Shingles is a contagious viral infection that is caused by the varicella zoster virus, the same virus that causes chickenpox. This virus affects a particular nerve section, causing painful rashes on the skin connected to that particular nerve. The rash normally appears in a form of a band on any part of your body.
Shingles mostly occurs in elderly people, especially those who don’t have healthy immune systems due to various factors: physical and mental stress, medications, and some wounds and injuries. Though this infection is not fatal, it can be very painful and the symptoms may take a couple of weeks to go away. Sometimes, the pain lasts even after the rashes are gone, the pain reducing very gradually. There are vaccines and medicines to reduce the infection and problems caused by shingles. Very few people get this infection more than once in their life. Shingles, although contagious, is not as serious or as severe as chickenpox.
Reasons for developing shingles
Anyone who has had chickenpox can develop this infection. Once the person recovers from chickenpox, the virus remains, albeit inactive, in the nerve roots near the spinal cord. This virus may become active after a few years when the individual has aged or has a weak immune system. The virus then moves through the nervous system and affects the skin. It is the reactivated virus that causes shingles.
If a person has not had chickenpox and whose immunity is weak, contracting this infection through contact with the blisters of a person with shingles is possible. However, once the blisters have crusted over, the virus can no longer infect others.
Developing shingles without a rash (Zoster Sine Herpete or ZSH)
In ZSH, diagnosis is not easily achieved, since the traditional shingles rash is not present.
The symptoms of shingles without a rash are usually similar to those with a rash, and are mostly concentrated on one side or part of the body such as the face, neck, around the eyes, or even internal organs.
These symptoms include:
- Painful burning sensation
- Itching sensation
- Feeling numb
- Continued dull pain
- Pain that spreads from the spine
Diagnosis of shingles without a rash
Although it is less common, shingles without a rash is possible, but it is often not easy for physicians to diagnose. It can be difficult to reach a complete diagnosis based on its symptoms only.
Doctors perform blood, cerebrospinal fluid, or saliva tests to detect VZV antibodies, but these tests are not often conclusive, and medical history may have to be looked into for clues hinting at the presence of shingles without a rash.
In both shingles with a rash and shingles without a rash, the symptoms usually clear up within two weeks. In some cases, patients may develop postherpetic neuralgia, which is remnant pain coming after the shingles rash has healed. This phenomenon is mostly witnessed in people who had previously been infected with shingles without a rash.
If you have a compromised immune system, you are more likely to develop shingles a second time. People who get vaccinated against shingles usually develop less severe shingles and at lower risk for developing postherpetic neuralgia. The vaccine is recommended for people older than 60.
Transmission of shingles
A person who has shingles cannot transmit shingles to another person, but a person can get chickenpox from someone who is infected with shingles. This is possible when the person without shingles has not had chickenpox in the past.
The rashes caused by shingles are infectious until they have completely dried up. However, if the rashes are properly covered, the virus cannot infect others, since it is transmitted only through direct contact with blisters.
In other words, shingles can cause chickenpox in someone who has never had chickenpox. In this instance, a person with the varicella zoster virus can pass it on to another person because it is not present in that person’s body. This leads to chickenpox. If you haven’t had chickenpox but happen to touch any oozing shingles blisters, you may contract chickenpox.
This virus doesn’t spread once the blisters have dried up and formed crusty scabs, or when the lesions are covered.
Less commonly, contact with the saliva or nasal secretions of an individual who has shingles, for example when the person coughs or sneezes, may cause chickenpox in a person who has not had it.
When is shingles contagious?
A rash starts to appear once the symptoms below show up:
- Skin tingling, itching, stinging and/or
- Numbness, usually on one side of the body, or a stabbing pain on one side
- Body ache
- Fever and chills
Once the rash appears and the blisters start forming, the virus becomes contagious.
Shingles has three stages:
- Prodromal stage - This is the stage before the rash appears. It is characterized by burning, itching, or tingling numbness in the affected areas. The person may also have a fever and flu-like symptoms. This stage lasts for several days or weeks.
