When you hear the word herpes, the first thing that comes to mind is the sexually transmitted disease caused by the herpes simplex virus (HSV). However, another type of herpes virus is much more common than HSV.
Herpes Zoster, or the Varicella Zoster virus, is another type of herpes virus that infects individuals to cause chickenpox or shingles (usually depending on the patient's age group and their past infectious history). Like herpes simplex, herpes zoster is also a double-stranded DNA virus, and the infections caused by Herpes Zoster also don't have a cure. However, unlike herpes simplex, herpes zoster is not transmitted sexually.
While there may not be a cure for the infections caused by herpes zoster, namely chickenpox, and shingles, there are effective treatments and vaccines available. But before we jump onto how these infections are treated, it is worth taking the time to learn more about the varicella-zoster virus.
AN OVERVIEW OF HERPES ZOSTER
Varicella-zoster, or the herpes zoster virus, is a double-stranded DNA virus that infects the host cells more or less the same way as the herpes simplex virus. However, unlike its counterpart, herpes zoster is not a sexually transmitted virus.
Virtually every human being on Earth has this virus inside of them. According to the CDC, almost 1 million cases of herpes zoster are diagnosed in the United States every year. Experts believe that humans contracted this virus from animals through parasites, and now it continues to live inside all of us. Although not every human suffers from the infectious consequences of this virus, it can, however, cause serious symptoms and complications.
The varicella-zoster virus causes two types of infections: chickenpox and shingles. Chickenpox usually occurs in children who are not vaccinated against the virus. Almost all of us have had chickenpox at some point in our lives. It is characterized by a maculopapular rash containing fluid-filled blisters that appear on the face and the body's trunk. These blisters resolve on their own by transforming into sores, scabs before finally drying out and scraping off of the skin.
Once a person has had chickenpox, their chances of developing the same disease ever again are virtually non-existent. This is because our memory T-cells develop effective antibodies against this virus, meaning that people infected with chickenpox once develop strong immunity against the disease for the rest of their lives. However, babies who had chickenpox before the age of 1 and people above 65 can get infected again and develop chickenpox for the second time in their lives.
Although the chances of chickenpox developing again after the first infection are non-existent, the virus itself does not go anywhere. Like the herpes simplex virus, the varicella-zoster virus creeps into the dorsal root ganglion in the spinal cord and stays there in a dormant state. Here, the virus stays for life and can infect an individual whenever triggered by an internal or an external factor.
Once the virus is reactivated, it causes another infection inside the body known as shingles. A maculopapular rash also characterizes shingles, but this rash is usually confined to a dermatome (an area of skin supplied by a single sensory nerve). Since the virus now travels through nerves, it only affects the distribution area of any particular nerve. Thus, the rash can appear in a belt pattern around one side of the torso. It can also appear on the face if it travels through the facial area's nerves. Similarly, complications of this virus can also reach other parts of the body through specific nerve distributions.
WHAT ARE THE SYMPTOMS OF SHINGLES?
The symptoms of shingles are divided into two categories based on their time of appearance. The early symptoms manifest within a day or two after the reactivation of the virus and resemble the symptoms of a common cold. These include:
- GI upset
Late symptoms of shingles consist of more constitutional tell-tale signs that develop 3 to 4 days after the infection. These include:
- Itching, burning, or tingling in a specific area of the skin
- Erythema in the affected part of the skin
- Appearance of rash
- The appearance of fluid-filled blisters
- Pain in the affected area
While developing chickenpox once you've had it is unlikely; shingles can develop in a person more than once. A person can take up to four to five weeks to recover completely after developing shingles.
WHO IS AT RISK OF DEVELOPING CHICKENPOX AND SHINGLES?
Children under the age of 2 and people above 65 are most likely to acquire chickenpox. 90% of the cases occur in children under the age of 2. Chickenpox can be transmitted to other people if they breathe in particles from the blisters or if they come into contact with the fluid from the blisters.
An individual’s risk of developing chickenpox increases if:
- They haven't had the vaccine for chickenpox
- They have never had chickenpox before
- They work or live with children who might have the disease
While the risk of developing chickenpox decreases if you have had the disease before, the risk of developing shingles rises dramatically since now the virus lives inside their body and can be activated at any time.
When a person has shingles, they can transmit the varicella-zoster virus to other people through contact with blister fluid. However, people who acquire the virus from shingles rarely develop shingles. Instead, they will be more prone to developing chickenpox (if they meet the criteria of being at risk, as mentioned above).
Here is a list of people who are at risk of developing shingles:
- People with compromised immune systems
- People older than 50
- Chronically ill patients
- Trauma patients
- People with stressful lives/occupations
While this list summarizes the main triggers for the reactivation of the varicella virus, which then causes shingles, there may be other factors that we do not know about yet.
COMPLICATIONS OF HERPES ZOSTER
Since the varicella virus travels through nerves in its reactivation stage, it can affect virtually any part of the body. This is the reason why the complications of shingles are widespread. However, two of the most common complications of shingles are post-herpetic neuralgia and Ramsay Hunt Syndrome.
Post-herpetic neuralgia is characterized by severe pain that persists even after shingles' resolution. This pain can be debilitating, especially for older individuals. Ramsay Hunt syndrome is a combination of symptoms that affect the skin, taste, and hearing of a person and include facial paralysis.
ARE SHINGLES CURABLE?
Unfortunately, shingles are not completely curable. Once the virus enters the body, it lives in the dorsal root ganglion for the rest of a person's life and can reactivate at any given moment. However, there are effective treatments available that can lower the severity of the symptom and even decrease the likelihood of reactivation of the virus.
Anti-viral drugs help suppress the virus to reduce the duration of an ongoing shingles attack. Anti-viral drugs also prevent future shingles outbreaks and can prevent complications such as post-herpetic neuralgia and Ramsay Hunt syndrome. These drugs are most effective when taken within three days of the onset of symptoms.
Supportive medication such as Ibuprofen, acetaminophen, and topical creams can help relieve the fever, itching, body aches, pain in the affected area, and other symptoms associated with shingles. Antibacterial agents are also helpful in preventing any superinfection in shingles.
IS THERE A VACCINE FOR SHINGLES?
Shingrix and Zostavax are two vaccines available for shingles in the United States. However, Zostavax has just recently been discontinued.
Shingrix is a recombinant zoster vaccine that provides strong immunity against the virus and its complications. Currently, the guidelines recommend that people above the age of 50 and immunocompromised receive two doses of the vaccine 2 to 6 months apart.
Two doses of Shingrix can prevent herpes zoster infection and postherpetic neuralgia in almost 90% of the patients. The protection level remains above 85% even after four years of receiving the vaccine!