There is a lot of confusion among the general population concerning herpes. Popular culture makes us believe that herpes is solely a sexually transmitted disease (STD), which couldn’t be further from the truth. The Herpes Human Virus (HHV) come in eight different variants, only a couple of which is transmitted via unprotected sex. The most common afflictions caused by the HHV virus are shingles and oral or genital herpes. This article will list the symptoms, causes and treatments for both that will help you understand the differences between the two.
What is What?
Shingles (Herpes Zoster)
Herpes zoster, or just zoster is an affliction of the skin. It is also known as shingles or zona. It is caused by the HHV3 virus, which is also known as the varicella zoster virus (VZV). It is typified by a painful skin rash with blisters and is limited to one particular side of the body. However, people do not get shingles right after they get infected with the virus for the first time.
When people are initially exposed to the virus, they usually undergo a bout of chickenpox. However, even after the afflicted person recovers from chicken pox, the virus stays dormant in the patient’s nerve tissue located near the spinal cord and brain. Later in the life, this virus may become active again, travel down the neural pathways to your skin and manifests itself in the form of shingles.
Herpes (Oral and Genital)
Herpes is caused by the herpes simplex virus. The herpes simplex virus has two variants, namely HSV – 1 and HSV – 2. HSV – 1 causes oral herpes, which is typically manifested as a sore around the mouth and lips. HSV – 2 cause genital herpes and they cause sores around the genitals and the rectum. Although genital herpes may cause sores in other parts of the body as well, they usually manifest below the waist.
Shingles versus Herpes:
People tend to wonder whether shingles and herpes are the same. The answer would be, not quite! Shingles and herpes are related and if you really want to stretch the definition, then you can say that shingles is a form of herpes in terms that they are both caused by viruses in the HHV family, and that both shingles and herpes are contagious,   however, the similarity ends there. They are separate diseases caused by similar, yet genetically unique antigens, as mentioned above and have different symptoms as we will find out shortly!
An onset of herpes zoster is usually characterized by fever, headache and a feeling of general discomfort or uneasiness (malaise). However these symptoms can be caused by a host of different diseases and cannot be solely used to diagnose a case of shingles.
If the person is suffering from herpes zoster, then he will typically feel a sharp pain in a localized area. This is because once the dormant virus becomes active, it infects a particular neural pathway, and the pain is felt in that particular part of the skin that this pathway is connected to. Sometimes multiple nerves, located adjacent to each other may be affected. This pain is typically felt in the chest, abdomen (tummy) or in the upper facial region, including the eyes. Sometimes the pain is misdiagnosed as an illness of the heart, lungs or kidneys, depending upon where the patient is feeling the pain.
Once infected with VZV, every person suffers differently and the sensation of pain varies from person to person. The pain someone feels may be very mild, some may feel an onset of pins and needles, whereas others can feel a constant throbbing, burning or even a gnawing sensation. There are even others who feel a stabbing sensation that comes and goes, causing the afflicted area to be very tender. It is rare for children to suffer from a bout of shingles (they usually get chickenpox), but if they do suffer from it, it is usually painless. The pain is more severe among the aged.
The next stage of the infection is the development of a rash. This usually occurs two to three days after the patient starts registering a painful sensation, however, at times the rash may take up to three weeks to appear. The rash looks like a typical case of hives, however it is different from hives in the sense that this rash is limited to a particular dermatome, which results in a stripe or belt-like pattern and is limited to just one side of the body. It never crosses over to the other side. The soft tissue under the scars can be swollen, due to an inflammation caused by the VZV virus.
A few days after the development of the rash, it tends to become vesicular, which results in the formation of small blisters that are filled with serous exudate. These vesicles are still painful and they slowly become cloudy or darkened as they get filled with blood and crust over the next seven to ten days. After this period, the crust falls off, often leaving behind scarred and discolored skin.
Sometimes people suffer from a VZV infection without the rash, which is known as zoster sine herpete, or zoster without herpes. However, all other symptoms of herpes zoster remain. In other rare scenarios, the patient just suffer from a rash and no pain!
Sensitivity to light and fatigue are other symptoms that accompany the aforementioned symptoms. A usual bout of herpes zoster lasts about two to four weeks.
Herpes simplex is characterized by the appearance of a blister around the mouth, genitals or rectum. When the blister breaks, it leaves tender sores that may be prone to additional infections.
