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Shingles (Herpes Zoster): Symptoms, Treatments, and Prevention Guide

Recognizing Shingles: Identifying Symptoms and Understanding Treatments
July 20, 2023
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Shingles, also known as herpes zoster, is a health condition caused by the varicella-zoster virus. This is the same virus that gives you chickenpox. If you've had chickenpox, the virus can wake up after many years and cause shingles. This disease is most famous for causing a painful rash, usually on one side of your body or face. But it can also lead to serious health problems if you don't get it treated right away. That's why it's really important to know about this disease. This guide will help you learn how to spot shingles, how doctors treat it, and how the shingles vaccine can stop you from getting it. Plus, we'll answer a question a lot of people ask: Is shingles contagious? By learning all this, you'll be ready to take action if you think you might have shingles, and you'll understand why it's so important to prevent it.

Recognizing Shingles

Shingles typically presents itself as a painful rash that usually develops on one side of the body or face. The rash begins as small blisters, which later form scabs. This is often preceded or accompanied by other symptoms like headache, sensitivity to light, and flu-like symptoms without a fever. The incidence of herpes zoster is higher in older adults, particularly those over 50 years of age and individuals with weakened immune systems. However, it can also occur in healthy adults and pregnant women.

The Role of the Immune System

The varicella-zoster virus remains dormant in the body's nervous system after an individual recovers from chickenpox. It can reactivate years later, causing shingles. This reactivation is often associated with a weakened immune system, which could be due to aging, stress, certain medications, or other infectious diseases.

In rare cases, shingles can lead to severe complications such as postherpetic neuralgia (PHN), a condition characterized by lingering pain in the area where the rash was present, and encephalitis, an inflammation of the brain. If the shingles rash appears around the eye, it can cause vision loss.

Lab Tests for Shingles

The Varicella (Chicken Pox) IgG Antibody Titer Test, Varicella-Zoster Virus Antibody (IgM), and Varicella Zoster Virus Antibodies (IgG, IgM) are all used in the context of shingles (herpes zoster) for various reasons.

  1. Varicella (Chicken Pox) IgG Antibody Titer Test: This test is used to determine if an individual has immunity to the varicella-zoster virus, either from past infection or vaccination. For people who present with shingles, this test might be used to confirm a past varicella-zoster virus infection, which can help in the diagnosis of shingles.
  2. Varicella-Zoster Virus Antibody (IgM): This test is used to detect a current or very recent infection with the varicella-zoster virus. In the context of shingles, a positive result would indicate an active shingles outbreak, as shingles is caused by reactivation of the varicella-zoster virus.
  3. Varicella Zoster Virus Antibodies (IgG, IgM): This test is particularly useful for diagnosing shingles as it measures both IgG and IgM antibodies. The presence of IgM antibodies would suggest a recent reactivation of the virus (as occurs in shingles), while the presence of IgG antibodies would confirm past exposure to the virus, either through chickenpox infection or vaccination.

Overall, these tests are valuable diagnostic tools that allow healthcare providers to confirm a diagnosis of shingles, particularly in cases where the symptoms might be atypical or the patient's medical history is unclear.

Risk Factors and Triggers for Shingles

Understanding the risk factors and triggers for shingles can help you better manage and potentially prevent the disease. Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. If you've had chickenpox, you're at risk of developing shingles later in life. But why does the virus reactivate for some people and not others? Several factors can increase your risk:

Age: Shingles most commonly affects people over the age of 50. The risk increases with age, possibly due to a natural decline in the immune system. More than half of all shingles cases occur in adults 60 years old or older.

Weakened Immune System: People with weakened immune systems are more susceptible to shingles. This includes individuals undergoing cancer treatment, those on immunosuppressive drugs due to organ transplantation, and those living with diseases that affect the immune system like HIV/AIDS.

Stress and Fatigue: Prolonged periods of stress or fatigue can weaken the immune system, making it easier for the varicella-zoster virus to reactivate.

Certain Medical Conditions: Diseases that affect the immune system, such as cancer or HIV, can increase the risk of developing shingles.

