is one of the most prevalent STDs, most infections are subclinical and usually self-limited in immunocompetent patients. The majority of anogenital infections are caused by HSV type 2 and, to a lesser degree, HSV type 1. There has been an increase in the number of cases of anogenital infection by HSV-1 as the practice of oral sex has become more widespread.
The HSV infection is characterized by severe anorectal pain. Tenesmus, discharge, and hematochezia are also reported with anorectal involvement. Additional systemic symptoms include fever, malaise, and myalgias. The classic perianal vesicles, pustules, and ulcers can be seen on physical examination.
The virus establishes lifelong latency in the sacral ganglions after the primary infection. Reactivation causes recurrent symptoms with varying intervals depending on physiological and environmental factors. Special attention must be given to immunocompromised patients who are at risk of a disseminated infection. Herpetic proctitis is the most common cause of nongonococcal proctitis in Men having Sex with Men (MSM).
Serotyping can be used to confirm the diagnosis. Detection of HSV-specific IgG has a sensitivity of up to 100% and specificity of 96%. Immunoglobulin G antibodies are negative at the onset of herpes disease and become detectable 2 to 12 weeks after the onset of symptoms and persist indefinitely.
Serology testing has the advantages of being more readily available, efficient (samples are easier to obtain), easily transported and processed, and allows for differentiation between genital herpes caused by HSV types 1 or 2.
Antiviral medications including acyclovir, valacyclovir, and famciclovir are used for treatment of Herpes Simplex virus lesions. They can reduce the symptoms of the disease. They do not eradicate the virus. They should be administered as soon as possible and at a higher dose during the first episode of the disease to prevent a prolonged, severe, or complicated illness. Thereafter, antiviral therapy can be given episodically for recurrent episodes to shorten the signs and symptoms, or as suppressive therapy to decrease the frequency of recurrences by 70 to 80%. Suppressive therapy also has the advantage of decreasing the risk of HSV-2 transmission to new sexual partners.
1. Murphy M, Chedister GR, George V. Non-HPV Perianal and Anorectal Sexually Transmitted Viral Infections. Clin Colon Rectal Surg. 2019 Sep;32(5):340-346. doi: 10.1055/s-0039-1687829. Epub 2019 Sep 6. PMID: 31507343; PMCID: PMC6731110.