From the Guidelines
Viral infections, such as herpes simplex virus (HSV) and human papillomavirus (HPV), can cause anal fissures, particularly in atypical cases where the fissure is not located in the midline. According to the most recent guidelines from the World Journal of Emergency Surgery 1, atypical anal fissures, which include those caused by viral infections, require a thorough medical history, physical examination, and laboratory tests to rule out underlying conditions. The American Gastroenterological Association also notes that anal fissures occurring off the midline may be associated with underlying diagnoses such as HIV/AIDS, syphilis, or herpes 1. Key points to consider include:
- HSV is more likely to cause anal fissures than HPV
- HSV-related fissures typically present with severe pain, multiple lesions, and systemic symptoms
- HPV rarely causes fissures directly but can lead to anal warts, which may cause secondary fissures
- Treatment depends on the underlying viral cause, with antiviral medications recommended for HSV and removal of warts for HPV-related issues
- Distinguishing viral-caused fissures from more common causes is crucial for proper diagnosis and treatment. In cases where a viral cause is suspected, particularly with recurrent episodes or additional symptoms, prompt medical evaluation is essential for proper diagnosis and treatment.
From the Research
Viral Causes of Anal Fissures
- There is evidence to suggest that viral infections, such as herpes simplex virus (HSV), can cause anal fissures or contribute to their development 2, 3.
- HSV type 1 and type 2 can infect the anal region and induce aphthous ulcers, which may lead to anal fissures 2.
- Anal herpes simplex virus infections can cause symptoms such as anal pain, bleeding, and diarrhea, which may be similar to those experienced by individuals with anal fissures 2, 3.
- However, there is no direct evidence to suggest that human papillomavirus (HPV) causes anal fissures.
- The treatment of anal fissures typically involves reducing anal pressures and may include non-surgical and surgical modalities, but antiviral medication may be necessary if an underlying viral infection is present 4, 5.
Diagnosis and Treatment of Viral Infections
- The diagnosis of HSV infections can be made using polymerase chain reaction (PCR) or other laboratory tests 2, 6.
- Antiviral medications, such as acyclovir and valacyclovir, can be effective in suppressing the frequency and quantity of HSV shedding 5, 6.
- Topical acyclovir therapy can be used to treat recurrent HSV episodes, and early treatment can maximize efficacy 5.