While these risk factors can increase the likelihood of developing shingles, they are not definitive triggers. Even healthy adults can develop shingles. However, understanding these factors can help in the prevention and early detection of the disease.

Triggers for Shingles

While the exact cause of the reactivation of the varicella-zoster virus isn't completely understood, several potential triggers have been identified:

Immunosuppression: Any condition or treatment that suppresses the immune system can potentially trigger shingles. This includes cancer treatments like chemotherapy and radiation, steroids, and diseases like HIV.

Stress and Emotional Trauma: Severe stress or emotional trauma may trigger a shingles outbreak, although the exact link is not fully understood.

Physical Trauma or Injury: In some cases, a physical injury or trauma—especially to the skin—may trigger a shingles outbreak.

Other Illnesses: Sometimes, a shingles outbreak can be triggered by another illness, particularly if it causes stress or weakens the immune system.

Understanding these risk factors and triggers can help inform prevention strategies and early treatment. If you're at a higher risk of developing shingles—due to age, a weakened immune system, or other factors—consider discussing prevention strategies, such as the shingles vaccine, with your healthcare provider.

Vaccination and Immunization Against Shingles

One of the most effective strategies for preventing shingles is vaccination. Vaccination against shingles not only reduces your risk of developing the disease, but it can also lessen the severity of the illness if you do get it.

Understanding Shingles Vaccines:

There are two vaccines that help reduce the risk of shingles – the Zostavax and the Shingrix vaccine.

  1. Zostavax: Until 2017, Zostavax was the recommended vaccine for shingles. It's a live vaccine given as a single injection, usually in the upper arm. Zostavax can reduce your risk of shingles by about 51%.
  2. Shingrix: The CDC now recommends the Shingrix vaccine as it's over 90% effective at preventing shingles. Shingrix is a non-live, recombinant vaccine that is given in two doses, with the second dose administered 2 to 6 months after the first one.

Effectiveness of Vaccination:

The Shingrix vaccine has been shown to be more than 90% effective at preventing shingles and the complications from the disease, like postherpetic neuralgia. The immunity provided by the Shingrix vaccine remains strong for at least 4 years, but research is ongoing to determine exactly how long it lasts.

Possible Side Effects:

The Shingrix vaccine can cause side effects, but they are generally mild and go away on their own. The most common side effects include:

  • Pain, redness, and swelling at the injection site
  • Muscle pain
  • Tiredness
  • Fever
  • Upset stomach

In rare cases, people may experience a severe allergic reaction to the vaccine. Any unusual or severe symptoms after vaccination should be reported to a healthcare provider right away.

Importance of Vaccination:

Vaccination is particularly important for those at high risk of shingles. This includes people over the age of 50 and those with weakened immune systems. Vaccination not only reduces the risk of developing shingles but can also prevent the long-term pain that can occur after shingles (postherpetic neuralgia).

The CDC recommends all healthy adults aged 50 and older get two doses of the Shingrix vaccine, even if they've had shingles or the older Zostavax vaccine in the past. The vaccine is also recommended for those who've never had chickenpox.

In conclusion, vaccination is a vital tool in the prevention of shingles. If you are in the high-risk group, discuss getting vaccinated with your healthcare provider. Remember, the best defense against shingles is prevention.

Side Effects of Shingles Treatment

While shingles can be painful and disruptive, treatments are available to help manage the symptoms and accelerate healing. The most common treatments for shingles are antiviral medications, pain relievers, and topical agents to soothe the skin. However, it's important to understand that like any medications, these treatments can have side effects.

Antiviral Medications:

Antiviral medications such as acyclovir, valacyclovir, and famciclovir are often prescribed to reduce the severity and shorten the duration of shingles. They work most effectively when started within 72 hours of the first sign of the rash.

Possible side effects of these medications include:

  • Nausea or vomiting
  • Diarrhea
  • Headache
  • Dizziness
  • Tiredness

Pain Relievers:

Over-the-counter pain medications like acetaminophen or ibuprofen can be used to help reduce pain. More severe cases might require prescription painkillers.

Side effects from these medications can include:

  • Nausea or vomiting
  • Stomach bleeding
  • Skin rash
  • Liver damage (when used in large quantities over time)

Prescription pain medications can have additional side effects such as drowsiness, dizziness, constipation, or addiction, particularly with long-term use.


