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There is often confusion between a herpes viral infection and shingles infection. It can be challenging for patients, and even some physicians, to differentiate between both conditions. Both shingles and herpes infections affect the skin, resulting in acute blistering on the affected skin surface.
Understanding the differences between shingles and herpes is essential, as the treatment for both conditions differs.
Herpes is caused by the herpes simplex virus (HSV), which comes in two types: HSV type 1 and HSV type 2. HSV type 1 [1] is traditionally associated with rash symptoms on the mouth and face, while HSV type 2 [2] is linked to anogenital rash symptoms. However, due to human interaction and various sexual orientations, HSV type 1 infection can be observed in the anogenital region, and HSV type 2 infection can also manifest on the mouth or face.
Shingles is caused by the varicella-zoster virus (VZV), also known as the herpes zoster virus [3]. This is typically where the confusion arises – the herpes zoster virus differs from the herpes simplex virus. VZV is the same virus that causes chickenpox. A person usually acquires chickenpox in their younger years, and the virus remains dormant in the body until later years. Due to ageing or lowered immunity, the virus can be reactivated, leading to shingles.
Although shingles and herpes share some similarities, both infections are caused by two different viruses, and the treatment for each condition differs. Accurate diagnosis and prompt treatment often require guidance from healthcare professionals.
Here are the general differences between shingles and herpes:
| Shingles | Herpes | |
| Virus | Varicella Zoster Virus | Herpes Simplex Virus 1 & 2 |
| Method of transmission | -Direct contact with the blister fluid lesions -Breathing in air particles from the blisters | -Direct contact with blister fluid lesions during sexual contact |
| Patient demographic | -Older (though it can occur in a young person as well) -Weaker immune system | -Younger -Sexually active person |
| Rash characteristics | -Painful fluid-filled blisters-Rashes in a ‘group’- following the nerve supply of the skin (dermatome) | -Painful fluid-filled blisters-Can be itchy-Rashes in a group or ‘cluster’ |
| Location | -Any part of the body-Tends to be one-sided and seldom crosses the midline | -Occurs over the mouth, genital, and rectal region |
| Prodromal symptoms | Can have pain/burning sensation over affected skin 1-2 days before rash out | Can be itchy or painful over affected skin 1-2 days before the rash out |
| Associated symptoms | -Fever-Lethargy-Headache-Diarrhoea -Upset stomach | -Fever-Painful swollen lymph nodes-Lethargy -Body ache-Painful urination (if it affects the genital region) Symptoms are ‘less dramatic’ during recurrence |
| Duration of rash | Can last up to 2-4 weeks before clearance | Can last up to 7-10 days before clearance |
| Complications | -Can develop post-herpetic neuralgia (lasting pain over affected skin that had shingles)-Can be associated with brain inflammation, lung infection, hearing loss, vision impairment, or even death, though these complications are rare | -Can be associated with brain inflammation such as meningitis and encephalitis, though these are rare-Herpes infection increases the risk of other forms of STD infections (including HIV, syphilis, chlamydia, gonorrhoea, HPV infection, etc.) |
Yes, this can happen, although it is rare for a person to develop both herpes and shingles infections simultaneously. This tends to occur when a person has a compromised immune system.
If you have concerns about either herpes or shingles (or both), please do not hesitate to contact your physician for further confirmation of the diagnosis and seek medical treatment early.
Shingles occur due to the reactivation of the varicella-zoster virus. Shingles will only occur in individuals who have had chickenpox or received the chickenpox vaccination before (hence, they have been exposed to the varicella virus in the past).
Shingles is more likely to occur in people who:
Risk factors for contracting herpes, on the other hand, include:
Fun fact of the day: herpes is not transmissible through contact with objects such as dirty toilet seats, public toilets, door handles, swimming pools, linens, beds, etc.
You can speak to your doctor to further understand the modes of transmission for both shingles and herpes and discuss ways to reduce the risk of acquiring both viral infections.
Shingles tend to be triggered when a person's immune system weakens due to health illnesses or ageing.
Herpes can be initially acquired through sexual contact, and over time, recurring flare-ups may occur secondary to:
Sometimes, unfortunately, the triggering factors may not be obvious. It is worth discussing with your doctor if you experience recurring flare-ups of either herpes or shingles. Your doctor may advise you on lifestyle measures to reduce the risk of flare-ups or even recommend medication or vaccination to prevent flare-ups of both viral infections.
You should consult your doctor if you develop any blistering skin rash. Shingles are usually very distinct and can be promptly diagnosed by most physicians based on clinical history and presentation. However, occasionally, when the clinical diagnosis is uncertain, your doctor may offer you a swab PCR test to confirm the diagnosis or differentiate it from other conditions, such as herpes.
In the case of a herpes blistering skin condition, your doctor may offer you a swab PCR test to determine the diagnosis. Due to the associated risk of herpes with other sexually transmitted infections, your doctor may also recommend other tests such as HIV, syphilis, chlamydia, gonorrhoea, hepatitis, HPV testing, etc.
As both shingles and herpes are viral infections, they are treated with antiviral medication. However, depending on the condition, the dosage and strength of antiviral medicines used to treat shingles are much higher than herpes. Therefore, it is crucial to accurately diagnose the condition and promptly administer the proper treatment and medication dosage.
Common antiviral medications used include acyclovir, valacyclovir, and famciclovir.
Although there is no cure for herpes infection, treatment is available to alleviate symptoms, promote faster resolution of blisters, and reduce the risk of recurrence.
Yes, a vaccination available against shingles is effective in preventing shingles and reducing the risk of post-herpetic neuralgia. According to the CDC, the shingles vaccine [4] (Shingrix) is 97% effective in protecting against shingles infection in healthy adults aged 50-69 years and 91% effective in older patients above 70.
You may consider shingles vaccination if you are:
If you are considering vaccination against shingles, please consult your doctor to understand the benefits of vaccination. Your doctor will assess your suitability for the vaccine and discuss potential side effects.
Unfortunately, there is no vaccination available to protect against herpes infection. However, there are some tips to reduce the risk of acquiring herpes infection.
Herpes and shingles are two distinct viral infections that can result in blistering skin conditions, raising concerns about health and potential complications. While there may be overlapping clinical presentations, an accurate diagnosis of the condition is crucial to providing the correct medications for managing the viral infection.
Blistering skin conditions should prompt a clinical evaluation, so do not hesitate to seek medical advice early and avoid taking chances with the condition.
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