After the initial active infection, Varicella zoster virus remains inactive in the sensory nerve tissue close to the spinal cord and brain, awaiting reactivation into a shingles episode.
Every year in the United States, over 1 million people per year will be affected by the herpes zoster virus, also known as shingles. Approximately one half of shingles cases affect people at least 60 years old.
Although the viruses behind shingles are part of the herpes virus family, they are not the same viruses that cause genital herpes and cold sores.
Many people with shingles wonder if they are contagious. The Varicella zoster virus, which is responsible for chickenpox and shingles, can be spread by direct contact with fluid from the small blistery rash that occurs with shingles. It can cause chickenpox in those who have not previously been infected with Varicella zoster virus.
The virus behind shingles can be spread to other people. Shingles itself is not contagious.
When a person is infected with shingles, they will first experience a tingling of the skin, burning and numbness, usually on one side of the body. After 2 to 3 days, clusters of small, pus-filled blisters then appear. These will be surrounded by red skin.
The rash and blisters normally continue to appear for 3 to 5 days.
At this time, the person is contagious. If another person is in direct contact with the blisters, they can get sick.
Transmission only occurs through direct contact with blisters, and it can cause chickenpox in someone who has never been infected with the virus. During the time before blisters appear and after crusting, there is no risk of viral transmission.
If the blisters are broken and scabbed, or if they are well-covered, they cannot spread the virus.
Ways to prevent viral transmission include:
- Covering the rash and avoiding touching it
- Practicing good hand hygiene by frequently washing both hands
- Avoiding coming into contact with certain people after blisters have formed
People to avoid after blisters have formed include:
- Pregnant women who have never had chickenpox or received the shot for it
- Children who have not yet had chicken pox or the vaccination
- Infants born early or those of low birth weight
- People with weakened immune systems, for example, with HIV infection, those receiving cancer treatment, or those who have some types of cancer, such as leukemia or lymphoma.
A person with a weakened immune system might be someone who is on immunosuppressive medications, those undergoing chemotherapy, those with HIV, and those who have had an organ transplant.
Shingles cannot be spread from one person to another, but the herpes zoster virus, which causes first chicken pox and then shingles, can. The infection cannot be spread through coughing, sneezing, or casual contact, unless it involves the rash.
There are certain people who are at a higher risk for developing shingles:
- People with weakened immune systems from conditions such as HIV, leukemia, or lymphoma
- People who are treated with medications that suppress the immune system
- People who are taking medications after receiving a transplant
- People who have had chickenpox
- People who are over 50 years old
People should speak to a doctor about any risk factors that they may be worried about. The doctor may be able to give advice on how to reduce the risk.
People who develop shingles can experience the following symptoms:
Blisters and rashes are two symptoms of shingles.
- A one-sided stripe of blisters wrapping around the side of the torso, body, or face
- Pain, which can be intense at times
- A widespread rash
- Rash in the eye
- Fluid-filled blisters that scab within 7 to 10 days and resolve within 2 to 4 weeks
- Upset stomach
- Sensitivity to touch or light
Many people who are affected will experience pain, itching, or tingling at the site of the rash around 1 to 5 days before the shingles outbreak. A rash and pain may not be present during some outbreaks.
Complications of shingles
Shingles can cause severe complications.
These can include:
- Loss of vision caused by shingles in or near the eye
- Eye infections
- Nerve problems such as brain swelling, facial paralysis, hearing problems, and problems with balance
- Skin infections caused by bacteria
- More rarely, it can lead to pneumonia and death
Prolonged pain, referred to as postherpetic neuralgia (PHN), can also occur. PHN can result in pain in the location of the rash and blisters after they have gone, which can be severe. This pain can be present for years following the rash.
Diagnosis and treatment
Most commonly, shingles is diagnosed on pain history and a physical exam. At times, a sample of the virus can be obtained and tested.
Although the shingles virus cannot be cured, medical treatment is available. This includes the use of medications like acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). This antiviral drugs can reduce the severity of the symptoms and shorten the duration of the illness.
Fluid-filled blisters caused by shingles will eventually scab over. Keeping rashes clean helps reduce the risk of infection.
Pain can be reduced by using certain medications including:
- Topical capsaicin cream, wet compresses, calamine lotion, and colloidal oatmeal baths
- Neurontin, or gabapentin, a drug used to treat nerve pain
- Elavil, or amitriptyline, an antidepressant
- Numbing medication, such as lidocaine cream, gel, skin patch, or spray
- Mood-altering medications
- Epidural injected corticosteroids and local anesthetics
Living with a shingles rash can be made more comfortable by taking steps to relieve the symptoms. Keeping any rashes clean and dry helps to reduce the risk of them becoming infected. Wearing loose clothing can also help people to feel less uncomfortable while waiting for a rash to clear.
If a person has already had chicken pox, preventing shingles may be difficult, but a person who has never had chicken pox will not get shingles.
The Centers for Disease Control and Prevention (CDC) recommend that people over 60 years old are vaccinated with the shingles vaccine at least once. The varicella-zoster shot, known as Zostavax, or VZV, is approved by the Food and Drug Administration (FDA) for those over 50 years old.
Although people can still get shingles following the shot, the duration and severity of shingles may be reduced. Receiving the shot may also lower the risk of developing PHN.
People should speak with their healthcare provider to see if vaccination is the right choice for them. The shot should be avoided in those with an existing infection, pregnancy, or a weakened immune system.
The CDC also recommend that children, teens, and adults receive the chickenpox shot in two doses. Although there is a very small chance the being infected with Varicella zoster virus despite vaccination, the CDC report that the vaccination may allow for milder chickenpox symptoms if this happens.
It is important to speak with a healthcare provider to determine if vaccination is the right decision.
Most people do not have shingles again after they have had it once.