Anal herpes: symptoms, treatments, and prevention

If you’ve had a sexual encounter with someone with anal herpes, or you’ve noticed some painful sores around your anus, you may want to know more about this sexually transmitted infection. 

Let’s break down what anal herpes is, how to recognize it, and what treatments are available if you have it. 

Anal herpes is a sexually transmitted infection (STI) characterized by painful or itchy sores, blisters, and lesions around the anus. 

It is caused by one of two types of the herpes simplex virus (HSV): HSV-1 or HSV-2. Typically, HSV-1 affects the mouth while HSV-2 affects the anus and genitals, but either type of herpes can cause this condition (Mathew, Jr., 2021; Sandgren, 2017). 

Yes, anal herpes is contagious and can be transmitted from person to person through sexual contact or intercourse—usually through skin contact with the herpes sores or blisters. It can also be passed through the fluids you may encounter during intercourse, such as saliva or semen, or by sharing sex toys (IQWiG, 2018; Mathew, Jr., 2021). 

HSV can also be transmitted when a person is asymptomatic, meaning their herpes symptoms are mild, nonexistent, or confused with other conditions (Sauerbrei, 2016). 

As a result, a person may pass on the virus without realizing it. In fact, experts estimate as many as 90% of herpes infections are undiagnosed (Mathew, Jr., 2021).

Several conditions can cause lesions on the buttocks besides HSV, including syphilis, lymphogranuloma venereum (a form of chlamydia), and hemorrhoids. The symptoms of anal herpes include (Mathew, Jr., 2021; Assi, 2014):

• Painful red bumps, blisters, or sores around the anus

• Scabs or crusting over from broken or bleeding sores

• Pain, itching, or irritation in the anal area

Additional symptoms may include flu-like symptoms like fever, headache, and general malaise, as well as constipation (Mathew, Jr., 2021; Assi, 2014).

Herpes symptoms may appear within two to 12 days of exposure (Sauerbrei, 2016). They are typically worst during the first outbreak, which may last two to three weeks (IQWiG, 2018; Mathew, Jr., 2021). 

Researchers do not know what specifically triggers a herpes outbreak, but some research has linked them to stress, sun exposure, illness, and injury (IQWiG, 2018; Sandgren, 2017). People with a weakened immune system may experience more severe and more frequent outbreaks as well (Sauerbrei, 2016).

Often, a physical exam is enough to diagnose anal herpes. 

But, because anal herpes has similar symptoms to other conditions, your healthcare provider may choose to order additional testing to ensure you have anal herpes before recommending treatment options. These tests may include a blood test or sending an anal swab to a lab (Mathew, Jr., 2021; Assi, 2014).

No, like other forms of herpes, anal herpes is not curable and is considered a lifelong condition. After the initial outbreak, the virus spreads to your nerve cells, where it remains permanently. 

Due to this, the virus will always be present in your body, although it can be dormant for periods of time. However, treatment can help you manage your herpes symptoms and reduce the risk of spreading it to a sexual partner (Mathew, Jr., 2021).

Anal herpes treatment reduces the intensity, frequency, and duration of anal herpes outbreaks. It’s also designed to reduce your risk of transmitting the infection to a sexual partner. Treatment includes antiviral therapy through medication (Mathew, Jr., 2021; Sandgren, 2017)

Antiviral medications like acyclovir, valacyclovir (see Important Safety Information), or famciclovir help relieve symptoms and shorten an active outbreak. They are often prescribed for one to two weeks. However, your healthcare provider may recommend taking these medications on a longer-term basis to further reduce your risk of recurrent outbreaks in the future and passing HSV on to someone else. This is known as suppressive therapy.

It’s important to remember that even if you respond well to treatment, that does not mean the virus is cured; it is only dormant. It’s still possible that you will have a herpes outbreak in the future.

Fortunately, researchers continue to develop new medications to treat herpes and speed up healing after an outbreak. There’s also the possibility a vaccine could lessen the severity of symptoms in the future (Mathew, Jr., 2021).

Besides abstaining from sex altogether, the best way to prevent anal herpes is to practice safe sex by doing the following (IQWiG, 2018; Mathew, Jr., 2021):

• Always use barrier protection (e.g., condoms) during sexual activity, including vaginal, oral, and anal sex.

• If you’re sexually active, get tested regularly.

• Ask your sexual partners to also get tested regularly.

• Limit the number of people you have sex with.

• Discuss STIs with new sexual partners before having sex.

• Do not share sex toys with someone who has herpes.

• If one of your sexual partners has herpes, abstain from sex during an active outbreak.

Some people may be at an increased risk of contracting anal herpes. These include women, African Americans, and people with a higher number of sexual partners (Mathew, Jr., 2021).

A note about herpes and HIV: Genital herpes can increase your risk of getting HIV (Mathew, Jr., 2021; Rübben, 2020). And having an STI like HIV is a risk factor for contracting genital herpes (IQWiG, 2018). 

If you notice signs of herpes, contact your healthcare provider. Even if you have not seen symptoms, if you’ve recently been sexually active with someone who told you they had anal herpes, make an appointment so you can get tested.

And if you receive an anal herpes diagnosis, know that this does not mean you can’t have a fulfilling sex life. By following their healthcare providers’ medical advice, avoiding sex during outbreaks, using condoms to avoid skin-to-skin contact, and taking advantage of antiviral therapies, many people with herpes are able to have active and satisfying sex lives.

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Current version

June 13, 2022

Written by

Amelia Willson

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.