Shingles, also called herpes zoster, is a painful viral illness caused by reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox.
After a person recovers from chickenpox, the virus does not completely leave the body. Instead, it remains inactive in sensory nerve tissue and may reactivate years or decades later as shingles.
Shingles can occur at any age, but it becomes more common with increasing age and in people whose immune systems are weakened.
Most people recover, but complications can occur, especially in older adults, people with weakened immunity, and when the eyes, ears or nervous system are involved.
What Causes Shingles?
Shingles is caused by reactivation of varicella-zoster virus.
The first infection with VZV usually causes chickenpox.
After the chickenpox resolves, VZV remains dormant in sensory nerve ganglia. If immunity controlling the virus weakens, the virus can reactivate and travel along a nerve toward the skin.
This produces the characteristic painful rash of shingles.
Worldwide, most adults older than 50 have previously been exposed to VZV and are therefore potentially at risk of shingles. WHO estimates the lifetime risk of developing shingles at roughly one in three.
Can You Get Shingles Without Having Chickenpox?
Shingles develops only in someone who has previously been infected with varicella-zoster virus or has been exposed through a live varicella vaccine.
A person may not remember having chickenpox, particularly if the childhood infection was mild.
So the absence of a remembered chickenpox illness does not necessarily mean someone has never encountered VZV.
Is Shingles the Same as Genital Herpes?
No.
Despite the word "herpes," shingles is not the same infection as genital herpes.
Shingles is caused by varicella-zoster virus.
Genital herpes is usually caused by herpes simplex virus type 2 or type 1.
These are different viruses, with different patterns of disease and transmission.
Who Is Most at Risk of Shingles?
The risk increases with age, particularly from about age 50 onward.
Other important risk factors include conditions or treatments that weaken the immune system, such as:
HIV infection;
some cancers;
chemotherapy;
organ or stem-cell transplantation;
prolonged or high-dose immunosuppressive medicines;
some autoimmune diseases and their treatments.
Shingles can also occur in otherwise healthy younger adults.
What Are the Early Symptoms of Shingles?
Symptoms may begin before the rash appears.
People may notice:
burning pain;
tingling;
itching;
unusual skin sensitivity;
numbness;
stabbing or electric-like pain.
Some people also develop:
headache;
tiredness;
fever;
general discomfort.
The pain or abnormal sensation usually occurs in the area where the rash later develops.
What Does a Shingles Rash Look Like?
The rash usually develops as grouped fluid-filled blisters on reddened skin.
A characteristic feature is that the rash often follows a dermatome, an area of skin supplied by a particular sensory nerve.
It commonly appears as a band on one side of the:
chest;
abdomen;
back;
face; or
neck.
The rash usually does not cross the body's midline in uncomplicated localised shingles.
The blisters eventually break, dry and crust over.
Healing commonly occurs over several weeks, although pain may last longer.
Does Shingles Always Cause a Rash?
Usually, but not always.
Rarely, a person can develop nerve pain associated with VZV reactivation without the typical rash. This is sometimes called zoster sine herpete.
Because many other conditions can cause nerve pain, diagnosis without a rash requires careful clinical assessment.
How Does Shingles Spread?
A person with shingles does not directly give another person shingles.
Instead, someone who has never been infected with VZV and is not immune can acquire the virus from a person with active shingles and develop chickenpox.
Transmission can occur through contact with fluid from shingles blisters.
In healthcare settings, infection-control precautions may differ for localised versus disseminated shingles and according to whether the patient is immunocompromised.
This is more accurate than simply saying shingles is always spread by an airborne route over a fixed distance.
WHO states that VZV can be transmitted from a person with a shingles rash.
When Is Someone With Shingles Contagious?
A person with active shingles can transmit VZV while the rash contains fluid-filled blisters.
Once all lesions have dried and crusted, the risk of transmitting the virus falls substantially.
Until then, the rash should be covered where possible and direct contact with susceptible high-risk people should be avoided.
Who Should Avoid Contact With Someone With Active Shingles?
Until the lesions have crusted, extra care is sensible around people who may be particularly vulnerable to chickenpox complications, including:
pregnant people without evidence of immunity;
newborn babies;
people with severely weakened immune systems;
people known not to have immunity to VZV.
What Is Postherpetic Neuralgia?
Postherpetic neuralgia, or PHN, is the most common important complication of shingles.
It refers to pain that continues after the shingles rash has healed.
Definitions vary between studies and clinical guidelines, but PHN is often defined as pain persisting for around 90 days or longer after the rash begins.
It may feel like:
burning;
stabbing;
aching;
electric shocks;
extreme skin sensitivity.
Risk increases substantially with age.
PHN can last for months and occasionally much longer.
The old statement that PHN occurs in about 45% of all shingles cases is too high as a general estimate and should not be retained.
Other Complications of Shingles
Although most cases resolve, shingles can sometimes cause serious complications.
These can include:
postherpetic neuralgia;
bacterial infection of the skin lesions;
eye complications;
hearing problems;
facial weakness;
neurological complications;
pneumonia in severe cases;
disseminated disease in immunocompromised people.