In some severe cases of shingles, your healthcare provider might prescribe corticosteroids along with antiviral medication. Corticosteroids can help reduce inflammation and pain.

Possible side effects from corticosteroids include:

  • Increased appetite and weight gain
  • Sleep problems
  • Mood changes
  • High blood pressure
  • Weakened immune system, increasing the risk of infections

Topical Agents:

Creams, gels, or patches can be applied to the skin to relieve itching and pain. Some of these are over-the-counter, while others may require a prescription.

Possible side effects of topical agents include:

  • Skin rash or irritation
  • Changes in skin color
  • Allergic reaction

While these side effects can occur, it's important to remember that not everyone will experience them, and in most cases, they are temporary and resolved once the medication is stopped. Always discuss potential side effects with your healthcare provider before starting any new medication. If you notice any severe or lasting side effects, seek medical attention promptly.

Coping with Postherpetic Neuralgia (PHN)

Postherpetic neuralgia (PHN) is a common complication of shingles, characterized by persistent nerve pain that can continue for months or even years after the shingles rash has healed. Coping with PHN can be challenging, but a combination of medication options, therapies, and lifestyle changes can help manage symptoms and improve quality of life.

Medication Options:

  1. Painkillers: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, might be recommended for mild pain. In more severe cases, prescription painkillers might be necessary.
  2. Antidepressants: Certain types of antidepressants, such as nortriptyline or amitriptyline, can be effective at relieving nerve pain.
  3. Anticonvulsants: Medications originally developed to control seizures, like gabapentin and pregabalin, can also be effective at managing PHN.
  4. Topical Anesthetics: Lidocaine skin patches or capsaicin skin patches can be applied to the affected area to provide relief.


  1. Physical Therapy: Physical therapy techniques, including massage, can sometimes help reduce pain and improve the function of affected areas.
  2. Transcutaneous Electrical Nerve Stimulation (TENS): This involves sending small, low-voltage electrical currents to the nerves near the skin's surface, which can relieve pain.
  3. Acupuncture: Some individuals find relief from acupuncture, which may help reduce pain by triggering the body's natural painkillers.

Lifestyle Changes:

  1. Manage Stress: High levels of stress can exacerbate pain. Techniques such as mindfulness, deep breathing, yoga, or tai chi can be beneficial.
  2. Maintain a Healthy Diet: Certain foods may increase inflammation in the body, which could exacerbate PHN symptoms. Aim for a balanced diet rich in fruits, vegetables, lean proteins, and healthy fats.
  3. Regular Physical Activity: Regular exercise can help reduce pain and maintain overall health.
  4. Quality Sleep: Poor sleep can intensify the pain. Practice good sleep hygiene, which includes regular sleep hours, a cool, dark, quiet room, and avoiding electronic devices before bed.

Coping with PHN can be difficult, but you're not alone. If you are struggling with PHN, it's important to communicate with your healthcare provider about your symptoms and pain levels. They can work with you to develop a comprehensive treatment plan that addresses your unique needs and improves your quality of life.

Treatment and Prevention

While there is no cure for shingles, antiviral medications like acyclovir, famciclovir, and valacyclovir can reduce the severity and duration of the disease if administered early. Over-the-counter pain relievers and soothing lotions may also provide relief from symptoms.

The best way to prevent shingles is through vaccination. The Centers for Disease Control and Prevention (CDC) recommends that adults over 50 years of age receive the recombinant zoster vaccine, known as Shingrix. The Shingrix vaccine is preferred over the older Zostavax vaccine due to its increased effectiveness. This recommendation is also supported by the Advisory Committee on Immunization Practices.

When to Consult a Healthcare Provider

If you suspect you have shingles, it's crucial to seek medical attention as soon as possible. Your healthcare provider will review your medical history and conduct a physical examination. Prompt diagnosis and treatment can reduce the risk of complications and speed up the healing process.

Frequently Asked Questions (FAQs) about Shingles

1. Is herpes zoster the same as shingles?

Yes, herpes zoster is the medical name for shingles. It's caused by the reactivation of the varicella-zoster virus, which also causes chickenpox.

