Vulvar Shingles: Symptoms, Treatment, And Prevention

Content

• Overview
• What are vulvar shingles?
• Symptoms of vulvar shingles
• Complications
• Vulvar shingles treatment
• Are vulvar shingles contagious?
• Preventing vulvar shingles
• The lowdown
• FAQs

Shingles are a medical condition caused by the varicella-zoster virus, the same virus that causes chickenpox. Usually, it manifests as a rash on different body parts. While the most common place for the rash is at the waistline, it can also develop on your face, eyes, and genitals.

Around 1.5 million¹ American women will develop vulvar shingles in their lifetime. While rare, this condition can be extremely painful and uncomfortable. While there isn’t a cure for vulvar shingles yet, it’s possible to manage the symptoms during the outbreak.

Let’s take a closer look at vulvar shingles symptoms and treatment.

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Vulvar shingle is a condition caused by the varicella-zoster virus. This virus enters the system when a person gets chickenpox and stays there for many years. In most cases, the immune system manages to suppress the virus. However, sometimes, it reactivates.

The longer the virus stays dormant, the more likely it is to break out. That’s why shingles often appear in older people.  While reactivation usually happens when the immune system isn’t in its top shape, some young and healthy people face it.

Shingles in the vaginal area have the same symptoms as shingles in any other place. However, the location makes it extra uncomfortable.

It’s important to speak to a doctor as soon as you notice the first signs of vulvar shingles. Timely treatment can help contain the outbreak and reduce unpleasant symptoms.

Vulvar shingles symptoms are the same as for other types of shingles. The only difference is the location of the rash. These include:

• Blisters filled with fluid

• Pain in the genital area

• Tingling and itching

• Numbness of the skin

• Chills and fever

• Headaches

• Upset stomach

Before the rash appears, you can experience pain, burning, and tingling sensation in the vulva area. In a few days, a rash will appear. Some people report an “electrical sensation” in the place of the would-be rash.

Once the blistering rash develops, the pain continues. Sometimes, the rash can be so painful that it’s impossible to touch it, even to put on topical cream. In a few weeks (usually between two and four), the rash dries, crusts, and heals.

During the outbreak, blisters can break and bleed. At this point, there is a risk of secondary infection. It’s imperative to get medical attention and have the doctor monitor your condition.

A common complication of shingles is postherpetic neuralgia (PHN). When the rash is gone, the place where it used to be can continue hurting.

In some cases, the pain, tingling, and burning come and go. In others, it’s constant. Some people live with PHN for months or even years. A doctor can help you manage the symptoms to improve your quality of life.

PHN treatment can include anticonvulsants, antidepressants, topical pain relievers, nerve blocks, spinal cord stimulation, and more. The earlier you start managing PHN, the easier it is to control.

To improve your chances of avoiding PHN, you must start treating vulvar shingles within three days of developing a rash.

To diagnose vulvar shingles, your doctor will:

Since shingles rashes have unique characteristics, they are easy to diagnose. However, in complex cases, a doctor may run a shingles test. It involves taking a rash sample with a swab and sending it to the lab for confirmation.

Once you have a diagnosis, the doctor can decide on the course of treatment. It can include:

• Antiviral medication: This therapy is usually reserved for people who are over 60 or have immune system issues. This medication is the most effective when taken at the early stages of the condition.

• Calamine lotion: The American Academy of Dermatology Association recommends using calamine lotion on shingles because it soothes the pain and itching.

• Topical lidocaine: Some doctors may prescribe topical lidocaine if vulvar shingles cause painful urination.

• Pain relievers: You can take over-the-counter medication to relieve pain during the shingles outbreak. The doctor may also prescribe other pain relievers.

The course of treatment for vulvar shingles may depend on many factors, including your age, the duration of the condition, and the extent of your symptoms. The treatment aims to reduce unpleasant symptoms and allow the condition to play out without complications.

Since the official name of shingles is herpes zoster, many people worry that it’s just as contagious as herpes. However, these are two different viruses. Vulvar shingles can’t pass from person to person even if you have sexual contact during the outbreak.

You can only contract vulvar shingles from another person if you’ve never had chickenpox and come into direct contact with an open blister. If you’ve had chickenpox before, you can’t contract shingles from another person.

Keep in mind that open blisters are a gateway for infection. So, if you have shingles in the vaginal area, it’s important to keep it clean. This may include abstaining from sexual contact until the blister heals.

