anal fissures are small tears in the thin, moist tissue lining the anus, and are caused by the passage of hard or large stools during bowel movements. Typically, they result in bleeding and can be a significant source of pain somewhat similar in nature to the discomfort associated with a genital herpes outbreak.

Living with anal herpes

It is important to understand that you don’t have to suffer when living with anal herpes. The prevalence of medications, treatments and remedies available today, ensure flare-ups and outbreak effects are reduced. Whilst the herpes simplex virus is one of the most common sexually transmitted diseases in the world, the wealth of information available to you can offer insight into early-onset detection. By taking precautionary and preventive measures, the virus may not dramatically impact your daily routine.

Maintaining healthy immune function via exercise and a balanced diet, avoiding stress and maximising the quality of your sleep are additional steps you can take to slow the outbreaks associated with the HSV-2 virus.

Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.