Serious complications require prompt medical care.
What Is Herpes Zoster Ophthalmicus?
Herpes zoster ophthalmicus occurs when shingles affects the ophthalmic branch of the trigeminal nerve.
The rash may involve the:
forehead;
scalp;
upper eyelid;
nose; or
area around the eye.
Eye involvement can lead to inflammation affecting structures such as the conjunctiva, cornea, uvea or other parts of the eye.
This can threaten vision.
A shingles rash near the eye should therefore be assessed urgently.
What Is Ramsay Hunt Syndrome?
Ramsay Hunt syndrome occurs when VZV affects the facial nerve around the ear.
Possible symptoms include:
severe ear pain;
blisters in or around the ear;
facial weakness or paralysis;
hearing changes;
dizziness;
altered taste.
This requires urgent clinical assessment because early treatment may improve outcomes.
What Is Disseminated Shingles?
Most shingles remains limited to one or nearby dermatomes.
Disseminated herpes zoster occurs when lesions spread more widely.
It is particularly concerning in people with weakened immune systems because the infection may involve internal organs and can become severe.
Hospital assessment and intravenous antiviral therapy may be required.
When Should You Seek Urgent Medical Care?
Seek prompt medical assessment if:
the rash is near the eye;
you have vision changes;
there is severe ear pain or facial weakness;
the rash is widespread;
you are immunocompromised;
severe headache, confusion or neurological symptoms occur;
pain is severe;
you are pregnant and believe you may have been exposed to VZV without immunity.
Early treatment matters.
How Is Shingles Diagnosed?
In many cases, clinicians can diagnose shingles from the combination of:
characteristic pain;
one-sided dermatomal distribution; and
typical grouped blisters.
Laboratory confirmation is useful when the appearance is unusual, the patient is immunocompromised, or another diagnosis is possible.
What Is the Best Laboratory Test for Shingles?
Polymerase chain reaction, or PCR, is generally the preferred laboratory method when confirmation is required.
A sample can be collected from vesicle fluid, a lesion base or crust material.
Older methods such as Tzanck smears have lower specificity and are no longer preferred when PCR is available.
What Can Look Like Shingles?
Conditions that may sometimes resemble shingles include:
herpes simplex;
contact dermatitis;
impetigo;
insect bites;
allergic skin reactions;
some drug eruptions;
other blistering skin disorders.
This is one reason self-diagnosis from a photograph alone can be unreliable.
How Is Shingles Treated?
Treatment has several goals:
shorten the active viral illness;
reduce formation of new lesions;
reduce acute pain;
prevent or manage complications.
The main treatment is antiviral medication, particularly for people at greater risk of complications.
Common oral antiviral medicines include:
acyclovir;
valacyclovir;
famciclovir.
The choice depends on availability, kidney function, severity, age and other clinical factors.
When Should Antiviral Treatment Start?
Antiviral treatment works best when started as early as possible, ideally within about 72 hours after the rash appears.
However, treatment may still be appropriate after 72 hours in certain circumstances, such as:
new lesions continuing to appear;
eye involvement;
neurological complications;
severe disease;
immunocompromised patients.
So someone should not assume that treatment is useless simply because three days have passed.
How Is Shingles Pain Treated?
Pain treatment depends on severity.
Options may include ordinary analgesics such as paracetamol or, where appropriate, NSAIDs.
More severe pain may require prescription treatment.
Persistent neuropathic pain or postherpetic neuralgia may be managed using medicines specifically used for nerve pain, which can include certain:
gabapentinoids;
tricyclic antidepressants;
topical treatments.
These should be selected according to the patient's circumstances and prescribed where appropriate.
Home Care for Shingles
Alongside medical treatment, practical measures may help.
Keep the rash clean and dry.
Wear loose clothing where possible.
Avoid scratching the lesions.
Cool compresses may relieve discomfort.
Cover active lesions when practical to reduce exposure to others.
People should avoid applying unproven substances or harsh chemicals to the rash.
Can Shingles Heal Without Antiviral Medicine?
Some uncomplicated cases, particularly in younger healthy people, may eventually resolve without antiviral medication.
However, that does not mean people should automatically wait for shingles to heal on its own.
Older adults, immunocompromised patients and people with facial, eye, ear or severe disease particularly benefit from early clinical assessment.
Can Shingles Happen More Than Once?
Yes.
Having shingles once does not guarantee lifelong protection.
Recurrences can occur, although most people do not experience repeated episodes frequently.
Vaccination may still be recommended after someone has previously had shingles, depending on age, immune status and national guidance.
Can Shingles Be Prevented?
Vaccination is the most effective specific preventive strategy for eligible adults.
The major modern vaccine is the recombinant zoster vaccine, commonly known by the brand name Shingrix.
WHO issued an updated position paper on herpes zoster vaccination in July 2025, with its recommendations focusing on recombinant zoster vaccine.
What Happened to Zostavax?
The older shingles vaccine Zostavax is a live attenuated vaccine.
It is no longer the preferred shingles vaccine in many countries, and in some markets it has been discontinued.
