Anorectal pain and mucopurulent, bloody rectal discharge suggest proctitis or proctocolitis. Proctitis is more likely to cause tenesmus and constipation, whereas proctocolitis and enteritis more often cause diarrhea.
HSV proctitis and LGV proctocolitis can cause severe pain, fever, and systemic manifestations.
Sacral nerve root radiculopathy, with urinary retention or anal sphincter dysfunction, is associated with primary HSV infection.