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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Wednesday, March 15, 2006

Shingles by any other name is still Herpes

No one likes to hear the word “herpes” mentioned during a medical visit, since it tends have all of those negative sexual connotations. I rarely just blurt it out to patients. We use those nicer words for herpes: shingles, chicken pox, cold sores, or fever blisters.

Chicken pox, a herpes viral infection, was once considered a rite of passage for most children. Now, the routine varicella vaccine will prevent most of these cases, and even protect you against shingles. No one seems pay attention to cold sores, another herpes-type infection. Shingles will make a person take notice.

Shingles by any other name is still a form of herpes. There are many different kinds of herpetic infections, but questions regarding plain ‘ol Shingles is one of the most frequent postings that occur on the WebMD General Health Board. Why?

Because in the United States, nearly 100% of adults have detectable herpes antibodies by the time they are 30 years old. Humans are the only source of infection, so we caught it from someone. In other words, nearly all of us have already been exposed and have the latent virus present in our bodies. The virus is just hanging around, living quietly in a nerve bundle, and suppressed by our immune systems.

For the vast majority of people, this virus will remain dormant for our lifetime. As we age or our immunity status changes, up to 10-20% of the population may experience the pain of herpes zoster (shingles). More than 66% of the people who develop herpes zoster are over the age of fifty; about five percent of the cases occur in children under the age of 15. Over a half of a million people will get herpes zoster this year in the U.S. In people who are immune compromised by HIV or undergoing cancer treatment with chemotherapy or radiation, the risk of getting herpes zoster increases eight-fold and can cause fatal complications.

If you have had chicken pox in your lifetime, you are considered immune just to chicken pox. Getting exposed to this herpes virus again may trigger activation and lead to a nasty case of shingles. Think about that when you send your child with chicken pox over to Grandma’s house. Chicken pox is VERY contagious. Herpes Zoster is only about a third as contagious.

Herpes zoster involves nerve pathways. In the first stage of the illness, people will experience strange nerve pain, such as burning, stabbing, prickly, numb, or tingling. Some people complain that the area itches intensely. People may also experience headaches, malaise, or flu-like symptoms. No matter what, the early symptoms of herpes zoster certainly get your attention for about 3-5 days (sometimes as long as two weeks) before the characteristic skin blisters develop.

The skin lesions of herpes follow a nerve pathway and appear as groups or clusters of tiny, clear blisters (vesicles), often with an angry red or bluish base. Because zoster follows a nerve pathway and nerves do not cross the midline of the body, zoster will occur on just one side of your chest…your face…or your back…your leg…or your butt. Less commonly, they can occur in your mouth, your ear (Ramsay Hunt Syndrome) or genital area. A serious, sight-threatening form can involve the eye and always requires an immediate consultation with an ophthalmologist.

The typical course of a herpes zoster infection lasts two to three weeks, assuming you have a good immune system, but there is always a risk of developing PHN – Post-Herpetic Neuralgia. PHN is nerve pain that persists long after the zoster has resolved and is more prevalent in the elderly or people with eye involvement. Herpes zoster, like a bad relative, can also show up again and again throughout your lifetime.

Antiviral drugs like acyclovir and others may reduce the severity of herpes zoster it taken early. Pain medications are usually necessary. Moist dressings of water or saline can be soothing and help the inevitable pain. Capsaicin cream (made from the hottest chili peppers!) is also used for managing the pain of PHN.

Herpes zoster is incurable, but it is treatable. And, many herpes infections, like chicken pox, it is preventable by vaccine.

Related Links: Herpes Viruses (Including the Chickenpox Virus) and the Eyes, Shingles Vaccine Works In Large Study

Technorati Tags: shingles, cold sores, fever blisters, chickenpox, herpes

Posted by: Rod Moser, PA, PhD at 12:59 pm

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