- Active stage - This is the stage when the rashes and blisters appear, usually over 3 to 5 days. Blisters appear in clusters and are filled with clear fluid. After 3 or 4 days, the fluid may become cloudy, then the blisters break open and the lesions leak fluid, then dry up after a few days, crusting over and then becoming scabs, which eventually fall off by themselves. The entire stage occurs over a period of 2 to 4 weeks.
- Postherpetic neuralgia - In some cases, the burning, stabbing, or dull pain persists even after the rashes and blisters have healed. The affected area is also extremely sensitive to touch. This is the chronic condition called postherpatic neuralgia, which can last for years.
How long is shingles contagious?
Painful blisters appear in a band along a nerve distribution on one side of the body. These blisters eventually break open and ooze fluid. This lasts about five to seven days. As the nerves are irritated where the rash occurs, the pain can be intense. While the blisters are in the formation stage, and until all the blisters have crusted over, the person is contagious and can spread the virus. The rash may take about two to four weeks to heal, but scars may be left behind in some areas.
Is the shingles virus contagious? How do you prevent it from spreading?
The virus behind shingles is easily transmittable, so it is imperative to prevent it from spreading if you have it. The virus remains inactive in the nerve cells after a chickenpox infection, and experts still do not completely understand what causes it to reactivate in some people.
To prevent the spread of shingles, sharing personal items, swimming, or engaging in contact sports should be avoided, in addition to foregoing school or going to work until the rash has healed.
Avoid contact with:
- Pregnant women who have not had chickenpox, as this could affect the development of the unborn child
- People with a suppressed immune system
- Babies less than a month old, unless you are the biological mother, since your baby will already have antibodies to counter the shingles virus
A 2011 Minnesota study conducted over a seven-year period showed that only about 6% of shingles victims got shingles a second time. The period between the first and second infection was not clearly stated but can be inferred to be between 96 days and well over 10 years, based on the study.
In general, the chances of developing a second shingles infection are the same as the odds of developing the first shingles infection.
Who is more at risk for developing shingles?
Anyone who has had chickenpox can develop shingles, but these people are more at risk:
- Adults above the age of 50
- People with poor immune systems
- Pregnant women
- Newborns and infants
- HIV, AIDS, and cancer patients
- Cancer patients undergoing chemotherapy and radiation
- People who are psychologically or emotionally stressed or already sick
- People who have undergone organ transplantation or individuals with certain autoimmune disease such as Crohn’s disease, rheumatoid arthritis, etc.
Risk factors for recurring shingles
The exact cause of recurring shingles has not yet been determined, but certain conditions influence the chances of getting it again.
People with a weak immune system are at higher risk than those with a normal immune system.
Your immune system may be compromised if you:
- Have had chemotherapy and/or radiation therapy
- Have had an organ transplant
- Have HIV or AIDS
- Are taking high doses of corticosteroids
Risk factors include these:
- Severe pain associated with the first shingles case
- Pain lasting for than 30 days or more with the first infection
- Being a woman
- Being older than 50
- Having a bloodline with a history of a high rate of shingles infection
Prevention of recurring shingles
Recurring shingles cannot be prevented, but the risk is leveled by getting a shingles vaccine; vaccination generally reduces the severity of the infection and also greatly reduces the risk of infection.
The vaccine is mostly recommended for people over fifty years of age but not those whose immune systems are too weak.
Symptoms of shingles
There are a number of early signs that can help one identify shingles. The symptoms of this disorder occur in phases. They may initially start with a headache, sensitivity to light, fever, and weakness. Later on, the individual will experience pain in the skin where the nerve is affected. Red and itchy rashes will form on the affected skin area. These rashes will be in clusters and gradually fill with fluid. More new blisters may form the following week, and the affected skin may become swollen because of the virus. It takes a couple of weeks for the rashes to disappear, but sometimes, the rash can leave marks on the skin.
Sometimes, someone suffering from shingles may not understand why they are experiencing pain. The pain for some can be severe, and at times, the pain may come before the rash appears. Some people may also not have any rashes at all but only experience pain. The virus mostly affects only a single nerve, and only the skin that is provided sensation by that nerve gets affected. But at times, the virus does affect more than one nerve. The most common nerves that get affected are those providing sensation to the skin over the chest, abdomen, and face. Thus, a person may not understand that they have developed shingles and think they have a problem with the heart or lungs depending on the area where they experience pain.
