Rectal Herpes or just a cut?

[tfe]

Hello (again!),

As a quasi-frequent forum contributer (thread starter/participant), I know that the only way to get a certain answer is w/a test. However, I would like whatever professional advice that you can offer in the interim.

Quick recap: I engaged in a single act of unprotected anal sex in Feb '05. The only thing explicitly ruled out via testing was HIV. Other PCPs, urologists, etc, didn't conduct tests due to the lack of symptoms and type of exposure (15 seconds of insertion, no ejaculation). I was hypersensitive until recently (and  now, I am once again), and while I understand that it is possible in some occasions for males to not exhibit symptoms, I still take consolation in the lack of any problems (except the below mentioned), and in the fact that I had medical professionals examine me when my symptoms were at their "worst."

Currently, here is my problem:

For the past few (months, it seems, but to be safe, let's say 4 weeks), I've experienced a dull irritation around the perianal area. It feels, for lack of a better term, like a small cut. It does not cause noticeable pain during the day, however it does contribute to discomfort when wiping or when soap from the shower enters the area. Frequently, I find small red dots of blood on the tissue after wiping (bright red, not mixed with stool).

I should add, that I sometimes use a razor (eeek) to clean excess itchy pubic hair from that area and wonder if it's possible that I cut it a while back and I'm still in discomfort from the constant matter that would irritate any potential healing that took place.

Anyways, I've been dealing with this discomfort, as it doesn't interfere with my day, and somedays it seems better than others. I engaged in PROTECTED anal sex on new year's eve (with a known 'friend'). There was minimal skin contact in this instance, and it didn't last too long, as the initial insertion into me was quick and painful and I didn't want to continue after much longer. The condom remained in tact and I didn't notice any open sores and no skin-to-skin contact could have been made in the area affected now (plus, I think it would be kind of quick for symptoms to show up in this regard + they'd generally be mild for an initial outbreak). This was only my 2nd partner ever w/ regards to anal.

I attempted to examine the area myself yesterday through intricate mirror placement + noticed two tiny "cuts" around the rectal opening, one at the bottom and one at the top. There was no discharge, no bumps and they just looked like a typical cut/scrape with nothing else visible.

I'm wondering, especially given their persistent nature, the type of symptoms, the timing and the fact that anal sex was introduced and the possibility of cuts before, if this sounds like herpes. There has been no change in the area in general, except now I notice it more because my mind is always on them.

I do plan to get tested, but was wondering if you had any observations.

Thanks a lot for your work!!

[H. Hunter Handsfield, M.D.]

I can't second guess the assessment and advice of an apparently knowledgeable providerr who actually has examined someone.  Probably I would do the herpes blood test, but if you can't afford it and don't have insurance to cover the cost, I have no solution.  But if your anal/perianal lesion(s) ever reappear, get back to the clinic within a day or two for a valid culture test.

HHH, MD

[tfe]

Hiya...

I went to the Mass. General Hospital's GID STD testing site and had some swabs, tests and whatnot conducted. Whatever she swabbed and could analyze immediately came back OK, and we have to wait 10 days for the rest.

In terms of the Herpes test, she said that the only visible lesions in the area in which I'm currently experiencing discomfort were small "paper cut" like wounds that are in the final stages of healing (skin over them, etc) and that they didn't look like they were anything serious. She said that a HerpeSelect test would not be free and that I should try altering my diet, apply some kind of OTC cream and see if that aids in the healing process.

The mild discomfort today is about the same as it has been through the whole ordeal; and at this point, there are no wounds she could culture and didn't see any areas of concern where I had discomfort. Because of this, she didn't take a culture and basically told me that unless I experience symptoms at a time when there would be a place to take a culuture, that she can't tell me one way or the other.

Taking in to consideration that I only had 3 instances of sexual contact, only one unprotected (a while ago) and that my rectal symptoms aren't specific to anything sexual, would you suggest further testing at this time (assuming the rest of the testing comes back negative?)

Thanks for your time.

[tfe]

Perhaps (again, the problem with lay-persons attempting to use medical vocabulary to convey their thoughts) the pictures had the lesions located at an incorrect spot in relation to mine.

Pardon the graphic nature of the statement, but I'm sure you're used to it by now ;-) The cuts appear right at the opening of the rectum and extend outwards slightly. Again, not physically inside, as if i were to run tissue across the area without any insertion, it would come in contact with the area in question. If i apply tissue directly to that area, there occasionally would be a drop of blood. And it only "stings" if i apply soap directly on it or during use of the bathroom, the stinging diminishes as time progresses from application of any soap agents. It has many "cut"-like qualities, and I'm wondering if my most recent sexual experience resulted in tears in already weak areas (i've had VERY little experience as a receptive partner).

Anyways, I don't know if that changes your observations. I infinitely thank you for being here and responding thoroughly.

I don't know if I can survive the stress through the weekend; however I'm not sure if (as these "cuts" are present now) the local hospital emergency room would be an appropriate destination.

Thanks again; enjoy your new year and I hope to have an update with good news (that being, that I don't have HSV2 and that it's simply a cut from shaving that got irritated and grew larger and more irritated with the sexual experience or something as benign).

Take care!

[H. Hunter Handsfield, M.D.]

The additional information seems to clarify that the lesion involves the anus itself, not just nearby; and therefore that trauma due to shaving is unlikely.  Your testing should include evaluation for all STDs, not just herpes; gonorrhea, chlamydia, syphilis.  You may indeed have just a garden variety anal fissure, but don't assume that without professional evaluation.

HHH, MD

[H. Hunter Handsfield, M.D.]

The additional information doesn't modify my assessment or advice.

HHH, MD

[tfe]

I will not make any additional comments on this thread other than to request clarification or respond to any of your questions... but for what it's worth (and again, I realize that these observations are moot, as I'm hardly qualified to make them), but my symptoms correspond with research articles posted about anal fissures, namely:

"Anal fissure is a tear in the inside lining of the wall of the anus. It is caused by the passage of very hard stools and strong pressing and a predisposition for this condition. The symptoms are clear and consist of very severe pain as the stool passes as well as itching, burning, bleeding and wet discharge from the anus."

The pictures look similar to my condition, but I'm not sure if any items in my story would explicitly rule this out or would support this.

I will now stop posting and obsessing and wait for a response :)

[H. Hunter Handsfield, M.D.]

The symptoms you describe are nonspecific--that is, they could be caused by a large number of conditions, ranging from the important to the trivial, sexually acquired or not.  Nobody can tell from just the description which conditions are most likely in any particular case.  Herpes sounds possible, but a benign anal fissure, smoldering folliculitis, yeast infection, some other dermatitis, or a slowly healing traumatic lesion all sound poissible.  In my experience, herpes lesions do not bleed--but to my knowledge this has not been studied and I would not rule out herpes based on that fact.  In fact, I wonder whether the bleeding is really coming from the lesion you describe, or from an anal or rectal lesion you cannot see--such as an anal fissure, other traumatic lesion, or hemorrhoid.

Bottom line (no pun intended):  You would be wise to see a provider competent in both rectal diseases and STD, such as a proctologist or your local healt, as you already are planning to do.

Good luck--  HHH, MD