Sacral Herpes:
Information for adults

The most common locations for sacral herpes simplex include:

• Lower back
• Right or left buttock
• Both buttocks

In women, other locations for HSV-2 infections include:

• External genitalia
• Labia majora and minora
• Vagina
• Cervix
• Around the anus

In men, other locations for HSV-2 infections include:

• Head and shaft of penis
• Scrotum
• Thighs
• Buttocks
• Around the anus

Shortly after exposure to the virus, a newly infected person may develop fluid-filled blisters (vesicles) or pus-filled bumps (pustules), occurring singly or in a group. These vesicles and pustules are usually quite fragile, so many people never notice them but instead see tiny open sores (ulcers). These painful ulcers subsequently become scabbed over. The scabs eventually fall off, leaving a red area that fades. The primary outbreak typically lasts 1–3 weeks.

In mild cases of primary herpes simplex virus infection, an individual may develop 1 or 2 lesions or may notice no symptoms at all. The lymph nodes in the groin may or may not be swollen. In severe cases of primary HSV-2 infection, people may develop fever, headache, neck stiffness, sensitivity to bright lights, muscle pain, painful urination, and discharge from the vagina or urethra.

Repeat (recurrent) herpes simplex virus infections are often milder than the primary infection, though they look alike. However, some people never develop the symptoms of a primary HSV infection and may mistake a recurrent infection for a primary infection. A recurrent infection typically lasts 7–10 days. People who are prone to recurrent outbreaks tend to get them 3–4 times per year, though some may have 10 or more outbreaks per year.

Many people with recurrent sacral herpes infections report that the skin lesions are preceded by sensations of burning, itching, or tingling (prodrome). About 24 hours after the prodrome symptoms begin, the actual lesions appear as one or more small blisters or open sores, which eventually become scabbed over.

Triggers of recurrent HSV infections include:

• Fever or illness
• Sun exposure
• Hormonal changes, such as those due to menstruation or pregnancy
• Stress
• Trauma, such as that caused by dental work or cuts from shaving
• Surgery
• Friction to the area, such as that caused by sexual intercourse or tight-fitting clothes