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Herpes vs. Shingles

They're All Blisters! How Can I Tell The Difference?
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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.

What is herpes?

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.

oral herpes
Herpes virus outbreak on the lips can manifest as small clusters of fluid-filled blisters.

What is shingles?

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.

shingles
Shingles usually manifest as a cluster of red, blister-like sores forming a linear pattern on a person's skin, typically following a nerve pathway.

What are the key differences between shingles and herpes?

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:

ShinglesHerpes
VirusVaricella Zoster VirusHerpes 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 symptomsCan have pain/burning sensation over affected skin 1-2 days before rash outCan 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 rashCan last up to 2-4 weeks before clearanceCan 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.)

Can a person have both herpes and shingles at the same time?

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 body
Shingles typically occur in ageing individuals or individuals with a compromised immune system.

What are the risk factors for developing shingles and herpes?

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:

  • Are of increasing age (the older a person, the higher the risk of developing shingles)
  • Have a history of immunocompromised conditions, such as cancer patients, individuals with autoimmune diseases, diabetes, etc.
  • Are patients on immunosuppressants or have received chemotherapy or radiotherapy

Risk factors for contracting herpes, on the other hand, include:

  • Sexual contact through oral, vaginal, or anal intercourse
  • Direct contact with herpes sores or genital or oral fluids

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.

What triggers herpes or shingles?

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:

  • Stress
  • Hormonal fluctuations, especially during menstruation (for women)
  • Sun exposure
  • Viral illnesses
  • Friction or skin trauma
stress shingles
Stress can trigger a shingles infection.

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.

How can I differentiate or confirm whether it is a shingle or herpes?

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.

What is the treatment for shingles or herpes?

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.

antiviral drugs
Antiviral medications are used to treat viral infections like shingles and herpes.

Can I protect myself against shingles?

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:

  • An adult aged 50 years and above
  • An adult aged 19 years and above with a weakened immune system
  • Someone who had chickenpox before or received the chickenpox (varicella) vaccine
  • Not pregnant
  • Not actively experiencing shingles
  • Not allergic to the components of the shingles vaccine

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.

Can I protect myself against herpes?

Unfortunately, there is no vaccination available to protect against herpes infection. However, there are some tips to reduce the risk of acquiring herpes infection.

  • Since herpes viral infection is typically transmitted through contact, abstaining from sexual contact is an effective way to prevent herpes.
  • Using barrier contraception, such as condoms, can reduce the risk of acquiring herpes. It is vital to use the correct method and change the condom after intercourse. Condoms are only effective in preventing herpes on the body parts they cover.
  • Regular sexual health screenings for sexual partners are healthy practices to reduce the risk of acquiring STDs, including herpes.
  • Treating partner(s) with active herpes symptoms is essential, as it lowers the risk of spreading the infection to other partners.

Summary

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.

References

  1. Saleh D, Yarrarapu SNS, Sharma S. Herpes Simplex Type 1. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK482197/ 
  2. Mathew Jr J, Sapra A. Herpes Simplex Type 2. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK554427/ 
  3. Nair PA, Patel BC. Herpes Zoster. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK441824/ 
  4. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html 

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