Most people do not display any symptoms for several months or even years after getting infected. Some people may display primary symptoms right after getting infected with the herpes simplex virus, however they are typically not visible for 4 to 7 days after infection. However, if the infected person does display primary symptoms, they are typically more severe than future occurrences. Primary symptoms may last for up to 20 days and may include the following:
- A medium to high fever signals the onset of an infection
- Painful red blisters that can burst upon minimal contact. Once it pops it leaves a small ulcer and they typically occur around the mouth (commonly known as cold sores), in the external genital area, thighs, buttocks and rectum. In most cases the ulcers heal and does not leave behind any long-lasting scars.
- The patient will feel an internal discomfort or uneasiness. She would complain that she is feeling “out of sorts”. This is often known as malaise.
- The patient will feel some pain while urinating. The flow of urine may be impeded as well!
- A watery discharge may be released from the vagina and may be accompanied by a foul smell
Once you are infected with this virus, it will stay with you forever and the symptoms will recur from time to time. However, if you are infected with Type 1 of the herpes simplex virus, then the probability and the frequency of the recurrence will be far less frequent than those who are infected with HSV – 2.
The recurrence of the symptoms is usually less severe than the primary symptoms, because over time, the human body builds up some amount of immunity against the virus. Even when the symptom recurs, they usually last for only 10 days. The recurrent symptoms are the same as the primary symptoms, except that they are less painful and are usually not accompanied by fever and general malaise, unlike the first time around!
What Causes an Onset of these Diseases?
Scientists are still not clear about what makes people vulnerable to the VZV virus, which causes herpes zoster. However, after extrapolating some relevant data, scientists have come up with the following trends that are statistically significant:
- Age: The chances of suffering from a case of shingles become greater with age. Typically half of all sufferers of shingles are over 60 years of age. People who are older than 80 are 10 times more likely to suffer from herpes zoster than those who are less than 10 years old. The closest explanation of this phenomenon is that our immune systems tend to be gradually weaker as we get older, the scientific term for which is immunosenescence.
- The health of the immune system: People with weaker immune systems are more vulnerable to an attack of herpes zoster. This can be caused by diseases that suppress the immune system such as HIV (AIDS). If someone has been consuming immunosuppressive drugs such as corticosteroids, then they can easily develop a case of shingles as well. Such people typically suffer from a bout of shingles at a younger age.
- Race and gender: Studies have shown that women are more likely to develop a case of shingles than men and African-Americans are more vulnerable to it than Caucasians.
Most people usually suffers from shingles only once in their lifetime, however there have reported cases where people have suffered twice or thrice from it!
It is to be noted that shingles or herpes zoster is contagious, but not in the traditional sense. In a nutshell a person cannot display the symptoms of herpes zoster right away, just by coming into contact with a person suffering from shingles. However, if someone has not yet suffered from chicken pox and then comes in contact with a person suffering from shingles, then that person would contract the VZV virus and would soon start displaying the symptoms of chicken pox. They would then be vulnerable towards undergoing a bout of shingles at a later stage in their life.
Being infected with herpes, especially HSV – 1 is more common than you may initially think. There are no risk factors besides advanced age, hence getting infected with Type 1 of the herpes simplex virus is unfortunately a rite of passage for most people. A study conducted by the University of Maryland Medical Center suggests that 62% of Americans are infected with HSV – 1 by the time they hit puberty and 85% of Americans contract the virus by the time they reach their 60s. If you receive oral sex from someone who has contracted HSV -1, it increases the chances of you contracting an HSV – 1 variant of genital herpes.
Type 2 of the herpes simplex virus is almost exclusively related to sexual activity, thus it is almost ubiquitous with the term genital herpes. If you have unprotected sex with someone displaying these symptoms (such as a blister on the genitals) then chances are that you would be infected as well! Hence if you have had a lot of different several sexual partners, or if you have had an unprotected sexual encounter at an early age, or if you already carry a different STD, then you are at a higher risk of contracting HSV – 2.
People ask whether shingles can cause genital herpes and the answer is a resounding no. The VZV virus does not cause people to mimic symptoms of HSV – 1 or HSV -2 and vice versa. One can say that this is a key difference between shingles and oral or genital herpes.
Unfortunately herpes zoster does not have a cure. However its impact can be minimalized by taking the following steps:
- Vaccines: They significantly reduce the chances of someone suffering from herpes zoster, however 100% immunity from the disease can never be guaranteed.
