Got bumps or blisters? How to tell if it’s anal herpes

Anal herpes is a viral infection caused by the herpes simplex virus (HSV), which is also sometimes just called “herpes”. There are two types of herpes simplex virus: herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2).

Herpes is very common. According to estimates from the World Health Organisation (WHO) in 2016, 67% of the world’s population under the age of 50 years have HSV-1 while 13% aged 15-49 have HSV-2.¹

HSV infection can cause oral (on the lips or around the mouth, often referred to as “cold sores”) or genital (on the penis, vulva, anus, or bottom) herpes, and it’s possible to have both at once. Oral and genital herpes can be caused by HSV-1, whereas HSV-2 is mostly associated with genital herpes.²

Symptoms of anal herpes can be similar to those of other conditions. For example, herpes may cause blisters around the genital area but so can other infections such as syphilis. Here’s how to tell whether you’ve got anal herpes.

What is anal herpes?

First, the basics: anal herpes is a type of genital herpes, in which symptoms of HSV occur around the anal area.

Genital herpes is spread during sexual contact with someone who is infected with the virus. This can include skin-to-skin contact, such as during oral, vaginal, or anal sex, sharing sex toys, if a cold sore touches your genitals, or via hand play (where the virus is transferred via your fingers).³

Herpes simplex virus can cause blisters or sores. In an anal herpes infection, blisters occur around the anus, perineal area, or on your bottom

The virus is more likely to be spread if the infected person has symptoms at the time, however it can also be spread when they do not have any symptoms at all. Often, the presence of symptoms is referred to as an “outbreak”.

How do I know if I have anal herpes?

Herpes simplex virus can cause blisters or sores. In an anal herpes infection, blisters occur around the anus, perineal area (the skin between your genitals and anus) or on your bottom.⁴

At first, they are small red blisters, which then burst to leave shallow and red open sores or ulcers. These will then heal over the course of 7-10 days. They are usually painful, especially if urine comes into contact with the ulcers when you go for a wee.⁵

Other infections can also cause ulcers, like syphilis. With syphilis, while ulcers can occur in the genital region they will usually be painless,⁶ whereas those from anal herpes generally cause pain.

Genital warts and haemorrhoids are other examples of conditions which can cause bumps in the genital area. Genital warts are small fleshy growths caused by the human papillomavirus (HPV), however these are usually painless and do not become ulcers.⁷

Sometimes, HSV can also cause what’s called “systemic symptoms”. These are symptoms which do not occur at the affected area of skin

Haemorrhoids are lumps which are caused by swollen veins located in or around the anus. These are often caused by constipation, and may resolve in the space of a few days. Whilst the area can be painful or itchy, they should not develop into ulcers.⁸

HSV can also cause discharge from the urethra (the tube your urine passes through) or a change to your usual vaginal discharge. Some people experience pain in their lower tummy when passing urine, and there can be itching or tingling sensation to the skin of the affected area.⁹

Thrush is a yeast infection which can cause similar symptoms to this. With thrush, discharge (from the vagina or urethra) may be white and creamy, often described as being like “cottage cheese”, and you may experience an itching sensation, however there will be no ulcers present.¹⁰

Sometimes, HSV can also cause what’s called “systemic symptoms”. These are symptoms which do not occur at the affected area of skin. With herpes, these are most commonly tiredness or fever.¹¹ These symptoms are most common in someone who has very recently acquired HSV and is having their first outbreak.¹²

It is also important to note that some people with herpes infection will never have any symptoms or outbreaks, and therefore many people do not know that they have HSV.

When should I see a doctor?

If you are experiencing new symptoms, if it advisable to speak to a medical professional, such your GP or sexual health clinic. Your doctor will take a history from you and examine you.

If you have ulcers, try to see a medical professional whilst they are present, as they will take a swab which can be tested for HSV. They may also test for other infections at the same time. This will allow them to take all of your symptoms and history into account, in order to diagnose you appropriately.

There’s no reason why people with HSV shouldn’t have a fulfilling, safe, and healthy sex life

HSV is a viral infection which stays dormant in the nerves of the affected area. There is no cure for HSV, however outbreaks can be managed with anti-viral medication. Symptoms can also be managed with other advice, such as applying Vaseline to the sores to reduce pain when you wee and washing your hands after touching the affected area to reduce transmission.¹³

There can be a lot of stigma attached to HSV infection, and many people worry about how a diagnosis will affect their sex lives. However, this stigma is improving as people become more informed about the condition. There’s no reason why people with HSV shouldn’t have a fulfilling, safe, and healthy sex life.

Barrier methods of contraception, such as condoms and dental dams can help to reduce the risk of passing on or contracting HSV,¹⁴ as can washing sex toys between use on individual people or covering them with a condom.

If you are diagnosed with any type of HSV, it is advised that you avoid sexual intercourse during an outbreak (when you have symptoms), as this is when the virus is most easily spread.¹⁵

Occasionally, HSV infection can cause more serious complications. These can be more common in certain groups, such as those with HIV who are not on treatment, people who are immunosuppressed, or people who are pregnant. If you are concerned about this, please speak with you doctor.

Featured image is an illustration of a person putting their hand in the back pocket of their jeans, as if they’re itchy or irritated

Page last updated April 2023
New update due 2026