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Anal HSV 2: When did you know you could bottom again?

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Hello! I’m a 32 yo bi cis-man who recently had my first HSV 2 outbreak (primarily in the anal region). It’s been a month now, and I’m feeling better after taking a week of valacyclovir. However, I still don’t feel 100%. I’m planning to get a referral from my doctor for a gastro so I can check for other conditions (I.e., anal fissures, etc.). I’ve had a history of hemorrhoids as well, which I want to look into.

I don’t think I’m ready for penetrative sex yet, since my butt still feels extra sensitive/raw. But I know I want to get back on the saddle eventually (with barrier protection). But it’s also hard to gauge how recovered I am since most of my lesions were internal.

So, for anyone with anal herpes, how did you know you were ready to bottom again? 

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Hey @CFlip, it's totally normal to feel cautious and take your time before jumping back into things, especially after dealing with something as sensitive as an anal herpes outbreak. It's smart to consult with a gastroenterologist, especially given your history with hemorrhoids; they can give you the all-clear or address any other issues that might be hanging around.

As for knowing when you're ready to bottom again, listen to your body. If you're still feeling sensitive or raw, it might be a sign to wait a bit longer. Everyone's recovery timeline is different, so don't rush it. And when you do decide you're ready, using barrier protection (brings down transmission by 65%) and daily suppressive therapy (brings down transmission by 50%) is a wise choice to help protect yourself and your partners. It's all about comfort and confidence, so trust your gut (and your butt!) on when the time is right.

This content is for informational purposes only. This information does not constitute medical advice or diagnosis. I'm not a medical professional, so please take this as friendly peer support. 

Helpful resources:

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Hey @CFlip - I'm Carlos. I'm not new to this forum but I have been away for a long time living life, or rather, navigating life. I acquired HSV back in 2002; I was 30 years old. At the time I was dating only men (used to date women in my teens and 20s). I learned it was anal HSV after an unusual rash on my left buttcheek. During my teens, I used to get a lot buttne (butt acne), so I thought the rash, although unusual looking, was related to either that, or folliculitis. I dismissed it as such because aside from itching and some skin swelling, I did not experience the typical flu-like symptoms that herald the first outbreak of HSV. I applied anti-itch ointments (even Caladryl!) A couple of weeks later my butt skin was clear... well, there were a couple of pimples as usual. What floored me was that 90 days later or so, the identical rash appeared again on the left buttock but further down near the crevice where the leg begins. I went to a local STI clinic, they performed a NAAT or culture test and the result was HSV positive. I'm sharing a bit of my story because I want you to know that you're not alone, that anogenital HSV is quite common among Men who have sex with Men (MSM) in addition to those who identify as Gay or Bi.

To add to what Adrial wrote (Sup Dale!), I too recommend seeing a gastroenterologist considering you're susceptible to hemorrhoids (I also am). Per the CDC: genital HSV infection (either strand) can cause sores or breaks in the skin or lining of the rectum. This provides a way for HIV to enter the body. Even without visible sores, HSV increases the number of immune cells in the lining of the anogenital region. HIV targets immune cells for entry into the body. Having both HIV and anogenital HSV increases the chance of spreading HIV to a HIV-negative partner during oral and anal sex.

If, as a Bi Cis Male person you are not on PrEP to keep you safe from acquiring HIV, I recommend you speak to your doctor about the treatment. For those of us who are MSM, PrEP has been a game-changer. Regarding the internal HSV outbreaks that you're experiencing, to echo what Adrial wrote, do use condoms and if your doctor recommends it, use daily suppressive therapy (Valtrex is superior to the other FDA-approved meds). I'm on both PrEP and Valtrex as treatment for prevention.

Your booty will heal, my guy! And you will know when you're ready to get back to enjoying anal sex with your pal(s). 


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