Herpetic proctitis is most commonly seen in men who have sex with men, and may present with varying degrees of redness, small patches of mild erosion, small amounts of exudate, blisters, and ulcers in the anal area. Herpes proctitis may be characterized by acute anorectal pain, constipation, bloody rectal mucus discharge, fever, general malaise, myalgia, and autonomic dysfunction such as abnormal sensation in the sacral and perineal areas, impotence, and urinary retention. Herpes proctitis may be primary or secondary, caused by reactivation of the herpes simplex virus in the sacral ganglia, resulting in detoxification in the anal perineum; it can also be caused by touching the hand with the virus. Herpes proctitis is also seen in heterosexual women who have anorectal intercourse.