9 Things You Didn't Know About Shingles

Ever had the chickenpox? If so, you can get shingles, says Anna Wald, M.D., head of the allergy and infectious disease division at the University of Washington School of Medicine in Seattle. Here’s what happens: After you get chickenpox, the virus hangs out quietly in your body and can reactivate as shingles later in life. More than 99% of Americans born before 1980 have had chickenpox, since a vaccine for it wasn’t introduced in till the ’90s. That’s a lot of people at risk of shingles.

If you’re over 50, listen up. “It’s thought that as you age, you start losing immunity, even to things you used to be immune to,” explains Edward Jones-Lopez, M.D., an infectious disease expert with Keck Medicine of the University of Southern California in Los Angeles. That gives the dormant virus leftover from chickenpox a better chance to take hold in your body as shingles—often decades later. Most people get shingles in their 50s and beyond, according to the National Institutes of Health (NIH).

Shingles symptoms are pretty unmistakable: A red, blistery, painful rash on one side of the body, or less often, the face. “If it crosses the midline of the body, it’s not shingles,” says Dr. Jones-Lopez. That’s because the virus hangs out in specific nerves that only occur in one side or the other of your body, isolating where symptoms appear. For example, you may see a rash line from the left side of your back around to the left side of your chest, he says. (Rarely, the rash may be more widespread, says the CDC.)

Want to avoid these painful symptoms? You’re in luck—the vaccine Shingrix is 90% effective at preventing the disease in adults over 50, says the CDC. This two-dose vaccine can have side effects, though: “Some people have pain and feel like they have the flu for a few days,” Dr. Wald says. Still, it’s preferable to the pain of shingles itself and prevents the risk of dangerous complications—so even if your first dose is unpleasant, make sure to get that second shot when the time comes.

If you do come down with shingles, head straight for the antiviral drugs. Three are currently available: Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir). Starting these meds as quickly as possible is important—they’re most effective if used right after symptoms appear, says Dr. Wald. The drugs come in pill form, but in severe cases—for example, when there’s more than one rash and you’re also immunocompromised—your doctor may treat you with antivirals via IV first, then switch to the pills, says Dr. Jones-Lopez.

Yeah, this is a confusing one to wrap your head around. Make no mistake: “When the shingle skin lesions occur, they can be contagious,” says Dr. Jones-Lopez. But it’s chickenpox that you can spread, not shingles—remember, shingles is caused by the reactivated chickenpox virus. “You can’t give shingles itself to someone because it comes from your own body,” Dr. Wald explains. If you have shingles, steer clear of people who have never had chickenpox until the blisters from your rash have scabbed over and healed completely.

In most people, shingles goes away after a couple of weeks, leaving no long-term damage. But serious complications can occur, include postherpetic neuralgia, which happens in one in 10 people with the disease, according to the CDC. “This is when people develop prolonged debilitating pain after having shingles,” says Dr. Wald. “The risk increases with age.” Other rarer complications include damage to the eyes, hearing problems, pneumonia, brain inflammation, and death.

Complications from shingles are generally uncommon, but some people are at a higher risk than others. Again, age is a big factor here, says Dr. Jones-Lopez. You’re also more likely to have complications if you have lesions on your face or eye area, according to the NIH. The other major risk factor for shingles complications is being immunosuppressed. “For example, people with diabetes, HIV, or cancer, or who are taking certain medications, are at higher risk,” says Dr. Jones-Lopez.

Because a weakened immune system can increase the risk of getting shingles, having the virus could indicate there’s something else not quite right in the body. “If someone develops shingles on the younger side, say 28 or 30, that is typically a clue for something else,” says Dr. Jones-Lopez. In this case, your doctor may investigate why your immune system appears compromised—you could have an undiagnosed condition.

You may have heard that once you’ve had shingles, you’re in the clear. Unfortunately, that’s a myth. While most people only have one episode in their lifetime, it’s technically possible to have more. In fact, shingles recurrences are more common than researchers previously thought, according to a study in the journal Mayo Clinic Proceedings. Basically, the virus can reactivate again, often causing a rash in a different part of the body. So even if you’ve had shingles already, it’s worth asking your doctor about the vaccine.

The possibility of getting shingles can be scary, considering the potential for pain and life-threatening complications. That’s why it’s vital to get the shingles vaccine. “Many people don’t know that shingles is preventable,” says Dr. Jones-Lopez. “It’s a very safe vaccine.” If you’re 50 or older, make sure you ask your doctor about getting vaccinated. And if you think you have signs of shingles, call your doctor right away. Remember, the faster you get those antiviral drugs in your system, the faster you’ll recover.