Herpes Zoster (Shingles)

Herpes zoster, commonly known as shingles, is a painful rash caused by reactivation of the varicella-zoster virus, the same virus that causes chickenpox. It typically affects one side of the body along the path of a single nerve, and is more common and often more severe in people with weakened immunity, including HIV infection.

• Burning, tingling, or painful sensation in a band-like area on one side of the body, often before any rash appears
• A blistering rash that develops within this same band-like area, usually on one side only, following the path of a nerve
• Fever and general malaise in some cases
• Pain that can be severe and may persist for weeks to months after the rash heals (post-herpetic neuralgia)
• Involvement around the eye requires urgent assessment, as it can threaten vision

• Caused by reactivation of the varicella-zoster virus, which remains dormant in nerve tissue after an earlier chickenpox infection, often from childhood.
• Reactivation is more likely with increasing age, stress, and weakened immunity, including from HIV infection, making shingles occurring at a younger age or with widespread distribution a possible indicator of underlying immune suppression.

• Diagnosed clinically based on the characteristic band-like, one-sided blistering rash, often preceded by localised pain.
• In someone with an unknown HIV status presenting with shingles, particularly if severe, recurrent, or affecting multiple nerve segments, HIV testing is recommended given the association with immune suppression.

An antiviral medicine, such as aciclovir, started as early as possible (ideally within 72 hours of rash onset), reduces the severity and duration of the illness and lowers the risk of long-term nerve pain.

Pain relief is an important part of treatment and may range from simple analgesics to stronger options for severe pain.

Keeping the rash clean and dry, and avoiding scratching, helps reduce the risk of secondary bacterial skin infection.

Shingles affecting the area around the eye, widespread shingles, or shingles in someone with known or suspected weakened immunity should be referred promptly, given the risk of complications including vision loss.

• Complete varicella (chickenpox) vaccination where available, which reduces the risk of both chickenpox and later shingles.
• Seek HIV testing if shingles occurs at a young age, is unusually severe, or recurs, since this can be an early sign of HIV infection.
• Avoid direct contact with the rash if not previously immune to chickenpox, since the fluid in shingles blisters can spread chickenpox to others.
• Seek prompt treatment as soon as symptoms appear, since early antiviral treatment improves outcomes.