From the Guidelines
Herpes zoster and herpes simplex are distinct viral infections with different causative viruses, presentations, and management strategies, and the most effective way to prevent herpes zoster is through vaccination with the recombinant zoster vaccine (RZV), which is recommended for adults 50 years and older 1.
Key Differences
- Herpes simplex is caused by herpes simplex virus (HSV-1 or HSV-2), while herpes zoster is caused by the varicella-zoster virus (VZV) 1.
- Herpes simplex typically presents as recurrent, grouped vesicles on the lips (HSV-1) or genitals (HSV-2), while herpes zoster manifests as a painful, unilateral, dermatomal rash with vesicles that doesn't cross the midline of the body.
- Herpes simplex can recur frequently throughout life, whereas herpes zoster usually occurs once, though recurrences are possible, especially in immunocompromised individuals.
Treatment and Prevention
- Both herpes simplex and herpes zoster respond to antiviral medications like acyclovir, valacyclovir, or famciclovir, but dosing regimens differ 1.
- Herpes zoster can lead to postherpetic neuralgia, a painful complication that may require additional pain management with medications like gabapentin, pregabalin, or tricyclic antidepressants.
- The recombinant zoster vaccine (RZV) is the preferred vaccine for preventing herpes zoster and is recommended for adults 50 years and older, with a vaccine efficacy of 97.2% against herpes zoster and 88.8% against postherpetic neuralgia 1.
Vaccination Recommendations
- Immunocompetent adults 50 years and older should receive the RZV vaccine to prevent herpes zoster and postherpetic neuralgia, as it has been shown to be more effective than the live zoster vaccine (ZVL) 1.
- The RZV vaccine has been shown to have a persistence of protection for up to 8 years, with a vaccine efficacy of 83.3% against herpes zoster and 73% at 10 years 1.
From the FDA Drug Label
The efficacy of VALTREX for the treatment of herpes zoster in immunocompetent adults was demonstrated in two randomized, double-blind clinical trials. VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established. VALTREX is indicated for treatment of the initial episode of genital herpes in immunocompetent adults. VALTREX is indicated for treatment of recurrent episodes of genital herpes in immunocompetent adults.
Comparison of Herpes Simplex and Herpes Zoster:
- Herpes Simplex: VALTREX is indicated for the treatment of genital herpes in immunocompetent adults, including initial episodes and recurrent episodes.
- Herpes Zoster: VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
- Key differences: Herpes simplex typically presents with genital lesions, while herpes zoster presents with a rash and pain, often affecting one side of the body.
- Treatment initiation: For herpes simplex, treatment should be initiated within 24 hours of symptom onset, while for herpes zoster, treatment should be initiated within 72 hours of rash onset 2, 2.
From the Research
Comparison of Herpes Simplex and Herpes Zoster
- Herpes simplex and herpes zoster are two distinct viral infections caused by different strains of the herpes virus 3.
- Herpes simplex is characterized by genital herpes and herpes labialis, which are prevalent, physically and psychologically painful, and often disabling 3.
- Herpes zoster, also known as shingles, is caused by reactivation of varicella zoster virus, which causes chickenpox, and is often very painful and may result in months or years of postherpetic neuralgia (PHN) 3, 4, 5.
- The treatment of herpes simplex and herpes zoster has been transformed by guanosine nucleoside antivirals such as valacyclovir, which is highly effective in treating both conditions 3.
- Valacyclovir is more effective than acyclovir and equally effective as famciclovir at hastening the healing of zoster-associated pain and PHN 3.
- The diagnosis of herpes zoster relies on polymerase chain reaction as the preferred test, while treatment focuses on optimal use of antiviral therapy and analgesics 4.
- Prevention of herpes zoster emphasizes utilization of a new recombinant zoster vaccine, which reduces the incidence of herpes zoster by more than 90% 4.
- Postherpetic neuralgia is the most common complication of herpes zoster, occurring in about one in five patients, and treatment is focused on symptom control, including topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants 5.
- The combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduces the incidence of postherpetic neuralgia 6.
- The incidence of postherpetic neuralgia after combination treatment with gabapentin and valacyclovir in patients with acute herpes zoster is around 9.8% 6.