Shingles pain varies from person to person and can be difficult to treat at times with over-the-counter medications.
The symptoms of shingles from the outside are similar to that of chickenpox. Both these infections cause open blisters oozing fluid. However, while shingles affects the skin on one part of the body, chickenpox blisters appear on various skin areas. Shingles can also appear on the side of the face.
Complications caused by shingles
- Postherpetic neuralgia: This is when the pain continues even after the rashes have completely dried up. This is more common in adults who are more than 60 years old. The pain will gradually reduce, but at times, it takes months for someone to completely recover. The chronic pain of shingles can lead to depression and disability. Timely antiviral medication during a shingles outbreak can reduce the incidence of a person developing postherpetic neuralgia.
- Skin infection: If the rashes are not treated in time and with proper medication, bacteria can congregate in the affected area. In such cases, the skin becomes very sensitive and red. The bacterial skin infection is caused by Staphylococcus aureus or group A Streptococcus bacteria. Such infections can be treated using antibiotics.
- Eye infection: Shingles that has developed near the eye can lead to swelling of the eye, and if not treated, can lead to loss of vision. Those individuals with rashes near the eye, or on the forehead or nose, should consult an eye doctor for thorough evaluation and go for the necessary treatment as soon as possible.
- Neurological complications: Depending on the nerve affected, this disorder can cause swelling of the brain, facial paralysis, and hearing problems. Inflammation of the brain is called encephalitis. This condition is life-threatening, especially for people with a weak immune system.
- Apart from affecting the brain, the virus can also cause damage to the liver and lungs.
What are the long-term effects of shingles?
- Lung inflammation
- Loss of hearing
- Loss of vision
- Brain inflammation
- Severe pain that continues even after the shingles rash has healed. This presumably occurs in 1 out of 5 cases of shingles.
- With age, pain is more likely to be severe
When to visit a doctor
Diagnosing shingles before the rash appears, or when it does not, can be challenging. In cases where diagnosis is difficult, laboratory tests are done to identify and confirm the type of infection present.
Meeting the doctor is advisable in the following cases:
- If the pain and swelling is in the eye or close to the eye
- If the person is over 65 years of age, since the chances of complications are higher for older patients
- If the affected person or anybody in the family has a poor immune system due to age, medication, or an illness
- The rashes are spread over a larger area and the person is experiencing severe pain
How to prepare for the doctor's appointment
A person should be well-prepared before meeting the doctor and should write down the following beforehand:
- Symptoms he or she is experiencing
- Medication currently being taken or taken in the past
- Family medical history
Apart from these, the person should also make a list of questions to ask the doctor in order to get complete information on the disorder and the methods of treating it correctly.
Shingles is commonly diagnosed and treated by a primary care physician or a family practitioner. Individuals who develop complications will need to see a specialist, such as an ophthalmologist or neurologist, depending on the symptoms of the complication. Patients with the complicated type of shingles, postherpetic neuralgia, will need the care of a pain specialist.
Treatment and medication for shingles
Medication helps limit the pain, shortens the duration of symptoms, and also prevents the spread of the virus. The main objective in treating shingles is to reduce the pain caused by the infection and avoid any complications. Here are some typical treatment methods:
- Lifestyle and home remedies: Wear loose, cotton clothes near the affected area. Also, place a cool cloth or ice pack on the affected area to help relieve the pain and sensitivity. One can apply creams prescribed by doctors to reduce itching.
- Painkillers: Various painkillers based on the severity of the pain are prescribed by the doctor. Some painkillers are given to reduce nerve pain.
- Antiviral medicines: This type of medication cannot remove the virus, but it can reduce the symptoms and stop the virus from spreading further. This medicine is normally beneficial if it is given to the patient within 72 hours of his or her developing the rash. But in some cases, doctors prescribe this medicine to older patients to avoid complications, especially if the disorder has affected the eye or ear or the patient has a weak immune system. This medication is not normally prescribed to children or younger adults, since they typically do not show severe pain or symptoms and have less chances of developing complications. The doctor prescribes these antiviral medications based on the severity of the symptoms and the affected area. An antiviral medication course has to be taken for a week.
