Many men think of shingles as simply a skin condition—a painful rash that appears for a few weeks and eventually disappears. In reality, shingles is closely connected to the nervous system, and for some people its most difficult consequence begins after the rash is already gone.
Shingles, medically known as herpes zoster, is caused by the varicella-zoster virus, the same virus responsible for chickenpox.
After someone recovers from chickenpox, the virus does not necessarily leave the body. Instead, it can remain inactive inside nerve tissue for decades. Later in life, the virus may reactivate and travel along a nerve toward the skin, producing shingles.
The risk increases with age, which makes shingles an especially important health issue for middle-aged and older men.
How Does Shingles Begin?
One reason shingles can initially be confusing is that pain may begin before any rash appears.
A man may experience burning, tingling, itching, numbness, or unusual sensitivity on one side of his chest, back, abdomen, neck, or face.
Even light contact from clothing may become uncomfortable.
Because there may be no visible rash at first, the discomfort can be mistaken for a pulled muscle, back problem, kidney pain, or another condition.
A rash typically develops later, followed by clusters of fluid-filled blisters.
Shingles commonly follows the path of a particular nerve and usually affects only one side of the body or face. A band of painful blisters wrapping around one side of the torso is one of its classic presentations.
Why Does Risk Increase With Age?
The immune system normally keeps the dormant virus under control.
As people age, immune defenses against certain infections may become less effective, allowing varicella-zoster virus to reactivate.
Certain illnesses and treatments that weaken the immune system can also increase the risk.
According to the CDC, approximately one in three people in the United States will develop shingles during their lifetime, and the risk rises with age.
When the Rash Disappears but the Pain Does Not
The most common complication of shingles is called postherpetic neuralgia, or PHN.
In PHN, damaged or irritated nerves continue sending pain signals even after the skin has healed.
The pain may feel burning, stabbing, electric, or extremely sensitive. For some people, even clothing touching the affected skin becomes painful.
According to the CDC, approximately 10% to 18% of people who develop shingles experience PHN, and the risk increases with age.
The discomfort can continue for months and, in some cases, years.
Shingles Near the Eye Requires Prompt Attention
Shingles does not occur only on the chest or back.
When the virus affects nerves supplying the eye and surrounding areas, it can cause serious complications.
A shingles outbreak involving the forehead, nose, eyelid, or eye should receive prompt medical evaluation because eye involvement can cause lasting damage to vision.
Involvement of other facial nerves may sometimes affect hearing or facial movement.
For that reason, a new one-sided painful or blistering rash on the face should not simply be watched at home for several days.
Early Treatment Matters
Antiviral medications can help shorten the illness and reduce its severity, particularly when treatment begins early.
The National Institute on Aging advises people who suspect shingles to contact a healthcare professional promptly and recommends evaluation no later than three days after the rash begins.
If unusual one-sided burning or pain is followed by a rash or blisters, do not wait for the entire rash to develop before seeking medical advice.
Is Shingles Contagious?
A person does not directly “catch shingles” from someone else.
However, the varicella-zoster virus from shingles blisters can infect someone who has never had chickenpox or received chickenpox vaccination. That person could then develop chickenpox.
Keeping the rash covered, avoiding scratching or touching the blisters, and washing hands frequently can reduce the chance of transmission.
People with active shingles should be particularly careful around individuals who may be vulnerable to varicella infection until the blisters have dried and crusted.
A Vaccine After Age 50
Fortunately, shingles is a disease for which highly effective prevention is available.
The CDC currently recommends two doses of Shingrix, the recombinant shingles vaccine, for adults age 50 and older.
For most adults, the second dose is given two to six months after the first.
Two doses are also recommended for adults age 19 and older who are or will become immunocompromised because of disease or treatment. In some immunocompromised patients, the second dose may be administered one to two months after the first.
In healthy adults age 50 and older, Shingrix is more than 90% effective at preventing shingles and postherpetic neuralgia.
“I Already Had Shingles. Do I Still Need the Vaccine?”
Previous shingles does not necessarily protect someone permanently.
Shingles can occur more than once.
The CDC recommends Shingrix for eligible adults even if they previously had shingles.
There is no specific required waiting period after a previous episode, although vaccination should not be given during an active shingles outbreak. Generally, the rash should have resolved before vaccination.
“I Don’t Remember Having Chickenpox”
That is common and usually does not prevent vaccination.
According to the CDC, more than 99% of Americans born in 1980 or earlier have had chickenpox, even if they do not remember the illness.
Routine laboratory testing for previous chickenpox is not necessary before Shingrix vaccination for adults age 50 and older.
What About Vaccine Side Effects?
Shingrix produces a strong immune response, and temporary side effects are common.
They can include soreness, redness, or swelling at the injection site, along with fatigue, muscle aches, headache, chills, fever, nausea, or stomach discomfort.
These reactions generally improve within two or three days.
The CDC recommends completing the second dose even if temporary side effects occurred after the first dose, unless a healthcare professional identifies a medical reason not to continue.
Who Should Discuss Vaccination With a Healthcare Professional?
People who have experienced a severe allergic reaction to a previous dose or vaccine component should be medically evaluated before further vaccination.
Shingrix should not be administered during an active shingles episode.
People receiving immune-suppressing medications or undergoing certain medical treatments should also discuss the best timing with their healthcare provider.
Final Thoughts
Shingles is a remarkable example of how an infection from childhood can reappear decades later.
The chickenpox virus that may have caused only a few uncomfortable days when someone was young can reactivate at age 50, 60, or 70 and attack a nerve.
For many people, the illness resolves within several weeks. For others, nerve pain can continue long after the skin has healed.
Men over 50 who have not received the shingles vaccine should consider asking their physician or pharmacist about Shingrix.
And anyone who develops unexplained one-sided burning pain followed by a rash or blisters should seek medical attention promptly—especially when the face or eye is involved.
Sometimes the most effective way to treat a painful disease is to prevent it from beginning in the first place.