Today, it’s possible to prevent vulvar shingles by getting vaccinated.

Chickenpox vaccine

If you haven’t had chickenpox before, your doctor may recommend getting vaccinated. While the best time to get the chickenpox vaccine is during childhood, adults can also benefit from it.

Vaccination can prevent the varicella-zoster virus from entering your body, thus minimizing your chance of getting shingles.

Shingles vaccine

The CDC² recommends all adults over 50 years of age get the shingles vaccine. You can get vaccinated earlier if you are older than 19 but have a weakened immune system. Besides offering strong protection against shingles, the vaccine can also prevent PHN.

The vaccine called Shingrix is over 90% effective against shingles. The effect lasts for at least seven years after vaccination.

Speak to your doctor about vaccination options that suit your individual medical history.

Vulvar shingle is a rare condition that causes pain and discomfort in the vaginal area. While there isn’t a cure yet, it’s possible to manage the symptoms and reduce the discomfort, especially if you start treatment early.

If you have vulvar shingles symptoms, contact your doctor as soon as possible. The faster you begin therapy, the easier it will be to contain the outbreak and prevent complications.

Can you get shingles in your vaginal area?

Yes, the condition is called vulvar shingles. The shingles rash appears in the vaginal area and causes pain and discomfort. Treatment options are the same as for regular shingles.

Can shingles cause vulvar pain?

Yes, you develop a rash in your vaginal area during a vulvar shingles outbreak. This rash can cause pain, tingling, and itching.

How do you treat vulvar shingles?

While you can’t cure vulvar shingles, you can control the symptoms and wait for the outbreak to subside. The treatment can include antiviral medication, topical pain relievers, over-the-counter pain relievers, and calamine lotion.

An Unusual Presentation of Herpes Zoster

• Journal List
• Kans J Med
• v.13; 2020
• PMC7006832

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Kans J Med. 2020; 13: 19–20.

Published online 2020 Jan 31.

, M.D.,¹, M.D.,², ARNP,³ and , M.D.³

Author information Article notes Copyright and License information Disclaimer

Herpes zoster, commonly known as shingles, occurs after a primary infection from the varicella zoster virus. 1 This virus remains latent in the ganglionic neurons derived from neural crest cells. During states of decreased cell-mediated immunity in the elderly and immunocompromised, the varicella zoster virus reactivates and travels along nerve fibers peripherally.2 This results in a painful vesicular rash, usually involving a single dermatome that does not cross the midline.3

Should herpes zoster present in unusual locations such as the genitals, it can be challenging to diagnose which can lead to a delay in treatment and complications. The most common complication of herpes zoster is post-herpetic neuralgia.4 Post-herpetic neuralgia is a debilitating complication because it is difficult to treat and is responsible for a large burden of the disease.5

Treatment of herpes zoster involves pain management and healing of the lesion. Antivirals (famciclovir, 500 mg orally 3 times daily or valacyclovir, 1 g 3 times daily for 7 – 10 days) speed up healing of the rash.6 Pregabalin (150 to 300 mg/day) typically is started and titrated (up to 600 mg/day) to relieve the pain of postherpetic neuralgia.

Our case highlighted how herpes zoster should remain on the differential diagnosis for elderly patients presenting with a new onset lesion of the genitals. Early diagnosis and treatment can speed recovery and prevent complications.

A 59-year-old male with no history of medical or medication related immunosuppression presented to the clinic with itching and burning around the head of his penis for the past few days. He was in a monogamous relationship with no exposure to sexually transmitted diseases. He denied urethral discharge, dysuria, hematuria, or tenderness. Vital signs were within normal limits. On physical exam, there was redness at the urethral opening without any skin lesions. The patient was diagnosed with balanitis and started on clotrimazol topical cream. He was directed to come back if his symptoms progressed.

Three days later, the patient returned with worsening discomfort around the site of presentation. He complained of severe sharp pain at his shaft and noticed new red spots on the head of his penis. Physical exam showed a tender glans and shaft of the penis with newly noticed few red vesicles at the left aspect of the glans penis.

HSV 1, HSV 2, and varicella-zoster titers were drawn. HSV 1 antibody titers were positive at 26.2. HSV 2 antibody titers were negative at 0.54. Varicella-zoster virus antibody IgM was positive at 1.24 ISR.

