Recurrent Shingles: Why You May Get Shingles More Than Once

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More people are getting shingles these days than before. In the U.S., about 1 in 3 adults will get shingles in their lifetime. And if you or someone you know has ever experienced it, you know it can be quite irritating and painful. In fact one Roman emperor's physician named the rash a "fiery girdle," which sounds like something you don't even want to get once, and for sure not twice. But some people are at increased risk of recurrent shingles. Learn who is at risk for getting shingles more than once, what causes it, and steps you can take to prevent it.

What is shingles?

Shingles is caused by the varicella zoster virus. This is the same virus that causes chickenpox. After someone recovers from chickenpox, the virus still remains inside the body. And it goes dormant in nerve cells. If your immune system can keep the virus in check, it stays quiet forever. But sometimes, with age or other conditions that affect the immune system, the varicella virus becomes active again.

The reactivated virus reappears with different symptoms than the original chickenpox infection. It causes painful, itchy blisters over one specific area of skin. This is often in a stripe distribution on one side of the chest, abdomen, or back. But it can happen anywhere on the body.

Can you get shingles more than once?

Yes, you can get shingles more than once. Experts used to think that shingles was a once-in-a-lifetime, bad-luck event. But studies have shown that around 6% of people will have shingles more than once. Shingles that happens again months or years later is called "recurrent shingles."

What causes recurrent shingles?

When people first get infected with varicella, they get chickenpox. Then the body's immune system gets the virus under control. But even after they recover from chickenpox, some of the virus hides out in nerve cells.

The immune system keeps it in check so the virus stays dormant forever - most of the time. But if something weakens the immune system, that hibernating virus can wake up and start causing trouble.

Experts are still learning why most people only get shingles once, while others get it again. They believe it has something to do with the strength of the immune system.

When someone gets shingles the first time, the immune system gets boosted. The immune cells that fight the virus get a refresher course from when it first saw the virus as chickenpox. So they ramp up production and double down on efforts to keep the virus in check the next time. But if the immune system isn't working the right way when you get shingles, you're more likely to get it again.

Who is at risk for recurrent shingles?

Most people who get shingles recover within a few weeks. The rash goes away and the pain improves. But some people are left with a burning or stabbing pain even after the blisters have healed - this is postherpetic neuralgia. Someone who develops postherpetic neuralgia that lasts 30 days or more has an increased risk for recurrent shingles.

About 12% of people 50 and older will still have postherpetic neuralgia 3 months after having shingles. It happens more often in people who:

• Are older when they get shingles

• Had a severe rash or extreme pain with shingles

• Developed pain as their first symptom - even before the rash appeared

• Had shingles around the eye

• Have a condition that affects the immune system

In addition to postherpetic neuralgia, other risk factors for recurrent shingles include:

• Age over 50

• People who are genetically female

• Autoimmune diseases, like rheumatoid arthritis and lupus

• Use of medications that suppress the immune system

• Leukemia and lymphoma

• High lipids

• High blood pressure

• Diabetes

• HIV

Can stress cause shingles to flare up again?

Researchers are still studying this, but there's some evidence that stressful life events may contribute to a shingles flare. This may happen more if age, nutrition, or mental health conditions are also affecting the immune system.

Stress can increase your chances of getting sick when you're exposed to a virus. It can also affect the body's response to vaccines. And sometimes, like with shingles, it can make it easier for the virus to reactivate.

But positive emotions and resilience can help. For example, one interesting study showed that people who felt a sense of purpose in life had a lower risk of postherpetic neuralgia.

Preventing recurrent shingles

There's no guaranteed protection against shingles or recurrent shingles. But vaccines offer the best chance at prevention. Shingrix, the current shingles vaccine, prevents shingles in 90% to 97% of people (depending on their age). And it prevents postherpetic neuralgia in about 90% of people.

Experts recommend Shingrix for people who are 50 and older. But it may also be given to younger people with health conditions that compromise their immune system. Even if you received the previous shingles vaccine (Zostavax), experts recommend getting the Shingrix vaccine to reduce the risk of shingles.

If you do get shingles, early treatment with antiviral medications can decrease the risk of postherpetic neuralgia. This is important since postherpetic neuralgia is a risk factor for recurrent shingles.

You can't change some risk factors for shingles, like your age. But there are steps you can take to enhance your immunity and lower your risk of recurrent shingles:

• Eat a balanced and nutritious diet with plenty of fruits and vegetables, lean protein, and whole grains.

• Stay physically active.

• Maintain a balanced weight.

• Make sure to get enough sleep.

• Don't drink too much alcohol.

• If you smoke, get help to quit.

Frequently asked questions

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