- When someone experiences a flareup of the varicella-zoster virus (VZV), the virus that causes chickenpox, shingles occurs. According to the Mayo Clinic, shingles is generally characterized by two main symptoms: pain, which can be very severe, and the development of a blistering rash along the path of an affected nerve. However, a very small number of people do not develop a rash as a result of the reactivation of VZV; this is a condition known as zoster sine herpete. Other people may develop only a very small rash that goes unnoticed by themselves and possibly by doctors; this condition is known as zoster cum herpete minimo.
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According to the American Academy of Family Physicians (AAFP), zoster sine herpete can be very difficult to diagnose, as the associated pain can easily be confused with other conditions.
In order to detect VZV in the absence of sores, according to the University of Maryland Medical Center, a number of tests can be run. These include a viral culture from spinal fluid (although this is expensive and less accurate than other tests), an immunofluorescence assay to detect antibodies to the virus and polymerase chain reaction testing to find direct evidence of the virus' genetic material. - It is important to seek immediate medical attention for onset of sudden pain, with or without a rash. If zoster sine herpete occurs, time is likely going to be lost ruling out other conditions, and it is important to begin antiviral therapy for the management of shingles as soon as possible. People who do not develop shingles sores do not require the use of agents like lidocaine and capsaicin for the topical management of pain. All medications should be used as indicated by a doctor for relief from symptoms and to minimize complications of the condition.
- A person who has had one outbreak of shingles, with or without the appearance of sores, is also vulnerable to another outbreak because the virus never fully leaves the system. People over the age of 60 who have healthy immune systems and are not pregnant can be vaccinated against shingles, even after having had previous outbreaks, according to the Centers for Disease Control and Prevention (CDC). People should talk with their doctors about allergies before being vaccinated against shingles, as potentially serious allergic reactions to components of the vaccine are possible.
