Herpes around the anus shows up as small, painful blisters that burst and leave sores behind. The pain is sharp and often comes with a burning feeling when passing stool. The symptoms return in episodes, with quiet periods in between.
That episodic pattern is the most useful distinction. A fissure or haemorrhoids nag on; herpes comes and goes.
The European guideline names herpes simplex as one of the most common sexually transmitted pathogens in the anal area (de Vries, 2021). Yet most Dutch pages only cover genital herpes.
How do you recognise herpes around the anus?
By fluid-filled blisters that burst after a few days, leaving shallow sores that dry into scabs. A tingling or prickling feeling often comes first, on exactly the spot where the blisters appear. With a first outbreak you can also feel fluish, with swollen glands in the groin.
The pain stands out. It is sharper than most other anal complaints and gets worse with bowel movements.
A first outbreak is usually the heaviest.
After that the episodes generally become milder and shorter. The wider story about the virus is in genital herpes.
What is anal herpes confused with?
With an anal fissure, with haemorrhoids and with warts. All three sit in the same place and cause complaints that resemble each other from a distance. The difference is in the shape, the pattern and the pain.
| What it is | How it looks | Pain | Pattern |
|---|---|---|---|
| Herpes | Clusters of blisters, then sores | Sharp, burning | Episodes with clear periods |
| Anal fissure | A tear in the skin edge | Fierce on passing stool, then aching | Persistent until it heals |
| Haemorrhoids | Swelling or lump | Often dull, sometimes itching | Variable, often with straining |
| Genital warts (HPV) | Firm cauliflower-like warts | Usually painless | Stay put and grow slowly |
| Syphilis | One hard, painless sore | None | Clears on its own, the disease does not |
The last row is the most dangerous mistake. A painless sore that clears by itself feels like good news and can be syphilis. See warts around the anus for the HPV side.
How do you get herpes around the anus?
Through skin-to-skin contact with someone carrying the virus, usually during anal or oral sex. A condom lowers the risk but does not cover all the skin that makes contact. The European guideline states that condom use is no guarantee, because these infections also spread without penetration (de Vries, 2021).
Transmission can also happen when the other person has no blisters at that moment.
That property is what makes herpes so widespread and what nobody sees coming. How that works is in how you get herpes.
How do you get anal herpes tested?
The most reliable route is a swab of a fresh blister or sore, which the lab examines with a PCR. That only works while something is visible; once the spot has healed there is nothing to sample.
A blood test exists too, but it says something else. It detects antibodies, so that you picked the virus up at some point, not where it sits or whether your complaint comes from it.
If you have symptoms now, see your GP or a sexual health clinic while the blisters are there.
What a result does and does not mean is in the herpes test. Herpes is not part of our test for chlamydia, gonorrhoea and trichomonas; that is a separate test, and we would rather say so upfront than afterwards.
What does treatment do and not do?
Antiviral medication can make an outbreak shorter and milder, especially when started early. It does not remove the virus from your body. That stays in the nerve ganglia and can become active again later.
Your GP prescribes that; we test and do not treat.
What such medication does and does not do is in genital herpes treatment.
Does anal herpes come back?
Often it does, and usually in a milder form than the first time. How often varies a lot between people, and many notice the episodes ease off after the first years. Stress, illness and a weakened immune system are frequently named as triggers.
A recurring complaint in exactly the same spot is a strong clue.
Take two people with a similar first outbreak, both around age 25.
One had four more episodes in a single year. The other had none at all in five years. The same virus, a completely different course. I mention that on purpose, because the figures you find online rarely describe you.
The RIVM tracks Dutch STI figures through the sexual health centres. Herpes is not tested routinely there, precisely because a positive blood test without symptoms changes little about what you do. If itching rather than blisters is your issue, read anal itching. And for the full picture of anal complaints: proctitis.
References
- de Vries HJC, et al. 2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. Journal of the European Academy of Dermatology and Venereology, 2021. PMID 34057249.
- Chan PA, et al. Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infectious Diseases in Obstetrics and Gynecology, 2016. PMID 27366021.
- Calas A, et al. Prevalence of urogenital, anal, and pharyngeal infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium: a cross-sectional study in Reunion island. BMC Infectious Diseases, 2021. PMID 33478403.
- World Health Organization (WHO), Herpes simplex virus, fact sheet. Accessed August 2026.
- RIVM, STI surveillance Netherlands. Accessed August 2026.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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Discreettest
Dr. Naimi, BIG-registered physician, oversees the medical standards behind our content and assessments. Read our medical policy
