Rectal and perianal
HSV infections due to HSV-1 and HSV-2 may be seen, especially among homosexual men and/or heterosexual women who engage in anorectal intercourse. Symptoms of HSV proctitis include anorectal pain, anorectal discharge, tenesmus, and constipation. Sigmoidoscopy reveals ulcerative lesions of the distal 10 cm of the rectal mucosa. Rectal biopsies show mucosal ulceration, necrosis, polymorphonuclear and lymphocytic infiltration of the lamina propria, and occasionally multinucleated intranuclear inclusion-bearing cells. Autonomic nervous system dysfunction manifested by burning sacral paresthesias, impotence, and urinary retention may also accompany symptomatic HSV proctitis. Perianal herpetic lesions are also seen in immunosuppressed patients receiving cytotoxic therapy. HSV-1 strains, usually identical to those found in the oropharynx, are obtained from these lesions, suggesting the mode of spread is autoinoculation of the perianal area from HSV-infected saliva and/or finger lesions. Extensive perianal herpetic lesions and/ or HSV proctitis may occur in patients with the acquired immunodeficiency syndrome (AIDS). Anecdotal observations suggest healing of these lesions can be achieved with the use of systemic acyclovir.