DEAR DR. ROACH: I am a 78-year-old female, and I am in my 10th week of shingles. I have them on my left chest and back (at the bra line!) and on my upper arm. I can't go anywhere because I can't stand when my clothes or bra touches me. I now have severe shooting pains on my arm area, mostly at night but also during the day. The rash on my chest, although mostly healed, is still very painful. I'm desperate for help. I use lidocaine, which helps for an hour or so. This is my second bout of shingles. I had them 10 years ago. I was (wrongfully) advised by my internist not to get the shingles vaccine after that last bout. Is there anything I can do? — P.C.
ANSWER: Shingles, also called herpes zoster, is caused by the recurrence of the chickenpox virus after years or decades of the virus being dormant. The herpes virus can escape the immune system during times of stress or simply as we age.
Pain around the time of shingles is nearly universal, but the duration of time is variable. The type of pain you have now is caused by damage to the nerve and is called "acute neuritis."
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Once the pain has lasted more than four months, the diagnosis of "postherpetic neuralgia" is made. Unfortunately, postherpetic neuralgia can last a very long time — for people over 65 with persistent, active PHN, the average duration of symptoms was about three and a half years.
By far, the best way to prevent PHN is the shingles vaccine. It keeps people from getting shingles at all, with high effectiveness, and even in those people who get shingles despite vaccination, the vaccine helps prevent getting PHN as a complication of shingles. As you have unfortunately demonstrated, getting the vaccine is important even if you have had shingles already. I am very sorry your internist did not advise you well.
Treatment of acute zoster, preferably within 24 hours of the onset of rash, but certainly within 72 hours, with antiviral medications can also help prevent PHN.
At this point, pain medication is indicated. Some authorities would consider the use of prednisone. I recommend consultation with an expert, perhaps in pain management.
DEAR DR. ROACH: Do you think scientists will find a cure for herpes 1 and 2 soon? Can a person with herpes 1 and 2 donate blood? Can herpes be transmitted via a kiss? — K.J.
ANSWER: Herpes viruses are very good at escaping the immune system, and although I would love to be wrong, I do not see a cure coming in the next five to 10 years at least.
About half the population of the U.S. is thought to have herpes simplex 1. By far, the most common way to get this is by oral contact, such as kissing. The person passing on the infection need not have symptoms to transmit the infection, although the presence of a cold sore dramatically increases the likelihood of infection. It is also possible to have HSV-1 genitally.
HSV-2 is the most common cause of genital herpes, which may never cause symptoms. When there are symptoms, they are most commonly painful fluid-filled blisters, but they can have many other appearances. Just like with HSV-1, HSV-2 can be passed on by a person when they don't have symptoms — and often, they've never had symptoms and don't know they have genital herpes. However, people are much more contagious when symptomatic.
People with HSV-1 and HSV-2 may both donate blood, but it's recommended not to do so during an outbreak.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.