What are the symptoms of shingles?
Burning pain or tingling and extreme sensitivity in one area of the skin. This may be present for one to three days before a red rash occurs. The rash soon turns into groups of blisters that look a lot like they are filled with water. The blisters generally last for two to three weeks.

Where does shingles appear on the body?
The blisters of zoster are most common on the trunk and buttocks. They can also appear on the face.

What are the complications of shingles?
Post-herpetic neuralgia is a condition in which either constant pain or periods of pain can continue after the skin has healed. It can last for a long time--sometimes for years. The blisters can also become infected.
Another complication is when the disease spreads all over the body called disseminated zoster. It looks similar to chicken pox. It happens in only about two to five percent of people.

How is shingles diagnosed?
Usually the diagnosis of shingles is based on the way the blisters look and pain on one side of the body. To be sure, a special test in which skin cells from a blister are examined under the microscope. If a certain type of cell damage is seen, this, combined with the location of the blisters and pain, makes the diagnosis. Results are usually available in several days.

Is shingles contagious?
The virus that causes shingles (herpes zoster) can be passed on to others, but they will develop chickenpox, not shingles. Shingles is much less contagious than chicken pox. Persons with shingles can only transmit the virus if blisters are broken and someone who never has had chicken pox comes in contcat with the fluid. Only staff who are non-suspectable to chickenpox should care for residents with shingles.

What about treatment?
In most people with shingles, the condition clears on its own in a few weeks and seldom recurs. Treatment is helpful. It usually consists of pain relievers as well as cool compresses to help dry the blisters.
Thc anti-viral drug, acyclovir, is usually prescribed for severe cases of shingles --with eye involvement, for example--or for those who are immunosuppressed. Acyclovir is given five times a day. The earlier it is taken after the disease begins the better; early cases of shingles sometimes can be stopped.
Corticosteroids, sometimes in combination with acyclovir, also are used for severe infection, such as in the eyes, and to reduce severe pain.
Post-herpetic neuralgia can be treated with an anti-depressant drug at night and frequent use of pain relievers during the day. An ointment containing capsaicin, an extract of pepper, is also helpful for some people. The ointment is applied to painful areas of the skin three to four times a day. It causes release of a chemical in the skin that eases the pain.

For more information contact:

American Academy of Dermatology
930 N. Meacham Road
P.O. Box 4014
Schaumburg, IL 60168-4014
Tel. 708-330-0230

Genital herpes

Sites of infection
In women, the genital areas most affected are the vulva and the entrance to the vagina. Sores can sometimes develop on the cervix. In men, sores are most common on the glans (end of the penis), the foreskin and shaft of the penis. Sometimes, sores can develop on the testicles. Less commonly both men and woman can experience sores on the anus, buttocks and tops of the thighs.
Some people do not experience recurrences and for those who do, recurrences are usually shorter and less severe than the initial infection. What is more, over time, recurrences seem to decrease in both severity and frequency, although there is no hard evidence that this happens. As with the initial infection, there is a large variation in people's experiences of recurrences. One person may experience no recurrences, whereas others may experience one or two or more per year.

What triggers genital herpes?
The initial episode is caused by sexual contact with an infected partner and occurs after a period that usually ranges from two days to three weeks. A recurrence takes place when the virus returns to the site of primary infection from its home in the nerve cells. It is not known exactly why the virus apparently becomes reactivated at various times.

Transmitting the infection
Persons with herpes can be infectious either at the time of symptoms or when there are no symptoms present. People who are experiencing an attack of herpes, either oral or genital, should consider themselves infectious from the start of the attack to the healing of the last ulcer.
Oral herpes lesions (cold sores) are also an important source of infectivity through the practice of oral sex and this should be avoided if one partner has an oral cold sore. People with no obvious lesions can still have infectious virus present at certain times through a process known as asymptomatic viral shedding. Asymptomatic viral shedding cannot be predicted but is known to occur on at least 5 per cent of days per year.
Occasionally one partner in a long term relationship may develop symptoms of herpes for the first time. Often this is due to one or both of the partners being carriers of the herpes virus and not knowing it. It does not necessarily imply recent transmission from someone outside the relationship.
By avoiding sex when the signs of herpes are present, and by using condoms with sexual partners between outbreaks, the chance of passing on herpes may be reduced.