2. Is herpes zoster a sexually transmitted disease (STD)?

No, herpes zoster is not a sexually transmitted disease. It's caused by the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant in the body and can reactivate later in life to cause shingles.

3. How serious is herpes zoster?

Herpes zoster can be serious, particularly for older adults and people with weakened immune systems. Complications can include severe pain, vision loss, and neurological problems.

4. How many days does herpes zoster last?

The rash and pain of herpes zoster typically last for 3 to 5 weeks. However, some people may experience postherpetic neuralgia (pain persisting at the site of the rash) for months or even years after the rash has cleared.

5. What is the most common cause of herpes zoster?

The most common cause of herpes zoster is the reactivation of the varicella-zoster virus. This can happen due to aging, stress, or conditions that weaken the immune system.

6. How is herpes zoster transmitted?

Herpes zoster cannot be transmitted from person to person. However, a person with an active shingles rash can transmit the virus to someone who has never had chickenpox or received the chickenpox vaccine.

7. What is the treatment for herpes zoster?

Treatment for herpes zoster includes antiviral drugs to reduce the severity and duration of the illness, and pain medications to manage discomfort. Topical creams can also be used to soothe the skin.

8. What are the symptoms of herpes zoster?

Symptoms of herpes zoster include pain, burning, numbness, or tingling, a red rash, and fluid-filled blisters. Some people may also experience fever, headache, sensitivity to light, or fatigue.

9. What is the difference between herpes zoster and shingles?

There is no difference between herpes zoster and shingles – they are two names for the same disease. "Herpes zoster" is the medical name, while "shingles" is the common name.

10. Can you get shingles more than once?

Yes, it is possible to get shingles more than once, though it's not common. Some people may experience shingles two or three times in their lifetime.

11. Are shingles contagious?

Shingles itself is not contagious, but the varicella-zoster virus that causes shingles can be spread to people who haven't had chickenpox or the chickenpox vaccine. Once infected, these people will develop chickenpox, not shingles.

12. Can children get shingles?

While shingles is much more common in adults, children can get shingles, especially if they had chickenpox before the age of 1.

13. Does the shingles vaccine guarantee I won't get shingles?

No vaccine is 100% effective, but the shingles vaccine significantly reduces your risk of developing shingles and postherpetic neuralgia. Even if you do get shingles after vaccination, the disease is typically less severe.

14. How long should I wait to be around pregnant women, newborns, or people with weakened immune systems after having shingles?

Until all your shingles and blisters have scabbed over, you are contagious and should avoid people who might be at risk. Once the blisters have scabbed over, the virus cannot be spread, and it is safe to be around others.

15. Can I get the shingles vaccine if I've already had shingles?

Yes, even if you've already had shingles, you can still receive the shingles vaccine to help prevent future occurrences.

16. Can shingles be prevented?

Yes, vaccination is the most effective way to prevent shingles. The Shingrix vaccine is currently the recommended vaccine for preventing shingles in adults 50 years and older.

17. Are there any home remedies for shingles?

Home remedies for shingles are mainly focused on relieving symptoms. These might include using cool, damp compresses on blisters, taking soothing baths, applying calamine lotion, and avoiding stress.

18. What triggers the reactivation of the varicella-zoster virus?

Potential triggers for reactivation of the varicella-zoster virus include age (the risk increases after age 50), stress, and conditions that weaken the immune system.

19. Can shingles cause other health problems?

Yes, complications can arise from shingles, such as postherpetic neuralgia, vision loss if shingles affect the eye, neurological problems, skin infections, and, though very rarely, stroke or pneumonia.


Shingles is a common and often painful condition that affects a large number of adults, particularly the older population. Recognizing the symptoms of shingles and seeking immediate healthcare can significantly reduce the risk of long-term complications. Remember, the best defense against shingles is prevention. Vaccination is highly recommended for adults over 50 and anyone with a weakened immune system.

The CDC's official website and the National Institute of Dermatology provide valuable resources for learning more about shingles and its prevention. While shingles can be painful and disruptive, with proper care and treatment, most people make a full recovery.

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