The shingles disease, or herpes zoster, is caused by the varicella zoster virus--the same virus that causes chicken pox in children. Unlike bacteria and other pathogens, viruses don't die once they've run their course. Instead, they lie dormant in the body and can flare up when the immune system is compromised. When a person catches chicken pox, the virus runs its course, then lies dormant in the nerve roots. For most healthy people, shingles is not an issue, and the virus usually affects the elderly, people with HIV and others with compromised immune function. While shingles primarily attacks sensory nerves on the body, it can attack other nerves, including those for facial expression and the bladder.
Is Shingles Contagious?
While the varicella zoster virus is transmissible through direct contact, the shingles disease is not considered fully contagious. If a person with a healthy immune system, who has already been exposed to the varicella zoster virus, comes in contact with the virus, his immune system will prevent him from getting sick. However, if someone has never had chicken pox, has never been vaccinated against it or has a compromised immune system, he may develop chicken pox or shingles from contact with open shingles blisters. The most common cause of shingles is a weakened immune system in a body where the varicella zoster virus is already resident.
Prevention and Treatment
The Centers for Disease Control and Prevention recommends those at risk get the shingles vaccine (Zostravax), even if they have a prior history of shingles outbreaks. This is because the vaccine can prevent a shingles outbreak, even in those who have already had shingles, and reduce the severity should an outbreak occur. Antiviral medications like valacyclovir, famcyclovir and acyclovir may be used in conjunction with painkillers to provide relief during an outbreak. While there is no cure for shingles, antiviral medications will significantly reduce the severity and length of the outbreak.
Shingles Outbreaks
In a shingles outbreak, the virus awakens and travels along the length of a nerve, causing inflammation. As the virus travels, all the structures associated with that nerve are affected. The virus may travel down one nerve or a bundle of nerves in the same area. The inflammation results in severe pain and a rash or lesions along the path of the infection, and the rash can last one day or several weeks. The most common sites for shingles are the face, abdomen, back and buttocks. The arms and legs may also be affected, but it is rare. Shingles rashes usually occur unilaterally (on one side of the body); however, bilateral outbreaks are possible. Because the virus is always there, it is possible for patients to experience multiple outbreaks. This is why preventative treatment, with the vaccine, is so important.
Complications of Shingles
According to the Centers for Disease Control and Prevention, more than 1/3 of shingles patients will develop serious complications--and the risk of complications increases after age 60. If shingles spreads to the face and eyes, it can cause facial paralysis, damage to the eye and even blindness. Shingles infections in the bladder can cause other infections and even kidney damage. Another common complication is postherpetic neuralgia (PHN)--a condition where pain persists for months and even years after the shingles rash has healed.
Shingles on the Face
An outbreak of shingles on the face can lead to a condition known as Ramsey-Hunt syndrome. Ramsey-Hunt has symptoms similar to Bell's palsy, including facial paralysis, pain, dizziness and localized tenderness. But there are other symptoms that are specific to Ramsey-Hunt, which include hearing loss (if the varicella zoster virus affects the auditory nerve), blisters from the shingles rash and swollen lymph nodes. Ramsey-Hunt usually lasts the duration of the shingles outbreak but may last longer if there is residual nerve damage.
Shingles in the Bladder
Most lay people think of shingles as a skin disease. Shingles is actually a neurological disease, because of the way the varicella zoster virus attacks the nerves. This is why it is possible for the virus to spread to areas not commonly associated with the skin. When a nerve is irritated, it becomes inflamed, which causes impaired function of the nerve and the structures associated with the nerve. In the case of the bladder, the nerves may become hyperactive, overstimulating the muscles that contract the bladder--causing urge incontinence and other symptoms of an overactive bladder. The nerves could also shut down, disrupting the signals from the bladder to the brain. When this happens in the bladder, the sphincter muscles may no longer function properly, causing either leakage or urine retention.
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