STDs Expert Forum
ANAL HERPES
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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ANAL HERPES

I had anal pain 3 months ago ,doctoer told me it is  herpes and she described me  Valtrex 1gm 2tbs every day for 10 days and i  did a culture test , i started took the medicine for two days and the pain gone but i was very stressed and i went very crazy to the point that i could not sleep , eat and the drup start gave me more side effects like fatigue, headacke....and i have visited her after three days and i told her about the side effects and she told me that i can wait until the result of the test and after 10 days or so the culture test was NEGATIVE for both and i did the blood test and it was Negative for HSV2 but Positive for HSV1 and another doctor in the same  clinic told me that it is just ORAL herpes , i relexaed a little and then i went to run the other STDS tests in another clinic and it  was NEGATIVE for HIV , Clamedyia, Gonorehea and Syhpilis and i told the doctor about what happened to me and after she examined me she told me that it is HEMORROIDES and it is not Herpes , but the issue still in my mind and i am still stressed about it and i still have a burning sensation along with leg pain ....later on i have visited the same clinic and another doctor examined me and she confirmed that it is just Hemorroides and she described me a hydrocoritzone cream for a week which it helps me alot and one of my friend advised me to use Prepation H  which helps me alot  and a  week ago , i did the blood test in another clinic and the result came Negative for HSV2 and Positive for HSV1 and i told the doctor the whole story and he confirmed that it is Hemorooides only  so the

i had received oral sex to my anus many times please advice

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239123_tn?1267651214
Welcome to the STD forum.

You had accurate advice on the community forum:  it is not possible to know at this point whether or not you anal herpes; or, if you do, whether it is caused by HSV-1 or HSV-2.  

If the doc who first examined you is familiar with herpes, her opintion has to be respected.  That makes anal herpes more likely, as does the apparent quick improvement when you took Valtrex.  However, you now have another doctor who suspects a hemorrhoid problem.  But of course you could have both problems; if the initial symptoms were indeed herpes but cleared up substantially, if not completely, on Valtrec, then only hemorrhoids might have been apparent at follow-up.

If you have anal herpes, my bet is on HSV-2 as the cause.  Anal HSV-1 is a lot less common than anal HSV-2.  It takes a few weeks for the HSV blood tests to become positive, so your positive test for HSV-1 -- which indeed mostly causes oral herpes -- probably reflects a distant infection. Half of all adults in the US have positive HSV-1 blood tests, mostly due to oral infection in childhood -- and most of those have no recollection of symptoms that suggest oral herpes.

I can't tell the timing of your latest negative HSV-2 blood test.  If that was quite recent, i.e. 3 months after onset of symptoms, it proves that you don't have anal herpes due to HSV-2.  There's also another big gap in your story:  What sort of sexual exposures did you have, that involved your anus, in the weeks before your symptoms started?  What do you know about that/those partner(s)?  This could help sort things out.

What to do now?  First, if you haven't had an HSV-2 blood test at least 3 months after onset of symptoms, do it now. If it has become positive, you will know you had anal herpes.  If it remains negative, it means that either you didn't have anal herpes at all; or possibly you had it, but HSV-1 was the cause.

Second, if and when you have another episode of painful anal lesions, see a health care provider immediately -- within 1-2 days -- for retesting for the virus by culture or PCR.  If positive for either HSV-1 or 2, it will nail the diagnosis.

If you have anal HSV-2, you can expect repeat outbreaks from time to time, and there will be a risk of transmission to sex partner by any sex involving your anus/rectum.  Also, your risk of HIV, if exposed, will be higher than otherwise.  If you have anal HSV-1, you probably will have few or no recurrent outbreaks, transmission to herpes will not be a high risk, and it will not place you at increased risk of HIV.

In closing, my bet is against herpes at all.  Continue to follow up with your doctor(s) about continuing symptoms or if you still have questions about all this.  Be aware that this forum is not ever going to be a source to determine exactly what your diagnosis is.

Good luck--  HHH, MD
6 Comments
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Avatar_m_tn
I had blood test 3 months after expsure......i had oral sex to my anus more than three months ago..... I did not do any knid of sex since then..My questions are:

Thanks for your reply and here is some more informations :

1-If it is ONLY anal herpes due to HSV1 , and i need to do normal sex with my girl friend , what is the chances to infect her .

2-I do not think that the first doctor was very confident about herpes as when i keep asking her many questions, she is trying to finish it fast

3-I tried to take Valtrex again when the pain came back, it did not give me any improvement .

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239123_tn?1267651214
So for sure you don't have anal herpes due to HSV-2.  Most likely you don't have anal herpes at all.

1) If you have anal herpes, it is due to HSV-1 and there is little or no risk of transmission to your gf.

2) That would seem to reduce the chance you have herpes.

3) Herpes does not cause pain as the only symptom.  And lack of improvement with Valtrex also means it wasn't due to herpes.

As I said above, a distant online source like this forum is not the way you are going to get final answers. That can only come with direct medical care.
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Avatar_m_tn
Thank you so much for those valuable informations and i do have some more for you:

Everytime, i use the restroom , i feel a burning sensation and leg pain which continues for awhile and it goes away and by the time now i do not have all those symptoms and i feel discomfort only  but it goes away very fast.




What is your advice for me to close that issue as it is still in my mind more than 3 months now
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239123_tn?1267651214
Herpes is not a likely cause of that symptom.  Also, herpes does not generally cause pain as the only symptom, without open sores.  As I said above, as I consider the entire story and test results, I'm pretty sure the initial problem was not herpes at all.  Your positive blood test for HSV-1 probably reflects distant (childhood) oral infection and is unrelated to the more recent medical events.  And as I also said, if you indeed have anal HSV-1, it likely will not be a problem again and will not be transmitted to sex partners.

Either way, it isn't a problem.  If anal pain or other symptoms persist, you're going to have to look to causes other than herpes.

And that's my sole advice for you "to close that issue".  This isn't a counseling site; all we can do is state the facts and/or our interpretation of the probabilities.  The rest is up to you.

That should end this thread.  Take care--  HHH, MD
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Avatar_m_tn
I do really appreciated your advice and help.

Thanks alot

You have a great wekend
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