Did you know that if you've ever had cold sores before, you've had herpes? Yep, it's true — but not quite as simple as it sounds. With 2 different types of herpes viruses, it can get a bit confusing; only 1 type is considered to be a sexually transmitted infection (and it's not the mouth-to-mouth kind).
If, instead of the cluster blisters on your mouth, you have them on your genitals — or in this case, around the anus — then you've got the STI kind.
Here's everything you need to know about herpes — HSV 1, HSV 2, and, most importantly, how to treat both kinds.
What's the difference between oral and genital herpes?
To start, there's the herpes simplex virus — and from that, there are 2 forms.
HSV 1 occurs more commonly around the mouth and is typically spread from mouth-to-mouth contact — think of cold sores that you may have had or may have seen. It's mainly transmitted via contact with the virus in sores, saliva, or surfaces in or around the mouth .
If someone has a cold sore, avoid kissing them while it's active (and they probably know this fact, and are discouraging it, too).
Herpes is incredibly common, with up to 80% of Australian adults carrying this type . However, it can also occur on the genitals, from oral-to-genital contact.
This type is the sexually transmitted infection type; occurring mainly in and around the genital area. It's estimated about 1 in 8 people have HSV 2 (that's around 12.5%), and of those infected, about 80% may be unaware they have it .
And yes, annoyingly, it's possible to have both types of herpes virus at the same time...so be safe out there.
What causes genital and anal herpes?
Unsurprisingly, genital and anal herpes are caused by...*drumroll please*...the herpes simplex virus . Generally, HSV 2 causes this type, but there may be some instances where type 1 causes genital or anal herpes.
A sexually transmitted infection, it's mainly transmitted during sex — as the name suggests— specifically through contact with surfaces of the genitals or anus, skin, sores or fluids of someone who is infected with the virus.
According to the World Health Organisation, HSV 2 can be transmitted even if the skin looks normal; it's often transmitted in the absence of symptoms . Infected people can pass the virus onto their sexual partners, without even knowing that they themselves are carriers .
What are the symptoms of anal herpes?
You may be wondering how 80% of those infected by the herpes virus have no idea they have it — and it's because most people infected by it don't have any symptoms.
However, if you do experience anal herpes symptoms, they can look or feel like the following:
- Stinging or tingling in the genital or anal area
- Small blisters on the genital or anal area that develop into small painful red sores
- Sores that look like a rash or cracked skin
- Sores in the anus, or on the buttocks and inner thighs 
- Pain when passing urine
- Pain accompanying regular bowel habits 
Your first outbreak of anal herpes may see you experiencing flu-like symptoms, such as having a fever, headache or swollen glands. With more severe anal herpes, it can take up to 3 weeks for your anal blisters and other symptoms to disappear .
Once infected, you can continue to have episodes of symptoms of anal herpes throughout your life.
How long after exposure do symptoms appear?
So remember how we (literally just) told you that many people don't show symptoms of anal herpes?
Well, it's often not possible to tell when a person even first acquired the infection. It may take weeks, if not years — and sometimes, it doesn't happen at all — for the first symptoms to appear .
According to Queensland Health, the virus lives in the nerve cells beneath the skin and may remain inactive and unnoticed for many years .
However, for those who do experience obvious symptoms — called an outbreak — the first outbreak usually starts about 2-20 days after infection. And from there, the first outbreak lasts between 2-4 weeks .
In the first year, it's quite common to experience recurrent outbreaks — in which "warning" symptoms may appear a few hours or days before a flare-up.
The first anal herpes outbreak is the worst; repeat ones are generally shorter, and less painful .
Healing stages of anal sores
Not-so-fun fact: herpes virus infections are the main cause of genital ulcers worldwide . And with these painful ulcers — or genital sores, or anal blisters — are the stagings of getting them, as well as the stages of how they heal.
Before an outbreak of anal herpes, you may notice tingling, itching or a burning sensation in the area the sore will occur — on this occasion, in and around the anus.
You might notice small, discoloured or white bumps beginning to form in the area.
Resembling a cluster of itchy or painful blisters — filled with fluid — of different sizes, the anal blisters either break or turn into sores that bleed or ooze a whitish fluid.
