A herpes simplex virus infection of the anal region can produce a pain similar to an anal fissure. Herpes can infect the anal area, either spread by the hands from a cold sore on the face, or transmitted as a sexual infection. At the anus, herpes often forms a crack rather than the small ulcers that tend to occur elsewhere. It can occur in individuals who have never had herpes elsewhere. The soreness occurs in episodes, each lasting for a few days.
A swab to check for the virus as soon as an episode starts can make the diagnosis. Treatment may include topical application of 5% aciclovir (zovirax cold sore cream®) ointment.
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