The original article should therefore not present Zostavax and Shingrix as equivalent current options.
Modern recommendations increasingly favour recombinant zoster vaccine because of its stronger and longer-lasting protection and suitability for many people who are immunocompromised.
Who Should Get Shingrix?
Recommendations vary somewhat by country.
In the United States, current CDC guidance recommends a two-dose recombinant zoster vaccine series for:
adults aged 50 years and older; and
adults aged 19 years and older who are or will be immunodeficient or immunosuppressed because of disease or therapy.
People should follow the recommendations used in their own country and discuss individual eligibility with an appropriate healthcare professional.
How Many Doses of Shingrix Are Needed?
The standard schedule is two doses.
For most adults aged 50 and older, doses are usually given several months apart.
The interval may be shortened in some immunocompromised people when completing vaccination sooner is clinically beneficial.
WHO's current travel guidance similarly describes recombinant herpes zoster vaccination as a two-dose vaccine for prevention of shingles and its complications in adults aged 50 years and older.
Does Shingrix Prevent Chickenpox?
No.
Shingrix is designed to reduce the risk of shingles and its complications.
It is not the same as the varicella vaccine used to prevent primary chickenpox infection.
Should You Get Vaccinated If You Already Had Shingles?
In many national programmes, yes, eligible adults may still be advised to receive recombinant zoster vaccine after recovering from a previous episode.
The timing should follow local vaccination guidance and individual clinical circumstances.
Can Immunocompromised People Receive Shingrix?
Recombinant zoster vaccine is not a live vaccine, which is one reason it can be used in many immunocompromised adults.
However, timing may need to be coordinated with immunosuppressive treatment to optimise vaccine response.
Patients receiving chemotherapy, transplant-related treatment or strong immunosuppression should discuss timing with their medical team.
Shingles and HIV
People living with HIV have an increased risk of shingles, particularly when immunity is substantially weakened.
Recurrent, extensive or unusually severe shingles can sometimes prompt clinicians to consider whether there is an underlying cause of immunosuppression.
However, having shingles does not automatically mean that a person has HIV.
Testing decisions should be based on clinical assessment and individual risk factors.
Shingles Myths and Facts
Myth: Shingles and chickenpox are completely different infections.
Fact: Both result from the same virus, varicella-zoster virus. Chickenpox is usually the primary infection, while shingles results from later reactivation.
Myth: You can catch shingles directly from another person's shingles.
Fact: A susceptible person exposed to active shingles can acquire VZV and develop chickenpox, not immediately develop shingles.
Myth: Shingles only affects elderly people.
Fact: It can occur at any age, although risk rises substantially with ageing and weakened immunity.
Myth: Everyone with shingles develops long-term nerve pain.
Fact: Most do not. The risk of postherpetic neuralgia increases with age and severity.
Myth: Once you have had shingles, you cannot get it again.
Fact: Recurrence is possible.
Myth: Vaccination is unnecessary after a previous shingles episode.
Fact: Eligible adults may still benefit from recombinant zoster vaccination after recovery.
Frequently Asked Questions
How long does shingles last?
The rash commonly heals over about two to four weeks, although pain can persist longer.
How long is shingles contagious?
Transmission risk continues while fluid-filled lesions are present. Once all lesions have crusted, the risk falls greatly.
Does shingles cross the middle of the body?
Typical localised shingles usually affects one side and does not cross the midline, although atypical or disseminated disease can be more extensive.
Can shingles affect the eye?
Yes. Shingles involving the ophthalmic division of the trigeminal nerve can threaten vision and requires urgent medical assessment.
Can children get shingles?
Yes, although it is much less common than in older adults.
Is shingles life-threatening?
Most cases are not life-threatening, but severe complications can occur, particularly in immunocompromised people or when the nervous system or internal organs are affected.
Is shingles an STI?
No. Shingles is not classified as a sexually transmitted infection.
Is there a cure for shingles?
Antiviral medicines suppress VZV replication and can shorten or reduce the severity of disease when used appropriately. They do not remove latent VZV from the body permanently.
The Bottom Line
Shingles is caused by reactivation of varicella-zoster virus, the virus responsible for chickenpox.
It typically produces a painful, blistering rash in a band on one side of the body.
Risk increases with age and weakened immunity.
Early antiviral treatment can reduce the severity and duration of acute disease, particularly when started promptly.
The most important complication is postherpetic neuralgia, while shingles involving the eye, ear, nervous system or several parts of the body can require urgent treatment.
Modern prevention now centres on recombinant zoster vaccination, particularly for older adults and certain immunocompromised adults.
If you think you have shingles, especially if the rash affects your face or eye, seek medical assessment promptly rather than waiting for the rash to disappear on its own.
References
World Health Organization. (2025). WHO position paper on herpes zoster vaccines.
World Health Organization. (2026). International travel and health: Varicella and herpes zoster.
Centers for Disease Control and Prevention. Shingles vaccination recommendations.
Centers for Disease Control and Prevention. Herpes zoster disease and recombinant zoster vaccine.
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