When Should I Worry About...

Shingles Q&A: Is Shingles Contagious & Everything Else You Need to Know

Nov. 30, 2020 - Katie McCallum

Ask anyone who's had shingles, and they'll likely recount a pretty miserable, painful, uncomfortable experience that couldn't end soon enough. Ask your doctor about shingles, and he or she will likely inform you that there's a vaccine to help prevent it.

Whether you think you may have shingles and are looking for answers or you just want to make sure you don't ever get it in the first place, Dr. Donald Brown, primary care practitioner at Houston Methodist, is here to answer common questions about shingles and the shingles vaccine.

How does shingles start?

Technically, your chance of getting shingles "started" the day you got chickenpox. (You remember that itchy rash that spread from your head to your toes, as well as through your kindergarten classroom, right?)

That's because shingles and chickenpox are caused by the same virus, called the varicella zoster virus. After you have chickenpox, the varicella zoster virus hides away in your body — where it can lie dormant for many, many years.

"The varicella zoster virus that initially causes chickenpox can come back to life, so to speak. When it does, it causes a different disease — called herpes zoster, or shingles," says Dr.Brown. "The result is still a rash, but this rash is typically localized to a single area on your skin and is much more painful than the itchy rash you experienced during chickenpox."

While shingles can appear anywhere on your body, it typically affects the chest, torso, shoulder or back.

Can anyone get shingles?

So, to get shingles, you have to have first had chickenpox. But, not everyone who's had chickenpox will get shingles. Confused yet? Here's Dr. Brown again:

"Anyone who's had chickenpox is susceptible to developing shingles, and somewhere around 20% of those people will get shingles during his or her lifetime. Shingles can develop at any age, but it becomes more common with increasing age or as a result of other health-related factors."

The other factors that can increase your risk of developing shingles include:

  • Being over the age of 50
  • Having a weakened immune system
  • Certain cancers or cancer treatments
  • Taking medications that suppress your system

What does shingles look like?

Rashes are always concerning, and a lot of different things can cause them. There are heat rashes, rashes caused by reactions to medications or allergens, and the list goes on. So how can you tell if your rash is in fact shingles or not?

"Before the rash even develops, shingles usually causes itching, burning or tingling sensations on a specific area of your skin. You may also have a fever, headache or just feel generally unwell. A few days later, the rash appears — typically as a band of blisters isolated to a particular area of your body," explains Dr. Brown.

Shingles symptoms are typically limited to the area of the rash itself, and the symptoms of shingles include:

  • Pain (of varying intensity)
  • Skin sensitivity
  • Fluid-filled blisters that ooze and eventually crust over
  • Itchiness
  • Fever
  • Headache
  • Fatigue
  • Sensitivity to light

How long is shingles contagious?

Similar to chickenpox, shingles is a contagious illness. But, before we address how long you may be contagious, we need to talk about how shingles spreads — which might actually surprise you.

"Shingles is indeed contagious, but it can only be spread to people who haven't yet had chickenpox, or the chickenpox vaccine. In these cases, the shingles virus typically spreads via direct contact with the opened blisters of your rash. After being infected, a person doesn't develop shingles, though — he or she develops chickenpox," explains Dr. Brown.

Since you can't really know who is and who isn't susceptible to chickenpox, it's important to take safety measures if you have shingles.

"When you have shingles, you're considered contagious until your open sores crust and scab over. This generally takes between 7 to 10 days," says Dr. Brown. "Depending on where your rash develops on your body and where you work, you may (or may not) be able to return to work before your shingles dry up."

Before your rash dries up, Dr. Brown recommends the following to prevent spreading shingles to others:

  • Make sure your rash is covered with gauze
  • Limit interaction with other people if your shingles rash is on your face
  • Consult with your doctor about returning to work if you work in a medical setting or nursing home, as well as if you interact with people frequently while at work

Will shingles go away on its own?

Shingles isn't life-threatening, but it can be incredibly painful and, in some cases, complications can arise. While this rash typically goes away its own, prompt treatment can reduce your pain and help shingles go away faster.

"Several antivirals can be used to treat shingles. These drugs can help you heal more quickly and reduce your pain, but they are most effective when started within 72 hours of your rash appearing. This means it's important to see your doctor as soon as you suspect shingles," says Dr. Brown. "When it comes to the pain associated with shingles, most people are able to manage it using over-the-counter pain relievers. But, pain can be severe for some people. In these cases, your doctor can prescribe stronger pain medications."

Beyond treating your immediate pain and rash, seeing your doctor is also important since serious complications can occur as a result of shingles, such as:

  • Postherpetic neuralgia (PHN) – pain that lasts for months to years after the rash clears, with this pain being debilitating in some cases
  • Skin infection – occurs if the open sores of your rash become infected with bacteria, which can require antibiotics and delay healing
  • Vision problems – while rare, if your rash develops near your eye, the associated inflammation can damage your retina and, in some cases, result in vision loss

"In particular, we want you to come into the office so we can try to reduce your chances of developing PHN — the most common complication of shingles. This condition can result in long-term pain that, in some cases, can be severe enough to reduce sleep quality, lead to weight loss and generally interfere with daily activities," warns Dr. Brown. "PHN occurs most frequently in those over the age of 60, and there's evidence that antiviral treatment can reduce a person's risk of developing this complication."

Can shingles come back?

Given that shingles results from the varicella zoster virus reactivating some amount of time after having chickenpox, you may be wondering if the virus can...re-reactivate after having shingles.

"Once shingles clears up, the virus simply goes back into hiding — and, unfortunately, it can reactivate again in the future," says Dr. Brown. "As far as the likelihood of shingles reoccurring, that's still largely up for debate. One study found that the chance of getting shingles a second time is about 5%, but other studies show this number to be lower."

One way to reduce your risk of getting shingles twice is the same preventive measure that helps prevent you from ever getting it in the first place: the shingles vaccine.

Which shingles vaccine is best?

Eventually, your doctor will start mentioning the shingles vaccine — which can help prevent shingles from developing, as well as reduce its severity if it does still develop. The shingles vaccine can also reduce your risk of postherpetic neuralgia, one of the most common complications of shingles.

"Because shingles becomes increasingly more common as a person ages, the shingles vaccine is currently recommended for people over the age of 50. There are two vaccine options, Shingrix and Zostavax, with Shingrix being the newer of the two vaccines — and the preferred choice as it is more effective."

When it comes to how the shingles vaccine works, Shingrix is a shot that requires two doses administered six months apart. There are temporary side of effects of this shingles vaccine that can be unpleasant, however. Shingles vaccine side effects typically don't last more than three days, but include:

  • Sore arm
  • Redness or swelling (at the location of the shot)
  • Fatigue
  • Muscle pain
  • Headache
  • Fever
  • Nausea

"These vaccines don't completely reduce your chance of getting shingles, but given the pain associated with this illness — as well as the complications that can occur — getting vaccinated for shingles is an important component of your preventive care as you age."

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