STDs Expert Forum
Anal Ulcers
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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 Ulcers

Hi Dr.,

I have had OCD issues with herpes in the past, and I thought I got over it, but now something new has happened.

I noticed that I have been having really bad pain in my anal area (so bad I had trouble walking yesterday and was almost crying from the pain), so I took a mirror and looked.  I found three ulcers on one side (two deeper, white-colored ones and one shallow one), and one shallow one on the other side.  They are all painful, but the deeper ones are the worst.  My groin lymph nodes also feel tender.

I only have one partner now, and he was a virgin when we met (no naked skin to skin contact before either, just oral sex).  I am worried that I had herpes before him, and that it is just now manifesting.

1. Is it true that most recurrent herpes is only on one side of the body?  Given this fact, can I infer that this is probably not herpes, since it is on both sides of my anus?

2. I have never had anal sex or done anything sexual regarding my anal area, so given this fact, it could not be an initial herpes outbreak, right?  Since those occur where the physical contact originally occurred?  My boyfriend and I have had oral sex, and the saliva might have dripped down to my anus, but I am experiencing absolutely no symptoms in the vulva area (where the oral sex was actually performed) or anywhere else.

3. Would you think that this is herpes?  It just looks so scary!

4.  Is it true that most anal ulceration is not caused by herpes, but by hard stools, etc?

5. Do you think I am just letting my anxiety get the best of me again?

Thanks so much for all of your help!
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Straight to your questions:

1) Yes, recurrent herpes is usuallly unilateral.  Bilateral lesions is against herpes as the cause.

2) Recurrent herpes can involve the anus, even if the initial infection was genital.  But this doesn't mean your lesions are due to herpes.

3) For the reasons you state yourself, I doubt this is herpes.

4) I am unaware of any data on the proportion of anal ulcers due to herpes versus other causes.  However, I suspect you are correct:  non-herpes lesions probably are more common than herpetic ones.

5) Most likely, yes. But if ulcerations truly are present, it would be wise to have them checked out by a health professional.

HHH, MD
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