Shingles and Pregnancy

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Shingles in pregnancy facts

What is shingles?

Shingles is a painful skin rash caused by reactivation of prior infection with the same virus that previously caused chickenpox, known as varicella zoster virus (VZV). VZV belongs to the herpes family of viruses, but it is not the same virus that causes genital herpes or cold sores on the mouth. When a person is infected with VZV in childhood, they typically develop chickenpox, but after the illness resolves the VZV remains in a dormant state in the nervous system and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates and causes the skin and nerve inflammation known as shingles.

Shingles occurs most commonly in people over the age of 60, but anyone who has ever had chickenpox is at risk, including pregnant women. It has been estimated that up to 1,000,000 cases of shingles occur each year in the U.S.

What do shingles look like?

Picture of Shingles (Herpes Zoster)
Picture of Shingles (Herpes Zoster)

Quick GuideShingles Rash Pictures, Symptoms, Vaccine Facts

Shingles Rash Pictures, Symptoms, Vaccine Facts

What are the signs and symptoms of shingles?

The hallmark symptom of shingles is a painful, blistering rash. Pain from shingles may be severe in intensity. The pain, or a tingling sensation in some cases, may precede the development of the actual rash, making the cause of the pain hard to ascertain. Small blisters form on a red base, and new blisters continue to appear for 3 to 5 days. The rash follows the path of individual nerves, and typically presents in a band-like pattern on one side of the body. After the blisters rupture, they begin to crust over and heal. The entire outbreak from onset to healing takes about 3 to 4 weeks.

Fever, headache, chills, and nausea can sometimes accompany the painful skin rash.

How is shingles diagnosed?

The characteristic rash of shingles typically suggests the diagnosis, and in most cases, no specific diagnostic tests are required. In cases in which there is pain but no apparent rash, the diagnosis can be very difficult. Laboratory testing to detect the genetic material or surface proteins of the VZV can be used in atypical or difficult cases.

What is the treatment for shingles in pregnancy?

Treatment for shingles is generally prescription or over-the-counter antiviral, pain, and antihistamine medication.

Antiviral medication to treat shingles

The prescription antiviral medications typically used to treat shingles are safe to take during pregnancy. These drugs include acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir). Antiviral medications can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash).

Pain medication to treat shingles

Pain medications, such as acetaminophen, can also be used for pain relief, although these will not affect the progression of the blisters and rash. Pregnant women should discuss any pain relief medications with their health care professional. Pregnant women should not take nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen (Advil, Motrin, Nuprin, etc.) late in the pregnancy.

Antihistamine medication to treat shingles

Antihistamines such as diphenhydramine (Benadryl) can help reduce any associated itching. Other home remedies for itching include oatmeal baths and calamine lotion. Many women find that applying cool cloths or compresses provides relief as well. Keeping the affected areas covered with clean gauze and wearing loose clothing can help speed healing and prevent secondary infection of the affected skin.

What are the complications of shingles in pregnancy?

Postherpetic neuralgia is the most common complication of shingles. This condition develops in about 20% of people who have shingles and is characterized by persistent pain at the affected site after the rash has disappeared. It goes away by 4 months after the initial rash in most people. This complication is less common in pregnant women since it rarely occurs in people under 40 years of age. Postherpetic neuralgia is more common in people over 60 who do not receive treatment for shingles.

Shingles that affects the eye is another uncommon condition. It is essential to see a doctor if you develop shingles around the eye area. In very rare cases, the virus can spread to the brain and membranes around the central nervous system. Other potential complications include hearing or balance problems and weakness of the muscles on one side of the face, known as Ramsay Hunt syndrome. All of these complications, like postherpetic neuralgia, are more common in older adults and affect pregnant women less commonly.

Sometimes, secondary bacterial infections develop at the site of the rash. These can be treated with antibiotics, and antibiotics can be chosen that are safe for use in pregnancy.

What is the outlook (prognosis) for shingles in pregnancy?

Most cases of shingles heal without a risk of serious complications or long-term problems.

Can shingles in pregnancy be prevented?

If you have had chickenpox in the past, you have been infected with the VZV and there is no absolute way to prevent shingles. However, you cannot catch shingles from someone else who has shingles or chickenpox if you have had chickenpox or have immunity to the chickenpox virus. However, pregnant women who have not had chickenpox may catch chickenpox from someone with shingles or chickenpox. Chickenpox infection during pregnancy can be dangerous to the unborn baby, so it is important to avoid contact with people with shingles or chickenpox if you have not had the condition or the vaccine.

Children in the US today are typically vaccinated against the VZV (chickenpox vaccine). A vaccine to prevent shingles (Zostavax) is also available that reduces the incidence of shingles by about 50%, but the vaccine cannot be taken by pregnant women. Women who receive the Zostavax vaccine should wait at least 3 months before attempting pregnancy.

Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES:

Medscape, Varicella-Zoster Virus.

"Shingles (Herpes Zoster)." CDC.gov. Updated Aug. 19, 2016.

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Reviewed on 9/7/2016
References
Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES:

Medscape, Varicella-Zoster Virus.

"Shingles (Herpes Zoster)." CDC.gov. Updated Aug. 19, 2016.

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