Recurrent shingles is rare (especially ≥ 2 episodes) and requires laboratory confirmation as other aetiologies such as recurrent zosteriform herpes simplex should be considered. Wolf’s post-herpetic isotopic response may also occur, resulting in the development of immunity related skin disorders at the site of a previous herpetic eruption.
Shingles is an HIV indicator condition, and recurrences are more common in immunocompromised patients. All patients with shingles should be offered an HIV test and those with laboratory confirmed recurrent infection should have an evaluation for immune deficiency. Please see Recurrent Shingles and Immune Deficiency for further detail.
C.M & N.B 12-12-23
The RIDU team is happy to provide advice or outpatient review (referral via SCI Gateway) for patients with confirmed recurrent herpes virus infections who have not responded to first line treatment.
People living with HIV should be referred to Infectious Diseases or Chalmers.
Please send a vesicle swab in viral transport medium for HSV/VZV PCR. Management should be driven by the results of the vesicle swab; appropriate treatment regimens can be found in the BNF.
Patients with confirmed recurrent shingles (VZV) should be evaluated for underlying immune deficiency. Antiviral prophylaxis is not indicated for individuals with recurrent shingles, but may be considered for those with recurrent herpes simplex virus (HSV) infections.
If the aetiology of the rash is unclear and the PCR is negative, consider seeking Dermatology advice.
