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Herpes zoster infection

Last reviewed: 9 Apr 2025
Last updated: 19 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • localized pain in a dermatome
  • pruritus
  • rash
  • corneal ulceration
Full details

Other diagnostic factors

  • fever
  • headache
  • malaise
  • fatigue
  • pain without rash
Full details

Risk factors

  • >50 years of age
  • female sex
  • HIV
  • chronic corticosteroid use
  • chemotherapy
  • malignancies
  • white ethnicity
  • certain acute or chronic conditions
  • vaccination against other infectious diseases
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • polymerase chain reaction (PCR)
  • immunohistochemistry
  • vesicular fluid culture
  • HIV test
Full details

Treatment algorithm

ACUTE

acute symptoms: immunocompetent

acute symptoms: immunocompromised

ONGOING

postherpetic pain

Contributors

Authors

Phuc Le, PhD, MPH

Assistant Professor

Center for Value-Based Care Research

Medicine Institute

Cleveland Clinic

Cleveland

OH

Disclosures

PL declares that she has no competing interests.

Michael Rothberg, MD, MPH

Professor

Center for Value-Based Care Research

Medicine Institute

Cleveland Clinic

Cleveland

OH

Disclosures

MR declares that he has no competing interests.

Acknowledgements

Dr Phuc Le and Dr Michael Rothberg would like to gratefully acknowledge Dr Kenneth J. Smith and Dr Linda Kalilani, the previous contributors to this topic.

Disclosures

KJS and LK declare that they have no competing interests.

Peer reviewers

Julius Atashili, MD, MPH

Department of Epidemiology

Division of General Medicine and Epidemiology

UNC at Chapel Hill

Chapel Hill

NC

Disclosures

JA declares that he has no competing interests.

Ken Mutton, MB, BS, FRCPA, FRCPath

Consultant Virologist

Manchester Royal Infirmary

Manchester

UK

Disclosures

KM declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007 Jan 1;44 Suppl 1:S1-26.Full text  Abstract

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: varicella-zoster virus. 2022 [internet publication].Full text

Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018 Jan 26;67(3):103-8.Full text  Abstract

Centers for Disease Control and Prevention. Adult immunization schedule by age. Recommendations for ages 19 years or older, United States, 2025. Nov 2024 [internet publication].Full text

Severson EA, Baratz KH, Hodge DO, et al. Herpes zoster ophthalmicus in Olmsted County, Minnesota: have systemic antivirals made a difference? Arch Ophthalmol. 2003 Mar;121(3):386-90.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Herpes zoster infection images
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  • Guidelines

    • Recommended immunization schedule for adults aged 19 years or older: United States, 2025
    • Update on recommendations for use of herpes zoster vaccine
    More Guidelines
  • Patient information

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