The patient was prescribed valacyclovir and gabapentin and asked to follow-up in one week. Upon follow-up, the patient described an improvement of his rash and pain. On physical exam, the left side of his glans penis appeared to be healing with a slight ulceration. He was to take acetaminophen as needed.

Herpes zoster is a common medical condition with a lifetime risk of developing the condition between 25% and 30%.7 This risk increases to 50% in those individuals 80 years and older. This age-related increased incidence of herpes zoster is thought to be due to decreased cell-mediated immunity. Individuals that are immunocompromised due to HIV or drug therapy are also at an increased risk. 8

Birch et al.9 evaluated specimens obtained from the genital lesions of adults presenting with presumed genital herpes infection. They discovered that about 3% of the herpes simplex virus positive specimens also were positive for varicella virus. It is possible that genital herpes zoster is underdiagnosed because of the atypical location of the rash.

When patients present with vesicular lesions of the genitals, most clinicians include herpes simplex virus on the differential diagnosis. Herpes simplex virus is a sexually transmitted disease caused by HSV-1 or HSV-2 that manifests as vesicles on the genitals, perineum, perianal, and buttocks during an outbreak.10 The classic presentation during primary infection is malaise, fever, or localized adenopathy; however, these symptoms are absent most of the time.11 Clinicians also include other infectious (e.g., herpes simplex virus, herpes zoster, syphilis, and chancroid) and noninfectious (e.g., Bechet’s syndrome, fixed drug eruption, psoriasis, and sexual trauma) causes of genital lesions on their differential diagnosis. 12

Diagnosing herpes zoster can be difficult when presenting in unusual areas, such as the genitals. It can be difficult to distinguish genital herpes zoster from other genital lesions due to varying clinical presentation or possible co-infection. Our case highlighted how herpes zoster should remain on the differential diagnosis for elderly patients presenting with a new onset lesion of the genitals. Early diagnosis and treatment can speed recovery and prevent complications.

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Articles from Kansas Journal of Medicine are provided here courtesy of University of Kansas Medical Center

Lichen sclerosus of the vulva | Ida-Tallinna Keskaigla

This information sheet provides an overview of what vulvar sclerosus is, what causes it and what options are available for its treatment. It also provides advice on how best to cope with the disease.

What is lichen sclerosus?

Lichen sclerosus is a progressive, chronic, benign disease of the skin and mucous membranes that most commonly affects the genital area (85–98% of cases), but can be observed in other parts of the body (15% of cases). Usually this disease develops before or during menopause, but can occur even in children. The frequency of cases of the disease is not exactly known. On average, it occurs in 1 in 59 women who see a gynecologist and in 300 out of 1,000 women who see a dermatologist. Lichen sclerosus causes a change in the epithelium (surface cells) of the skin and mucous membranes – the structure of the epithelium changes, the skin and mucous membranes become thinner (but sometimes vice versa – the mucous membranes thicken or hypertrophy), local inflammation appears. The vagina is not affected.

What causes the development of the disease?

The cause of lichen sclerosus is unknown. The disease is associated with various mechanisms, but none of them has received final confirmation, for example:

• Genetic factors – the disease is more common in close relatives.
• Immunological factors – disorders in the immune system that cause autoimmune reactions from the skin and mucous membranes (autoimmune diseases occur when the body’s defense cells and proteins begin to destroy their own body cells and thus interfere with their normal function). The disease is more common in women with other autoimmune diseases – lupus, thyroid disease, vitiligo, diabetes, etc.
• Hormonal factors – low levels of estrogens (female sex hormones).

• Local processes in the skin – dysregulation of markers that affect the normal development of skin cells.
• Infection – the disease has been associated with various bacteria and viruses, but no study has shown a clear relationship.

What are the symptoms, complaints and effects?

• The most common complaints are itching, burning, dryness, pain in the vulva, perineum, and sometimes around the anus. If the skin around the anus is also affected, the patient may feel pain during bowel movements.
• Skin becomes white and pale. Lesions may be focal or involve the entire vulva and around the anus.
• Violet-red spots on a white background, erosion and ulceration may be observed, often due to scratching of the skin.
• The disease causes scarring in the vulva, as a result of which they can be deformed – the labia minora may disappear (combined with the large ones) or the entrance to the vagina may narrow.
• Sexual dysfunction – pain during sex, psychological problems.
• Urinary disorders (soreness).
• In 10% of women with lichen sclerosus, white spots are noted in the vulva and on other parts of the body – for example, on the back, in the waist, under the mammary glands.
• In some women, there are no complaints at all, and the disease is diagnosed incidentally during the examination.