- Early detection: This is really hard to do, as the early symptoms are very similar to other common afflictions. However, if the patient is really lucky and shingles is detected at an early stage, then a strong dose of antiviral drugs significantly reduces the chances of complications.
However, unless you have a degree in medicine, please do not self-evaluate and self-medicate in case you suspect that you are suffering from shingles. We strongly suggest that you should consult your family practitioner at the first sign of discomfort. A typical regimen includes the following:
- A paracetamol (such as Tylenol or acetaminophen) for the pain. Topical treatments such as Capsaicin cream is typically prescribed as well!
- Strong antiviral medicine. Some examples are:
- Famciclovir (Brand Name: Famvir): It is a nucleoside drug that was approved by the FDA in 1994. It acts like a DNA and helps counter the replication of the viral DNA.
- Valacyclovir (Brand Name: Valtrex): Very similar in nature to famciclovir. The main difference is that it is safer, but takes longer to have the desired effect on the patient.
- Acyclovir (Brand Name: Zovirax): Again, very similar to famciclovir and valacyclovir except it is most effective during an early onset of the disease. Also it is not very effective when it comes to treating recurrent symptoms.
- If the rash gets ruptured, then the open wound remains vulnerable for other added infection as well, hence it needs to be protected and disinfected from time to time. A topical application of povidone iodine or a calamine lotion is typically recommended.
Sometimes shingles may not be detected unless an advanced stage is reached. Such cases are usually accompanied with an inordinate amount of pain. In such instances some prescription-only painkillers may be suggested by medical professional. Some examples include:
- Lidocaine is one of the most popular numbing agents that are prescribed in such cases. We recommend the skin patch because it would protect the area of infection from secondary infections. However lidocaine is also available as a gel or a spray as well. In case the skin patch is not available at the pharmacist, you may use the cream or the spray and then protect the afflicted area with a dressing as well!
- In extreme cases, painkillers with narcotic agents, (also known as opoids) may also be prescribed. Codeine is one of the most common examples, others being Hydrocodone (Brand Name: Vicodin) and Oxycodone (Brand Names: Oxycontin, Percocet, Percodan). However, the reason they are called opiods is because if the patient is not careful, then she may become addicted to it, which would obviously open a whole new can of worms. You need to follow your doctor’s instructions down to the last letter while ingesting these drugs.
- If the pain is so severe that it is causing seizures, then anticonvulsants may be prescribed to control the situation. They come in various classes and are prescribed according to the patient’s medical history. Although gabapentin (Neurontin) is the most popular option, it should only be consumed after a consultation with a qualified physician!
- Sometimes a protract episode of pain and infection can affect the mental health of the patient as well, causing severe depression that can lead to a host of other different afflictions. Tricyclic antidepressants such as amitriptyline may be prescribed in such cases.
- Treating the pain is not sustainable strategy unless the infection is controlled. If the patient is not responding sufficiently to the antiviral medicine (mentioned earlier in this article), then corticosteroids may be prescribed. They prevent the formation of scars, even if the boils or stubs are ruptured. They can come with a host of side-effects hence should only be administered by a qualified physician.
- In case of secondary infection, additional antibiotics may be prescribed such as flucloxacillin or erythromycin.
Just like herpes zoster, infections caused by the herpes simplex virus do not have any cure either. However, there is medication available in the market that will ease the pain, duration and frequency of an outbreak. However, you should start with the following home remedies:
- Use paracetamol or ibuprofen to ease the pain. They are usually available over the counter (without a prescription)
- Try taking a bath in water that is lightly salted
- Use ice packs. But make sure that the ice does not touch your skin
- Apply Vaseline or some other petroleum jelly
- If urinating becomes incredibly painful, then you may try doing so while sitting in warm water. If that does not help, then you may apply lidocaine to the affected area
- Avoid wearing tight clothing around the region of the outbreak
- Wash your hands thoroughly, especially if you have touched the infected area
- Do not engage in sexual activity during an outbreak
If you do not get adequate relief from the steps mentioned above, then please conduct your family practitioner. The anti-viral medication for herpes simplex is identical to that of herpes zoster, with a typical regimen consisting of famciclovir, valacyclovir or acyclovir depending upon the physician’s discretion.
We hope to have explained the differences between herpes zoster (shingles) and herpes simplex. If you have any questions, or if you believe that we may have missed out on some essential information, kindly let us know in the comments section underneath!