simultaneus mouth and genital herpes outbreaks common?

[guyinseattle]

Hi, basically I have an open soar on the anterior and slightly off to the side of my anus, so I'm a bit worried that it could be a herpes sore. What made me think this is that at the time I got the anal sore, I also developed a cold sore on the lip--I know for sure that I do have, the common kind of herpes. So basically my question is, if when the virus is active in the body do people often have outbreaks in in both the genital region and the lips, (supposing they had the virus in both places), or if it doesn't work like that, and a person who had herpes on both the lips and genitalia would usually have outbreaks on separate times for the different parts of the body.

Also if I did have anal herpes, what would be the chance of the virus traveling over to the genitals, and then becoming a sexually transmissible infection. (basically that's my main fear, I don't want to have to worry about infecting anybody.) So supposing I did have anal herpes, would it be OK to still have sex with a partner without significant risk of infection?  

I know that's a lot of if's and but's, but I hope it makes sense. I'm a college student and really can't afford to see a doc at the moment. The symptoms I have are an oval shaped cut, slightly off to the left and lower side of the anus, also a slight clear foul smelling discharge,(from the cut, does herpes do this?), moderate bleeding-especially after bowel movement--a bit of a sensation of burning, and it has remained open for about a week. Please let me know if this sounds at all like herpes from the description, or if it sounds more likely to be an anal fissure or something else.

Thanks much

[Edward W Hook, MD]

You did not say anything about your sex preference so I do not know if there is a reason for you to be concerned that you might have acquired rectal herpes from someone sexually or not.  At the same time, your question seems to indicate that you are concerned about herpes spreading around your body from place to place.  This almost never happens and when it does, the spread occurs by direct inoculation, not other means of spread inside or through your body.  The chance that you somehow spread HSV from your oral cold sore lesion to your rectum is miniscule.  The anal lesion you describe sounds much more like an anal fissure and or irritated hemorrhoid than a herpes lesion.  You can have this address however by going to your local health department where you can be seen for little or no money.  You handle suggests you are in Seattle.  If that is the case, the Seattle-King County Health Department STD Clinic is one of the best STD clinics in the nation and provides top quality, well informed health care.

Finally, regarding your question about whether, if your anal lesion is herpes (I doubt it), it could be spread to others sexually, the answer is no, unless you are participating in rectal sex.

Hope this helps. Go to the Seattle STD Clinic and please let us know what they say.  Good luck.  EWH

[guyinseattle]

Hey Doc. Thanks for your reply, it really is invaluable to have this kind of feedback available, for someone like me. So I went In to the std clinic, and it was indeed very affordable and convenient, but I didn't get what I had hoped for from it--in part due to stupid shyness on my part, part misunderstanding. Basically the Doc asked me whether I had anal sex, and I answered no, but my words exactly we're: "Although I have had oral sex around there." I think she assumed I was talking about regular oral sex, but infact I was referring to oral sex performed on my anus. So at that point she said, well if you haven't had anal sex it isn't our clinic that would do a biopsy on the cut, and I somehow didn't have the nerve to clarify that in fact I had received oral in that area. So that was that; she told me to see a regular practitioner, and I got some regular std tests, but I didn't get the biopsy which is what I was hoping for..Sigh..

So now the only things that have me slightly concerned still is the fact that the "fissure," is slightly off to the side, and lots of the articles I've been reading keep saying that if the fissure is on the midline, it is probably a fissure but if it is on the laterals it could likely be cause by something else. So I'm wondering what exactly they mean by the midline; whether they mean the exact middle of the anus, or if there is a bit of flexibility as an area. Basically if the exact middle were about 6 O'Clock, I'd say the fissure I have is at about 5:45, so definitely in the area but slightly off. Here are a couple of the articles I read:
http://www.emedicine.com/med/topic3532.htm
and
http://www.uptodate.com/patients/content/topic.do?topicKey=digestiv/11250

In the second article it says:

"A fissure most commonly appears in the 12 or 6 o'clock position (show picture 1). Fissures located in other locations are more likely to be associated with an underlying disorder (eg, Crohn's disease)."

Whereas in a couple others it's more flexible using terms like "anterior, posterior, lateral quarters" etc. So what say you Doc, you think 5;45 is still "midline range"?

And lastly just to completely clear my mind of this doubt(yet another worried hypothetical coming up), supposing (again) it were a herpes  lesion, then the chance of it passing from my anus to the genitalia, (mine), is minuscule right? I only worry because there does tend to be sweat moving around the area and given the close proximity of the two.  

Thanks again, and I hope I haven't bored and or annoyed you to death with this! =)

D.

[Edward W Hook, MD]

Yes, what you describe is most consistent with a fissure, even at 5:45.

Yes, menuscule.  EWH

Fianlly, don't hold out on your docotrs in the future, as you have seen, the person it can hurt most is you. Take care.  EWH