Breakout Location and Infection Route

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    I didn’t get a whole lot of time to discuss this all with my doctor when I was diagnosed as it was a bit of a shock and of course I wasn’t thinking particularly straight. So I have a question about transmission routes:

    My genital herpes outbreak is in the anal region. My doctor asked me if my husband and I have ever had anal sex and I automatically answered ‘no’ because we don’t. BUT, when we were first together we DID experiment. That was about nine years ago so it didn’t immediately occur to me because hey, it was nine years ago.

    The doctor mentioned something about the route of least resistance to the effect of anal sex being the most likely culprit due to my outbreak presenting in that area. Is this true? Is it likely that I got the infection this way when we were experimenting? My husband is the only one I have ever experimented with.


    Dr. Kelly


    Thank you for sharing! Your question is excellent!

    The herpes virus can present itself (i.e.) show symptoms anywhere along the nerve branch where transmission occurred. While the virus lives within your spinal chord, when it is active, it travels along the nerve at the level of your spinal chord and it then becomes active at the surface of your skin. An “anal outbreak” is one of several branches from the same root. Think of a tree and all of it’s branches. If your symptoms are directly around the anus, then we know S5 nerve root was infected. If; however, the symptoms are further away from the anus, then it would indicate another sacral nerve (S2, S3 or S4) was infected(see image from
    Pelvic Dermatomes

    As you can see, the S3 branch extends up and around the vagina and it also affects the skin more distantly around the anus. It really depends on how close your symptoms are to the anus. If your symptoms are directly next to the anus, then the S5 nerve root was affected, which means that transmission did occur from friction around the anus. If the symptoms are in the general area, then it could indicate that transmission occurred from contact anywhere within the patch of skin associated with the nerve root, aka the dermatome.

    Check out the image and reference where your symptoms are. This will be the telltale sign of whether or not you contracted herpes from anal sex or not.

    I hope this helps.

    Live. Love. Thrive.
    Dr. Kelly


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