Medically tested by Danica Alexander, DO
Shingles can be scary and also puzzling. What exactly is this famously painful rash, who gets it and why does it suddenly appear? Is shingles contagious? Who should be vaccinated? If you’re confused, you’re not alone. Read on for answers to some of the most frequently asked questions about this viral infection. Some of these may surprise you.
What is shingles?
Herpes zoster, also known as herpes zoster, is a viral infection caused by the varicella zoster virus, the same virus that causes chickenpox. When you get shingles, the same viral particles that gave you chickenpox as a child are reactivated, this time causing different symptoms.
The main symptom of shingles is a painful blistering rash that usually appears in a strip on one side of your body, often on the face or trunk.
How does shingles start?
For about a day or two before you see the rash, you may notice pain, burning, or stinging in the area where it will appear. It is sometimes described as an “electric” sensation. Other early signs include:
- Sensitivity to light
- Headache
- Fever
- Chills
- Fatigue
- Stomach disorders
Does shingles itch?
Some people experience mild to severe itching before the rash appears. Rarely, itching may persist for several months or even years after the rash has subsided. The condition is known as postherpetic pruritus.
What does shingles look like?
At first, you’ll see reddish patches of skin with clusters of small, firm bumps. Tiny blisters appear 12 to 24 hours later. They grow larger and cloudier and increase in number over the next two days. The blisters may coalesce into large blisters, which may burst. After a rupture, the blister fluid forms a yellow-brown crust and a scab forms underneath.
Can shingles spread to other parts of the body?
The rash is usually limited to one area, but some people develop it over a larger area of the body. Widespread shingles, known as disseminated shingles, usually affects people who have a weakened immune system.
How long does shingles pain last?
Shingles symptoms usually go away once the rash clears up completely, which takes 2 to 4 weeks, but the pain may remain for another month or two. A relatively small percentage of people who develop the rash — about 10% to 18% — experience burning pain that lasts for months or years. The complication, called postherpetic neuralgia, can be treated but not cured.
Who gets shingles?
Anyone with chickenpox can get shingles, including children, but it is more common in people over 50 due to the natural decline of immunity that occurs with age. Other risk factors include:
- Having an acute or chronic illness
- Having a disease that weakens the immune system, such as HIV/AIDS, leukemia or lymphoma
- Taking medicine that suppresses the immune system
- Undergoing radiotherapy or chemotherapy
Can you get shingles if you’ve never had chicken pox?
You can’t get it if you’ve never had chickenpox. If you come in contact with the fluid from the shingles blisters, you are likely to get chickenpox if you have never had it.
Can stress cause shingles?
Some studies suggest that experiencing chronic, daily emotional stress could make you more vulnerable, as could experiencing a stressful event like losing a job or the death of a loved one.
Is shingles contagious?
If you have shingles, you cannot give it to another person. However, you can spread the virus to someone who has never had chickenpox or who has not had the chickenpox vaccine, and they may develop chickenpox.
When is shingles contagious? Transmission of the varicella zoster virus is more likely to occur when you have open sores. You are no longer considered contagious once the blisters clear.
Can you get shingles more than once?
Most people only get it once, but it’s possible to get it again, especially if you have a weakened immune system.
Is shingles dangerous?
Herpes zoster can lead to serious complications, such as postherpetic neuralgia and bacterial skin infections. If the outbreak occurs in a facial nerve near the ear, you could develop Ramsay Hunt syndrome, which can cause facial paralysis and deafness. You are also likely to develop scarring and vision loss if the rash appears in or around your eye.
Fortunately, you can reduce the risk of complications — and speed up healing — if you see your doctor as soon as symptoms start and get an antiviral medication such as acyclovir (Zovirax) or valacyclovir (Valtrex).
Can you die from shingles?
Death from shingles is very rare. According to the Centers for Disease Control and Prevention (CDC), fewer than 100 people die from it each year. Almost all are elderly or people with weakened immune systems.
Who can get the shingles vaccine?
The vaccine, Shingrix, is recommended for adults age 50 and older and for people age 18 and older who are immunocompromised.
Experts recommend that everyone who is eligible be vaccinated. This includes people who have already had shingles, had the chickenpox vaccine, or had the Zostavax shingles vaccine, which is less effective and is no longer used. Be prepared for temporary side effects.
If you’ve never had chickenpox, ask your doctor if you should get the chickenpox vaccine.
Does Medicare pay for the shingles vaccine?
You can get Shingrix at your doctor’s office or local pharmacy. If you have Medicare Part D coverage, the download will cost you nothing. Medicaid may or may not cover it, so check with your insurer.
Most private insurance companies also cover the vaccine, but check before making an appointment as there may be an out-of-pocket cost. If you cannot afford Shingrix, contact the vaccine manufacturer, GSK, to see if you qualify for financial aid.
How often do you need to get the shingles vaccine?
You only need to be vaccinated with Shingrix once in your life. You will receive the vaccine in two doses, with the second vaccine given 2 to 6 months after the first. If you are immunosuppressed, it may be beneficial to take the second dose earlier. Your doctor should advise you on the timing.
Can you still get shingles after the vaccine?
While Shingrix is highly effective, there is a small chance that you will get the infection. If you do, it will be milder and shorter, and you will be less likely to experience complications.
Written by Jessica Brown, health and science writer/editor based in Nanuet, New York. He has written for Prevention magazine, jnj.com, BCRF.org, and many other outlets.
