Shingles: Symptoms, Treatment, and the Vaccine
What Shingles Is — and Why Speed Matters
Shingles (herpes zoster) is a painful rash caused by the reactivation of the chickenpox virus (varicella zoster) in people who have had chickenpox earlier in life. After the original infection, the virus lies dormant in nerve cells for decades — sometimes for life — but can reactivate when the immune system is weakened by age, illness, stress, or immunosuppressive medications.
About one in three Australians will develop shingles during their lifetime, and the risk increases sharply after age 50. While shingles is rarely life-threatening, it can cause severe pain — and in some cases, that pain becomes a long-term problem called postherpetic neuralgia.
The most important thing to know: antiviral treatment works best when started within 72 hours of the rash appearing. If you suspect shingles, see a GP that same day or the next.
Symptoms of Shingles
Shingles typically progresses through clear stages:
Stage 1: Pre-Rash (1–5 days before the rash)
- Burning, tingling, itching, or shooting pain in one area of skin
- Sensitivity to touch
- Flu-like symptoms — headache, fatigue, fever, light sensitivity
- Often misdiagnosed as muscle strain, sciatica, or another nerve issue
Stage 2: Rash Appears
- Red, raised rash develops in a band or stripe — almost always on ONE SIDE of the body or face
- The rash follows a nerve pathway (called a dermatome) and usually does not cross the midline
- Common locations: chest, back, abdomen, face, scalp, around an eye, or limbs
- Within 24–48 hours, the rash develops fluid-filled blisters
Stage 3: Blisters Crust Over (7–10 days)
- Blisters break, ooze, and crust over
- This is when the rash is no longer contagious to others
- Skin heals over the next 2–4 weeks, sometimes leaving scarring or pigmentation changes
Why You Must See a GP Quickly
If you suspect shingles, do not wait. Antiviral medications (valaciclovir, famciclovir, aciclovir) significantly reduce the severity and duration of the rash AND the risk of postherpetic neuralgia — but only if started within 72 hours of the rash appearing. After 72 hours the benefits diminish substantially.
You should also see a GP urgently if:
- The rash is on or near your eye — shingles can damage vision permanently
- The rash is on your face, scalp, or near your ear — risk of facial nerve damage
- You have a weakened immune system (cancer treatment, transplant, HIV, autoimmune disease on biologics)
- You are pregnant
- The rash is widespread or covers a large area
- Pain is severe
- You develop fever, confusion, or worsening weakness
Postherpetic Neuralgia: The Complication to Avoid
Postherpetic neuralgia (PHN) is chronic pain that persists in the area of the shingles rash long after the skin has healed. It can last months to years, and in some cases is permanent.
The pain is often described as burning, stabbing, electric shock-like, or extreme sensitivity to touch (so that even a bedsheet feels unbearable). PHN is more common in older patients, those with severe initial shingles, and those who delayed treatment.
Treatment options for PHN include nerve pain medications (gabapentin, pregabalin, tricyclic antidepressants), topical lidocaine patches, capsaicin cream, and pain specialist referral in severe cases. Prevention through prompt antiviral treatment and vaccination is far more effective than treating PHN once established.
Treatment of Acute Shingles
- Antiviral medications — 7-day course, prescribed by your GP. Most effective within 72 hours of rash onset
- Pain relief — paracetamol, ibuprofen, or stronger medications if needed
- Gabapentin or pregabalin — if nerve pain is significant
- Cool compresses on the rash for comfort
- Calamine lotion for itch
- Loose, breathable clothing to reduce friction
- Avoid scratching or popping blisters — risk of bacterial infection and scarring
The Shingrix Vaccine — Free for Most Australians Over 65
Shingrix is a highly effective shingles vaccine that reduces the risk of shingles by over 90% and dramatically reduces the risk of postherpetic neuralgia. It is given as two doses, 2 to 6 months apart.
Under the National Immunisation Program (NIP), Shingrix is available free to:
- All Australians aged 65 and over
- Aboriginal and Torres Strait Islander people aged 50 and over
- Immunocompromised adults aged 18 and over (with eligible conditions)
If you fall outside these groups but are 50 or older, Shingrix is still recommended and is available privately from Family Doctor clinics — typically around $300 for the full two-dose course. Many adults consider this excellent value given the severity and duration of shingles and PHN.
Even if you’ve had shingles before, the vaccine is still recommended — shingles can recur.
Is Shingles Contagious?
Shingles itself is not contagious, but the varicella zoster virus IS contagious to anyone who has not had chickenpox or been vaccinated against it. If they catch the virus from your shingles rash, they will develop chickenpox (not shingles).
You are contagious from the time the rash appears until all blisters have crusted over (typically 7–10 days). During this period:
- Cover the rash with a loose dressing
- Avoid contact with pregnant women who have not had chickenpox
- Avoid newborns and infants
- Avoid people with weakened immune systems
- Wash your hands frequently after touching the rash
Frequently Asked Questions
Can I get shingles if I never had chickenpox?
No. Shingles is the reactivation of the chickenpox virus, so you must have had chickenpox first. However, almost all Australian adults born before the chickenpox vaccine became routine (1995) have had chickenpox, often without knowing it as a child.
How long does shingles last?
Acute shingles typically lasts 2–4 weeks. The rash crusts over within 7–10 days and heals fully within 2–4 weeks. Pain may persist longer, particularly in older adults.
I had the old Zostavax vaccine. Should I get Shingrix too?
Yes. Shingrix is significantly more effective and longer-lasting than Zostavax, and the two vaccines work in different ways. ATAGI recommends Shingrix for all eligible adults regardless of previous Zostavax vaccination, with at least 12 months between Zostavax and Shingrix.
Can I get shingles more than once?
Yes, although recurrence is uncommon. Vaccination after a shingles episode is still recommended to reduce recurrence risk.
I’m under 50 — can I still get the vaccine privately?
Shingrix is approved in Australia for adults aged 50 and over. Adults under 50 with specific immunocompromising conditions may be eligible. Discuss with your GP.
What if I think I have shingles but it’s a weekend or after hours?
See an after-hours GP, telehealth GP, or attend an emergency department. The 72-hour antiviral window is critical and waiting for Monday could mean missing it. Shingles rashes that appear on Friday should be assessed Friday or Saturday.
Don’t Wait — Book Today If You Suspect Shingles
If you have a painful, blistering rash on one side of your body, or unusual nerve pain followed by a developing rash, contact your GP immediately. Early antiviral treatment makes a real difference. Family Doctor clinics offer same-day appointments at most locations.