Anal Herpes: Symptoms, Treatment, Prevention & More

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
March 31, 2022

According to the World Health Organization (WHO), an estimated 491 million people aged 15-49 (13%) worldwide are carrying the genital herpes virus.

Many people experience no symptoms, but the virus still remains contagious, passed on through close, direct, and intimate contact with an infected individual.

Having unprotected sex with someone can put you at risk of contracting any sexually transmitted infection (STI).

Anal herpes is a strain of the herpes simplex virus that manifests as red or white sores or pus-filled blisters around the anus, and can be passed to another person through anal sex.

While there is no cure, there are several treatment options available to help manage your symptoms.

In this article, I’ll go over what anal herpes is. I’ll discuss treatment, symptoms and prevention. I’ll also discuss when to see a doctor.

What is Anal Herpes?

Herpes is a contagious virus that affects almost half of American adults under 50 years old.

There are two strains of herpes simplex viruses: HSV-1, which affects the mouth, and HSV-2, which affects the genitals and anus, and is spread through close, direct, and intimate contact.

While herpes can cause painful sores, blisters, and ulcers around the area of infection (most often on the mouth and genitals), some people experience mild symptoms or no symptoms at all.

This can be problematic as they are unaware they are potentially exposing others.

Once you contract HSV, the infection is lifelong as there is no known cure. Initially, you will go through an acute phase, where symptoms, if prevalent, will be more severe.

After this phase, the virus will move from your skin cells and into your nervous system, where it will lay dormant until it is reactivated. 

Several circumstances can trigger an outbreak such as a weakened immune system, including during illness or surgery, significant sun exposure, pregnancy, or other times of physical or emotional stress.

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Anal Herpes Symptoms

The symptoms of anal herpes are similar to the symptoms of several other conditions including hemorrhoids and syphilis, which can make it difficult to diagnose.

You should consult your doctor for a physical examination if you have any of the following tell-tale signs of anal herpes:

  • Red bumps or painful, colorless blisters 
  • Persistent pain around the anus in the anal canal
  • Itching around the anus
  • Ulcers that develop at the site of original blisters
  • Changes in bowel habits
  • Scabs that form from ulcers that have ruptured or bled

When you first contract anal herpes, your symptoms will typically appear within 2-10 days after the virus enters the body.

The first outbreak is often more severe than subsequent outbreaks.

Initial symptoms of an outbreak may include:

Anal Herpes Treatment

Antiviral medications, such as acyclovir, famciclovir, and valacyclovir are the most effective medications for treating anal herpes.

These medications cannot cure HSV-2, but they can reduce the severity and frequency of symptoms.

They can also shorten the duration of the infection, which improves the chances of the virus being passed on to a sexual partner.

In some cases, if your anal herpes is severe, your doctor may suggest intravenous antiviral therapy.

This involves injecting the antiviral medication directly into your bloodstream using a needle inserted into a vein.

Is Anal Herpes Contagious?

HSV-2 is contagious and is almost exclusively transmitted through genital-to-genital contact during sex.

Sexual contact with an infected person can result in anal herpes.

You are more likely to spread the virus when symptoms are present but it can still be transmitted to others even in the absence of symptoms.

Can Anal Herpes be Cured?

Unfortunately, there is no cure for HSV, and once you are infected, the virus will stay in your nerve cells for the rest of your life. However, symptoms can be managed relatively easily with antiviral medications.

The virus is rarely a dangerous or life-threatening condition, but to ensure the safety of others, you should get regular STD checkups and practice safe sex.

Certain circumstances can cause a recurrence of the condition.

You may experience an outbreak if you:

  • Are stressed
  • Have a weakened immune system due to illness or surgery
  • Have been exposed to direct, intense sunlight
  • Are fatigued 
  • Are pregnant

Recurring outbreaks tend to be shorter and less severe than the initial outbreak.

Although the virus is life-long, the number of outbreaks may gradually reduce over time.


People with genital HSV infection should abstain from sexual activity whilst experiencing symptoms.

This is when the virus is more contagious, but it can still be transmitted when no symptoms are felt or visible.

You can reduce the risk of contracting HSV-2 by:

  • Always using a barrier contraception during sexual activity (vaginal, anal, or oral sex) such as condoms
  • Getting regular sexual health screenings for STIs
  • Ensuring all your sexual partners also undergo routine sexual health screening or practicing monogamy if you are in a relationship
  • Abstaining from sex altogether

Risk Factors

If you have HSV-2, you can be more susceptible to HIV.

This is because herpes infection can cause open sores or breaks in the skin or lining of the mouth, vagina, and rectum, providing a way for HIV to enter the body.

Not only this, but herpes increases the number of immune cells in the lining of the genitals, which HIV targets to enter the bloodstream. 

If you test positive for HSV-2, you should also receive HIV testing.

Additionally, if you test positive for both HSV-2 and HIV, you run an even higher risk of passing this to a sexual partner.

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When to See a Doctor 

You should visit your doctor immediately if you have any symptoms of anal or genital herpes.

Your doctor will do a physical examination and they may want to do additional testing to determine if you have any other STDs. 

To protect yourself and your partners from STDs, you should get regular testing from your healthcare provider or an STD clinic.

This is important, as many cases of herpes are asymptomatic and you could contract or be spreading the virus without being aware.

How K Health Can Help

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Check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes. 

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Frequently Asked Questions

Can herpes be mistaken for hemorrhoids?
Herpes can easily be mistaken for hemorrhoids and syphilis. Hemorrhoids are veins around the anus that have become inflamed and irritated. These can be mistaken for the lesions that can occur from an anal herpes outbreak.
Can herpes be spread anally?
Yes, herpes can be spread through direct, intimate, and sexual contact with an infected person. You can pass herpes through anal sex as well as vaginal sex and oral sex.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.