References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Anal herpes is a herpes simplex virus (HSV) infection affecting the skin around and inside the anus. It causes painful blisters and sores similar to genital herpes, and is transmitted through anal sex or skin-to-skin contact with an active herpes sore. It can be caused by either HSV-1 or HSV-2, though HSV-2 is more common in this location.
If you’re experiencing pain, blisters, or sores around your anus and are worried it might be herpes, this guide covers the symptoms, how it’s diagnosed, treatment options, and how to manage outbreaks.
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Symptoms of Anal Herpes
Anal herpes symptoms are similar to genital herpes but located around and inside the anus:
First outbreak (usually the most severe)
- Tingling, itching, or burning sensation around the anus before blisters appear
- Small, fluid-filled blisters around the anal opening
- Blisters that burst into shallow, painful ulcers
- Pain during bowel movements
- Anal discharge (mucus)
- Swollen lymph nodes in the groin
- Flu-like symptoms: fever, headache, muscle aches, fatigue
- Pain sitting down
Recurrent outbreaks
Recurrences are usually milder and shorter than the first outbreak:
- Fewer blisters, less pain
- Healing typically takes 5-10 days (vs 2-3 weeks for first outbreak)
- No flu-like symptoms
- Some people experience a warning “prodrome” — tingling, itching, or shooting pain in the buttocks or legs 1-2 days before blisters appear
Some people with anal herpes have very mild symptoms that they attribute to haemorrhoids, an anal fissure, or general irritation. If you have recurring anal discomfort that comes and goes, herpes is worth considering.
How Do You Get Anal Herpes?
- Receptive anal sex with someone who has genital herpes
- Oral-anal contact (rimming) from someone with oral herpes (cold sores / HSV-1)
- Skin-to-skin contact between the genital/anal area and an active herpes sore
- Asymptomatic shedding — the virus can be present on the skin without visible sores and still be transmitted
Condoms reduce the risk but don’t eliminate it, as herpes can affect skin not covered by the condom. Dental dams provide protection during rimming.
How Is Anal Herpes Diagnosed?
- Swab test: The most accurate method during an active outbreak. A clinician swabs a blister or sore and sends it for PCR testing. This identifies whether it’s HSV-1 or HSV-2.
- Visual examination: An experienced sexual health doctor can often identify herpes by its characteristic appearance, but a swab confirms the diagnosis.
- Blood test: Detects HSV antibodies. Useful between outbreaks but takes 12 weeks after exposure to be reliable. Cannot tell you where on the body the infection is located.
If you suspect anal herpes, visit a sexual health clinic during an active outbreak for the most accurate diagnosis. Don’t wait for the sores to heal, as the swab test becomes less reliable as they dry up.
Treatment
Anal herpes is managed with the same antiviral medications as genital herpes:
During outbreaks
- Aciclovir — 400mg three times daily for 5 days (first outbreak) or 800mg three times daily for 2 days (recurrence)
- Valaciclovir — 500mg twice daily for 5 days (first) or 500mg twice daily for 3 days (recurrence)
Suppressive therapy (for frequent outbreaks)
If you have 6 or more outbreaks per year, daily antiviral therapy can reduce recurrence by 70-80%:
- Aciclovir 400mg twice daily, ongoing
- Valaciclovir 500mg once daily, ongoing
Suppressive therapy also reduces the risk of transmitting herpes to sexual partners by approximately 50%.
Symptom relief
- Soak in warm (not hot) salt water baths to soothe sores
- Apply petroleum jelly to sores before urination or bowel movements to reduce stinging
- Wear loose cotton underwear
- Take paracetamol or ibuprofen for pain
- Keep the area clean and dry between baths
- Avoid touching or picking at sores (wash hands if you do touch them)
Anal Herpes vs Other Anal Conditions
| Condition | Appearance | Pain | Recurring? | Contagious? |
|---|---|---|---|---|
| Anal herpes | Blisters → ulcers, clustered | Burning, stinging | Yes (outbreaks) | Yes |
| Haemorrhoids | Swollen veins, may bleed | Aching, itching | Yes (chronic) | No |
| Anal fissure | Linear tear in anal skin | Sharp pain during bowel movement | Can recur | No |
| Anal warts (HPV) | Flesh-coloured growths | Usually painless | Can recur after treatment | Yes |
| Anal abscess | Swollen, red, warm lump | Severe, throbbing | Can recur | No |
Living with Anal Herpes
Anal herpes is a manageable condition. Key points:
- Most people experience fewer and milder outbreaks over time
- Antiviral medication effectively controls symptoms and reduces transmission
- Herpes does not cause long-term health damage
- Many people with herpes have normal, healthy sex lives with appropriate precautions
- Disclosing to partners is important but doesn’t have to be devastating — herpes is extremely common
Read more: Genital herpes guide | Aciclovir | How to tell your partner
Frequently Asked Questions
Can you get anal herpes without anal sex?
Yes. Herpes can spread from genital to anal skin through general skin-to-skin contact during sex, even without penetrative anal intercourse. Oral-anal contact (rimming) can also transmit HSV-1 from the mouth to the anus.
Can anal herpes cause internal symptoms?
Herpes can infect the lining of the rectum (herpes proctitis), causing rectal pain, discharge, bleeding, and constipation. This is more common in people with weakened immune systems. If you have these symptoms, see a doctor.
Is anal herpes more painful than genital herpes?
Outbreaks in the anal area can be particularly uncomfortable because of friction during bowel movements and sitting. Topical anaesthetic gel (lidocaine) and salt baths can help manage pain.
Can I still have anal sex if I have anal herpes?
Avoid anal sex during outbreaks (when sores are visible). Between outbreaks, condoms significantly reduce transmission risk. Daily suppressive antiviral therapy further reduces the risk. Discuss with your partner and make an informed decision together.
Related reading
- Can You Get Herpes From a Toilet Seat?
- Can You Get Herpes From Kissing?
- Comprehensive Test: Chlamydia, Gonorrhoea and Herpes
- Cold Sores vs Syphilis Sores: How to Tell the Difference
- Genital Warts vs Herpes: What's the Difference?
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