- Steroids: Steroids lessen the swelling and pain caused by shingles and allow for a speedy recovery. They may be given as an add-on along with the antiviral medication, but are not always recommended by doctors.
- For postherpetic neuralgia, there are various treatments available, including topical anesthetic patches, opioid pain medications, and tricyclic antidepressant medications.
- The individual can also apply some type of dressing as recommended by the physician to absorb the fluid oozing out of the blisters and protect the sores. This will help prevent spreading the virus to other individuals.
Using L-lysine supplements to treat shingles
L-lysine is a natural remedy against shingles, and its supplements can be taken to combat it. Lysine is a naturally-occurring protein building block and an essential part of a balanced diet. L-lysine refers to the supplement, which is also thought to relieve colds. Incidentally, herpes simplex virus type one (HSV-1), which causes the common cold, is under the same umbrella as the shingles virus, varicella zoster.
What doctors treat shingles and how is it diagnosed?
The appearance and pattern of a rash may be compared as against the traditional, distinctive shingles rash by the doctor. Painful, blistering sores on localized dermatomes (localized area of skin provided its sensation by a single nerve) may also hint at shingles. Lab tests such as blood tests may be used.
Diagnosing shingles without a rash may be difficult. In instances where the diagnosis is not conclusive, lab tests help to affirm the diagnosis. Testing can be done on blood or on lesion fluid samples to detect antibodies.
You should be aware that shingles is contagious while the rash is in blister-stage.
Diagnosis and treatment are usually done by a primary care physician or an emergency room physician.
For individuals who react negatively to treatment, a neurologist or ophthalmologist may have to be brought in. Patients with postherpetic neuralgia may require pain specialists.
How do you treat shingles at home?
Painkillers may be bought to ease the pain. The rash may take up to 4 weeks to heal and pain may persist even after the rash has healed, but it usually will disappear a short while later.
When healing from shingles at home, take these general measures:
- Keep the rash clean and dry to avoid external infection
- Wear loose fitting clothing
- Buy calamine lotion to ease itching and pain. This lotion can be applied directly onto the rashes.
- Use a cool compress at intervals throughout the day.
- It is very important to maintain good personal hygiene and stay clean.
- Avoid picking at the blisters and scratching the area of the rashes, and try to keep the affected area clean as much as possible to avoid any bacterial growth. If left alone, the blisters will crust over and the scabs will fall off naturally.
- To avoid spreading the disease to another person, keep the rashes covered.
- Baking soda also helps dry the sores so that they heal quickly.
If home treatment doesn’t help in easing the discomfort and pain, it would be best to reach out to a doctor. Getting the pain under control right away will avoid nerve damage, which otherwise may last for as long as months or years.
Public exposure when infected with shingles
How long is shingles contagious? Well, shingles, after developing symptoms until the time the rashes and blisters dry up, is highly infectious. It is acceptable to be in public, but it is best to avoid being close to anyone, especially pregnant women.
The herpes zoster virus, the chickenpox causative agent, poses a great health risk to both pregnant women and children and can lead to medical complications including pneumonia and birth defects. If you expose anyone of either to the virus, it is important to contact an OB/GYN for recommendations.
There are two vaccines available on the market that can be taken to avoid getting shingles:
- Chickenpox vaccine: The varicella vaccine is now a part of the routine vaccine schedule given to children to protect them from chickenpox. Nowadays, this vaccine is also prescribed as a precautionary measure to adults who have never had chickenpox. This vaccine does not give guaranteed assurance, but it can reduce the intensity of the infection and chances of complications.
Shingles vaccine: The varicella zoster vaccine is now available on the market to help avoid developing shingles. As with the chickenpox vaccine, there is no 100 percent assurance that the virus will be prevented from reactivating, but the vaccine will reduce the duration and severity of the infection should it occur.