Nearing the end, the visible sores will begin to crust over, like a scab
Eventually, your anal herpes sores will go away; it may take your painful sores a week or more to heal .
There's prescription herpes medication — like our Pilot herpes treatment — that can prevent or treat outbreaks, and also ointments to help your sores heal faster and hurt less.
Can anal herpes be cured?
No, anal herpes can't be cured. Neither can all the other types of herpes, including genital herpes and cold sores. Once you have herpes simplex virus type 2, it stays in your body ; after the first episode, it remains dormant in your body for the rest of your life .
However, anal herpes won't spread in your body and cause blisters elsewhere — so if you have anal blisters, you won't find that the next herpes outbreak suddenly causes armpit blisters.
After the first of your herpes outbreaks, you'll find that recurrent outbreaks are usually milder and shorter over time — and, thankfully, you should experience less frequent outbreaks. They're likely to be caused by certain triggers — some avoidable, and some just part of everyday life.
- A weakened immune system (including chemotherapy for cancer)
- Surgery on your genital area
- Drinking alcohol
- UV light (think sunbathing or sunbeds)
- Friction on your genital area (sexual contact, formfitting clothing) 
But it's not all doom and gloom — even though anal herpes can't be cured, it can be treated.
Are you able to have sex if you have anal or genital herpes?
Just because you've received a genital or anal herpes diagnosis, doesn't mean you have to give up sex altogether — you can still have a healthy sex life, and that's whether you partake in vaginal, anal or oral sex.
What's important is that you tell your sexual partner (or sexual partners, you do you) that you have herpes or any other sexually transmitted infections. You can talk to your GP, who can help you decide who to tell and how to tell them.
And whether it's anal herpes or genital herpes (or even oral herpes), you should always use protection — practising safe sex is key; it's the best way to lower the risk of transmission and prevent herpes infection .
Remember, even if you're currently asymptomatic — you can still spread herpes directly to your partner through sexual contact if you're "shedding" the virus at the time .
Treatment for genital and anal herpes
As we said before, genital herpes and anal herpes can't be cured — but they can be treated.
Antiviral medication, like our outbreak medication treatment, can possibly reduce symptoms, and help control severe or frequent outbreaks . These antiviral medications can also reduce the risk of passing the virus on to a sexual partner — when combined with condoms, the risk stands at less than one per cent.
Whereas our daily suppressive therapy treatment can reduce viral shedding by 70-80%, meaning fewer outbreaks (that are also less severe), with transmission risk also becoming much lower.
In fact, a study quoted by John Hopkins found that in partners where one has herpes and the other does not, treating the one with herpes with suppressive therapy can prevent transmission of symptomatic herpes in over 90% of cases .
Treating anal herpes symptoms
When it comes to the mild symptoms of genital or anal herpes, there are ways to treat — well, more so help relieve — the symptoms at home.
- Gently bathing the painful sores (or anal blisters) with a warm salt solution (1 teaspoon to 2 cups water). Fun fact: this is also good for haemorrhoids and anal fissures
- Pain medicine, like paracetamol or ibuprofen
- Local anaesthetic cream or ointment
- If urination is painful due to genital sores, weeing while you're sitting in a warm bath (no different to peeing in the shower, which we've all done) 
How to prevent the transmission of genital and anal herpes
As we've discussed, if you have anal herpes and you're participating in a consensual sexual encounter — don't be silly, wrap that willy. Or, if you're having anal sex and you're what's colloquially referred to as a bottom, make sure your partner is wearing a condom.
This is whether or not you're currently exhibiting anal herpes symptoms.
In addition to this, if you're participating in oral sex, then use a dental dam — over the vulva or anal area. As above, this is at all times, even when you don't have symptoms.
There are times when it's safer to avoid sex altogether:
- When there are sores or blisters present — this is when your herpes infection is most, well, infectious
- If your partner has any blisters, sores, or other symptoms of herpes
- When a cold sore is present — in this instance, avoid oral sex 
In addition to this, treating anal herpes with medication — suppressive therapy or antiviral medications, like our Pilot offerings — also helps lower the risk of transmission to a partner.
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