When the varicella-zoster virus first strikes, it causes chickenpox. But the virus doesn’t move on after you get better. Instead, it hangs around, waiting for a chance to re-emerge as shingles.

“I tell patients that if we’ve had chicken pox any time during our lifetime, that virus stays in our system. It migrates into our nerve cells, hiding deep in our spinal cord nerve cells,” said Dr. Kevin Borgerding, an internal medicine physician at UCHealth Primary Care in Craig. “It can break out any time later in life as shingles. That’s why we now vaccinate young children against chickenpox, so they don’t get the virus to begin with.”

Risk factors for shingles

While shingles can strike at any age, it’s most common in older adults.

“Age is the most important factor in whether we get shingles,” Borgerding said. “There’s a dramatic increase in the incidence of shingles after age 50 because our immune system is aging.”

Patients who are immunocompromised are also at higher risk of developing shingles, including transplant patients, anyone with HIV, people who are on chemotherapy or long-term steroids, and people with certain autoimmune conditions.

Women are at a higher risk of developing shingles than men, while white people are at higher risk than those who are Black.

Another surprising risk factor is physical trauma. For instance, patients older than 65 who had a shingles outbreak on their scalp were 25 times more likely to have experienced a head trauma the week before the outbreak than those who didn’t get shingles.

Is shingles contagious?

A person with shingles can spread the contagious varicella-zoster virus, and therefore, someone who hasn’t had chickenpox or the chickenpox vaccine may get chickenpox (and then shingles later in life) from someone with shingles. A person with shingles is contagious until the last blister has died and scabbed over.

Symptoms and stages of shingles

Shingles show up as a painful rash in one spot on one side of the body. Red, raised lesions appear first, then evolve into fluid-filled blisters that eventually break open and scab over.

“The rash only breaks out on one half of the body because the nerves that supply skin sensation only go to one side,” Borgerding said. “If we see people with a rash that crosses the midline, we know it’s not shingles.”

A deep burning, throbbing or stabbing pain may be felt at the site of the outbreak before the rash appears, which can make it tricky to diagnose.

“Prior to the development of the rash, pain is often misinterpreted as another disease,” Borgerding said. For instance, intense pain on the chest may first seem like a heart issue, when it’s actually a budding shingles outbreak.

Older patients and patients who are immunocompromised are more likely to experience more dramatic pain and a more intense rash.

In some cases, the pain is mild. A person may even mistake shingles for something else. “I’ve seen so many people who come in thinking they have a spider bite, and it ends up being shingles,” Borgerding said.

Shingles present with systemic symptoms, such as fever, headaches or general malaise, only about 20% of the time.

Treatment and prevention for shingles

If you suspect you may have shingles, it’s important to see a provider immediately.

“The sooner, the better, because the sooner we can start them on anti-viral therapy, the sooner we can help eradicate the virus,” Borgerding said.

The nerve where the shingles virus is reproducing can get highly inflamed, which can sometimes result in debilitating pain. Speedy treatment can help lessen those symptoms.

While shingles typically don’t reoccur, the associated nerve pain can resurface multiple times.

“The nerve can be chronically irritated after you have shingles,” Borgerding said. “That’s one of the reasons shingles can be very debilitating.”

The good news is that there is an effective way to prevent the disease: the current shingles vaccine, which is given once as a two-shot series.

“It’s highly effective at preventing a shingles outbreak and preventing the chronic nerve pain related to shingles,” Borgerding said.

The vaccine is recommended for adults ages 50 and older, whether they’ve had shingles or chickenpox before.

“There’s a pretty high incidence of developing shingles during your lifetime, and it can be extremely painful – plenty of patients have chronic nerve pain,” Borgerding said. “Getting the shingles vaccine can help prevent that.”

This story first appeared in the Steamboat Pilot.