How is the disease diagnosed?

Diagnosis is usually made on the basis of characteristic findings on examination of the affected skin. Sometimes, to confirm the diagnosis, it is required to take a sample of from of the skin or mucous membrane for a biopsy – the area is anesthetized and a piece of tissue is taken, which is then examined under a microscope. A biopsy is a simple procedure that can be performed on an outpatient basis in a doctor’s office. A biopsy is indicated when the diagnosis is unclear, initial therapy fails, or a tumor is suspected.

What are the options for treatment?

All women with lichen sclerosus need treatment (even if they don’t complain). It is important to understand that this is a chronic disease, which, as a rule, cannot be completely cured. However, medication can successfully keep his symptoms under control. The goal of treatment is to eliminate itching and pain, and to reverse skin changes. Drugs do not affect the already formed scar tissue. When treatment is interrupted, the disease usually worsens, and itching, burning and skin changes appear again.

The most effective and preferred treatment is an ointment or cream containing glucocorticosteroids, in rare cases intradermal injections. At the initial stage of therapy, the affected area is lubricated 1-2 times a day for 1-3 months; then the medicine will need to be used 1-2 times a week. The exact scheme of therapy will be determined by your attending physician according to the severity of your disease.

The drug is applied in a thin layer; usually, to lubricate the skin and mucous membranes in the vulva, it is enough to squeeze a small amount of ointment / cream onto the finger.

In addition to the glucocorticosteroid preparation, you can also use:

• topical cream or vaginal tablets containing estrogen (female sex hormone), especially if dryness in the vulva and vagina is a problem during menopause and causes pain in the sex time;

• softening and moisturizing ointments, oils.

All bacterial and fungal infections of the vulva require treatment.

Surgical treatment is required in rare cases – mainly only in the presence of uncomfortable scars and adhesions.

Requirements for hygiene in the vulvar area

In addition to the use of medicines, regular and correct hygiene is very important. Any skin irritation should be avoided.

• For washing use odorless and non-irritating intimate wash gels.
• Do not use deodorizing soap.
• Avoid prolonged contact with detergents. When taking a bath or shower, they should be used last.
• Cotton underwear should be worn and sleep without any underwear at night.
• When washing, use detergents for sensitive skin. Do not use fabric softeners.
• For pain during sex, use a natural lubricant.

ITK883
This informational material was approved by the Women’s Clinic on 01/01/2023.

Treatment of herpes zoster in Odessa — infectology ON Clinic Odessa

Herpes zoster or herpes is an infectious disease that affects the skin. The causative agent of pathology is the varicella-zoster virus.

Shingles symptoms

The incubation period (time from infection to onset of symptoms) for shingles is about 10-20 days. Shingles begins with headache, fatigue, tingling, or pain in the affected area of ​​the skin. Other symptoms of shingles:

• fever;
• muscle weakness;
• rash in the form of red-pink vesicles (vesicles) filled with fluid.

Shingles rash can occur on the face, back, chest, abdomen, and genitals. Vesicles appear on only one side of the body and are accompanied by itching.

The negative effects of herpes zoster include postherpetic neuralgia (prolonged pain that persists after the rash disappears), loss of vision or hearing, and encephalitis (inflammation of the brain tissue). To prevent the development of complications, it is necessary to make an appointment with an infectious disease specialist.

Causes of shingles

After a person has been ill with chicken pox (chickenpox), the virus becomes inactive and remains in the nerve plexuses for a long time. The reasons for the reactivation of the virus and the occurrence of shingles may be a decrease in immunity, hypothermia, severe stress.

A person with shingles is contagious and can infect people who have not had chickenpox. Infection occurs by airborne droplets when sneezing or coughing.

Treatment of herpes zoster in Odessa

To diagnose herpes zoster, an infectious disease specialist takes an anamnesis and conducts an examination. Treatment for shingles depends on the severity of the symptoms.

Treatment of herpes includes the use of antiviral drugs. In order to anesthetize and reduce itching with herpes zoster, the doctor prescribes antihistamines (anti-allergic) and non-steroidal anti-inflammatory drugs. In the treatment of shingles in the elderly, immunomodulators are also used (regulate the functioning of the immune system).

In order to quickly cure shingles, you must follow the rules of personal hygiene and follow all the doctor’s recommendations.