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Up to 30 percent of people in the United States will develop shingles in their lifetime, and the risk of developing it increases as we age.
By: Jordan Stachel
About 1 in 3 Americans will develop shingles in their lifetime. While incidence rates seem to be plateauing or dropping over recent years, there is still an increased risk of developing shingles as you get older. Though not life-threatening, the condition can cause unbearable pain.
Shingles is usually easy to diagnose unless it develops without the telling rash. Shingles development without this rash is known as “zoster sine herpete” (ZSH), and while uncommon, it can present increased difficulties for individuals trying to attain an appropriate and expedient diagnosis.
Are There Different Types of Shingles?
Shingles does not have different types. It is a viral infection caused by the activation of the varicella-zoster virus (VZV), also called human herpesvirus 3, the same virus that causes chickenpox. If you have ever had chickenpox, you were exposed to the varicella-zoster virus, which stays in your body for the rest of your life. If this occurs, the virus can reactivate as shingles years later.
The VZV is a member of the herpes family of viruses. When shingles develops, it affects the nerves throughout the body and can present with painful, uncomfortable symptoms.
What Are the Symptoms and Early Signs of Shingles?
Shingles can last around two to six weeks and present with several symptoms, including:
Fever.
Headache.
Lethargy.
Chills.
Upset stomach (i.e., nausea, indigestion).
Itching, tingling, or burning of the skin affected.
Shooting pain similar to an electric shock.
Redness of the skin.
Rash (most commonly seen on the torso).
Fluid-filled blisters accompanying a rash.
Changes in eyesight if the ophthalmic nerve is affected (i.e., loss of vision, increased sensitivity to light, blindness).
As the shingles virus travels along specific nerves, the rash usually appears in a band on only one side of the body. The band corresponds to the spot where the nerve fires off signals. It also remains mostly localized, meaning it doesn’t spread over the entire body.
While symptoms may be uncomfortable, shingles is not typically life-threatening for generally healthy adults with a well-functioning immune system. Immunocompromised adults are more at risk for complications caused by shingles.
What Causes Shingles?
Shingles is caused by the chickenpox virus, VZV. After you have chickenpox, the virus goes dormant within the nerves in the body. If the virus becomes activated, typically later in life, there is a potential for shingles to develop. It is assumed that if you were born before 1980 in the United States, you likely had chickenpox, even if you might not remember. In many people, the virus may stay dormant and never develop into shingles.
While the reason for reactivation is not completely understood, it is generally believed that the shingles virus can reactivate if an individual’s immune system is weakened or compromised or if the person is taking immunosuppressants or is under high levels of stress. As you age, the likelihood that your immune system may become compromised increases, which makes you more susceptible to shingles.
Who Is More Likely to Develop Shingles?
The increased likelihood of developing shingles is influenced by factors that include age, overall health status, and genetics. Shingles is caused by the reactivation of the VZV, which can be triggered by the following factors:
Age: The primary driver behind developing shingles is age. As the body ages, the growth of T cells, the cells that help regulate the immune system, is diminished, which can lower overall immune functioning. People over 50 are most at risk, and people over 60 are more likely to have more serious complications.
Sex: Women are more at risk than men, according to the U.S. Centers for Disease Control and Prevention (CDC).
Race: Whites are at least 30 percent more likely than blacks to develop shingles, according to one 2020 meta-analysis in Open Forum Infectious Diseases. Another 2018 survey found that Hispanics were 16 percent more likely to develop it than whites, and Asians were 17 percent more likely to develop it.
Medications and treatments: Certain medications or treatments, especially immunosuppressants, can compromise the immune system and leave one vulnerable to shingles. Radiation and chemotherapy can increase risk, as well as drugs that prevent organ transplant rejection or the long-term use of steroids like prednisone.
Genetics: While further research is needed into how genetics play a role in the activation of the shingles virus, it is thought that having a family member who has had shingles may increase one’s risk of developing the condition. It’s also thought that certain genes, like the human leukocyte antigen (HLA), can increase one’s risk for persistent post-herpetic neuralgia.
Underlying conditions: Conditions like cancer and HIV that weaken an individual’s immune system put one at higher risk.
History of physical trauma: A history of physical trauma was one of the main risks of shingles, according to the 2020 meta-analysis.
How Is Shingles Diagnosed?
Shingles is usually diagnosed easily because of the accompanying rash along the path of the affected nerve. Not infrequently, the nerve’s discomfort or pain precedes the rash by several days and so definitive diagnosis is suspected but briefly delayed.
Typically, a health care provider will ask questions regarding one’s medical history and conduct a physical examination. If a rash is present, the health care provider usually can diagnose shingles by visual cues alone. See your health care provider within 72 hours of the onset of the rash to optimize your subsequent treatment.
If the rash is absent or not typical, despite over three days of suspicious nerve root pain, further diagnostic tests may be ordered. Tests that may be used to aid a difficult diagnosis include the following:
Polymerase chain reaction (PCR) testing: A swab of unroofed lesions, scabs, saliva, or tissue is taken and analyzed for the presence of VZV. PCR, or DNA tests, are typically ordered when someone presents with symptoms to detect an active infection. Once the swab is taken, results are typically received within one day.
Antibody or serologic testing: A blood sample is taken to examine IgM and IgG levels, two antibodies that may be produced if someone is exposed to VZV. IgM typically appears within a week or two after an initial exposure, whereas IgG antibodies are produced several weeks after exposure and/or infection. VZV antibody testing may also be ordered to see if a person has developed immunity to the virus.
Direct fluorescent antibody (DFA) testing: For this test, cells are analyzed from a skin lesion. This is considered to be a more rapid but less accurate testing method compared to PCR testing.
What Are the Complications of Shingles?
Shingles can develop alongside several complications, with many areas of the body affected.
Some possible complications of shingles include:
Postherpetic neuralgia (PHN): This is the most common complication of shingles and involves a persistent burning or shooting sensation in the affected nerve and skin. This pain can last a long time, past the point of healing of the rash and blisters, but the pain is typically localized to the area of the body in which the rash was present.
