Anal Herpes

[flyingcliff]

1. Is it possible I could have gotten herepes 4 years ago from the protected anal sex and am just having symptoms now?

2. If that is not possible, then how could I have anal herpes when I haven't had anal sex in years and have never had unprotected receptive anal sex? I understand that I am at risk for herpes but the placement of them seems a little strange.

4. Do I need testing and what test should I get done because I know there are certain ones that aren't reliable?

[H. Hunter Handsfield, M.D.]

People can and do get anal herpes without having anal sex at all.  A substantial minority of people with genital HSV-2 have anal recurrent outbreaks, even if the initial infection was not in the anal area.  In other words, anybody with HSV-2, and some people with gential HSV-1 infections, can have anal recurrent outbreaks and/or asymptomatic shedding of HSV in the anal area.  For obvious reasons, anal herpes probably is most common among men who have sex with men, typically from anal sex; next most common in heterosexual women; and least common, but still not rare, in strictly heterosexual men whose anal areas have never been sexually involved.  To the specific questions:

1) As suggested above, with or without anal sex, and regardless of condom use, it is possible for any sexually active person to have recurrent or asymptomatic anal herpes.

2) Explained above.

3) You don't provide enough information to know whether or not you should be tested for HSV infection in general or anal herpes in particular.  Your question implies you have had anal symptoms of some sort.  If so, you should see a health care provider the next time those symptoms occur, especially if the symptoms involve anal sores, for possible direct testing for the virus.  Or you might have a blood test to determine whether you are infected with HSV-2.  I might be able to give you more specific guidance if you want to post a follow-up comment with more details about the reasons for your questions, including your sex and the nature of your sexual exposures.

I hope this helps.  Best wishes--  HHH, MD

[flyingcliff]

Hey thanks so much. Um I don't really no where to begin as far as my sexual past only to say I have been careful with almost all of my sexual experience except for the 4 unprotected vaginal sex encounters I have had within the last 6 months. Of all those experiences I am positive that 2 of them aren't infected with an std and the other 2 I am not sure of. The more I have looked at the sores/fissures they seems to look more hemorroids (hemorrhoids). Does that and herpes have similar symptoms? It seems as though the sores are like raw skin and when poked at or wiped they bleed and that it is more on the inside of the anus than I first thought. I have read up on some other posts and you said that anal herpes tends not to bleed, correct?

I know that gay/bisexual men are more likely to have herpes but I have not had a relation with a man for about 4 months and when I did so it was only mutual oral sex and was protected and I didn't have any symptoms. It was a transexual prostitute and I know that you say most prostitutes in America don't have std's. I haven't had anal sex receptive or insertive for over 3 years. I try my best to be smart and be protected and sometimes I do mess up but I think I have learned a lot about how sti's are transmitted (thanks to you) and all I can say is that most of my sexual experiences have been low risk, except for the 4 unprotected vaginal sex acts. The reason i don't go further past the 6 month mark is because I had a full std screening and I was negative for everything but HPV. I just was unsure of the test I took for herpes because you said some tests like the herpes select give false information, so I might have gotten a false negative on the herpes test and thought maybe this was my first outbreak.

[H. Hunter Handsfield, M.D.]

Thanks for the additional information.  It really doesn't change much.  Just to clarify a couple of additional points raised by these comments:

Your sexual lifestyle puts you at the low end of the STD/HIV risk spectrum.  There is no way to be so certain one or more of your past partners didn't have herpes, since so many HSV infections are asymptomatic.  As far as your own test results go, most likely "negative for everything but HPV" does not mean you don't have HPV; routine testing for that virus isn't available and probably wasn't done.  Most important, you can be sure you don't have herpes, assuming the negative test was for type 2 herpes simplex virus (HSV-2).  The reliability problem in HSV testing is that some positive results are false, but negative results are highly reliable.

Your description of the anal problem is most suggestive of hemorrhoids, or maybe anal fissures.  Both are common symptoms in their own right and your negative herpes test reliably indicates HSV isn't the cause.  But you should see a health care provider if the problem is continuing, or the next time it reappears.  Anal fissures and hemorrhoids both respond to easy treatment once an accurate diagnosis has been made.

Take care.  Stay safe.