This vaccine is normally prescribed to people who are over the age of 60. It is given as a single dose injection in the upper arm, and has certain side effects like redness, itchiness, and swelling. Some people also develop a rash near the injected area and get headaches.
The shingles vaccine is not beneficial to people who are already suffering from the infection. It is a live attenuated vaccine that helps boost the immune system and should be administered only once. Since this is a live vaccine, it is not advisable during pregnancy or for those with a weak immune system. Once this vaccine is administered, it helps prevent the recurrence of shingles. Also, it is safe for the person to be around children or pregnant women.
Side effects of the shingles vaccine
The vaccine was tested on a large population scale to ensure accuracy and certainty in the results. The vaccine usually has minimal to no side effects when administered with proper caution.
Less severe effects include:
- Sore skin
- Headache after vaccination
Severe side effects are rare, and for the involved party who develops an acute allergic reaction, also known as anaphylactic reaction, it is very important to seek emergency medical services right away since the condition is life-threatening.
Its warning signs are:
- Swelling of the face
- Itchy, swollen areas of the skin
- Redness of the skin
- Breathing difficulties
- Anomalies in heartbeat
- Slow pulse
Shingles vaccine and thimerosal
The shingles vaccine has no thimerosal. Thimerosal is an added preservative in some vaccines. It contains mercury and is also used to prevent the growth and development of bacteria and other germs in them. Thimerosal was falsely linked to autism in a research work done long ago.
Manufacturing and administering the shingles vaccine
The vaccine is made from a weakened but live form of the virus to avoid infecting healthy people. However, people with a weaker immune system do need to exercise some caution, as the vaccine may cause some of them to be sick.
Before vaccination, such people should inform the doctor. After vaccination, it is safe to be around infected people. It is essential to keep people who have not been vaccinated and young children or babies away from contact with chickenpox or shingles rashes.
In some people, a chickenpox-like rash may develop on the skin around the area where the injection was administered.
Who should be vaccinated?
People over the age of 60 are more likely to be infected; therefore, they should be vaccinated.
Currently, the only vaccine accepted by the Food and Drug Administration (FDA) is zostavax. The vaccine reduces the chances of infection by almost half and avoids painful nerve complications associated with the disease. The Food and Drug Administration has also approved zostavax for older adults between the ages of 50 and 59. The shingles vaccine is effective in preventing the future occurrence of shingles.
Apart from the vaccinations, one should make sure to keep the shingles rashes clean and covered. This will help prevent the virus from spreading to other people who are at risk. Try to not touch the blisters and make sure to wash your hands frequently.
Reasons against shingles vaccination
Some people may develop an allergic response to some of the vaccine's contents. Speak with your doctor first if you are reactive to gelatin, neomycin (an antibiotic), or any other ingredient included in the vaccine.
Also speak with your doctor if you have a suppressed immune system, which may be due to any of these:
- Diseases and chronic illnesses that compromise the immune system
- Drugs that lower immune response, such as steroids
- Cancer affecting the bone marrow or lymphatic system
- Active tuberculosis (TB)
- Cancer therapy such as radiation therapy or chemotherapy
The vaccine should not be given to pregnant women or those who desire to be pregnant.
A minor illness, such as the common cold, should be fully recovered from before the vaccine is given.
The bottom line
For people who have had chickenpox, shingles is a common phenomenon. It is rare for a complication to arise but it tends to be devastating if it does, and if you suspect you have shingles, it is best to seek immediate medical help.
Home remedies for shingles such as L-lysine may not be harmful, but it may not be beneficial either. Seeing a doctor is the best option as it has way more advantages than letting a shingles infection proceed untreated.
Prescribed antiviral drugs can ease severe symptoms of shingles as well as reduce the time that you are ill, and help prevent the development of incessant pain after the blisters have healed.
L-lysine can relieve sores but no evidence supports it as being effective in treating shingles.
- Shingles is caused by the chickenpox-causing virus, varicella zoster.
- Shingles does not spread through direct contact with the infected person, but can spread if one comes in contact with the blisters that carry the virus.
- This virus affects a particular nerve section, causing painful rashes on the skin.