What precautions should a non-immune husband take after having sexual intercourse with his wife who has a shingles rash?

Management of Shingles Exposure in Sexual Partners

The husband does not need any specific intervention unless he has never had chickenpox or is immunocompromised, in which case he should avoid direct contact with the wife's rash until all lesions have crusted over. 1

Understanding Transmission Risk

Shingles (herpes zoster) is caused by reactivation of varicella-zoster virus (VZV) from latent infection in dorsal root ganglia. 2, 3 The key distinction is that shingles itself is not transmitted person-to-person; however, the virus can be transmitted from active shingles lesions to cause chickenpox (varicella) in susceptible individuals who have never had chickenpox or the varicella vaccine. 2, 3

Critical Factors to Assess in the Husband:

• History of chickenpox or varicella vaccination - If positive, he has immunity and requires no intervention 4
• Immunocompromised status (HIV infection, immunosuppressive medications, chemotherapy, chronic high-dose corticosteroids) - These individuals remain at risk even with prior varicella history 5, 6
• Age and vaccination history - Over 95% of adults aged 50+ are seropositive for VZV 6

Management Algorithm for the Husband

If the Husband Has Prior Chickenpox History or Vaccination:

• No prophylaxis needed 4
• No activity restrictions required 4
• Sexual intercourse one day ago poses no retroactive risk since transmission requires direct contact with active vesicular lesions 2

If the Husband Has NO History of Chickenpox AND Is Susceptible:

• Avoid direct contact with the wife's rash until all lesions have completely crusted 1
• Varicella-zoster immunoglobulin (VZIG) or intravenous immunoglobulin should be administered within 96 hours of exposure if he is immunocompromised 1
• If more than 96 hours have passed or VZIG is unavailable, initiate oral acyclovir 7-10 days after exposure for a 7-day course 1
• Consider varicella vaccination if he is immunocompetent and has no contraindications 4

If the Husband Is Immunocompromised (HIV, Transplant, Chemotherapy):

• These individuals should avoid exposure to persons with chickenpox or shingles regardless of prior varicella history 4
• Post-exposure prophylaxis with VZIG within 96 hours is indicated 1
• If VZIG unavailable or >96 hours post-exposure, use acyclovir prophylaxis starting 7-10 days after exposure 1

Infection Control Measures for the Wife

The wife should cover her shingles rash and avoid contact with susceptible individuals until all lesions have crusted. 1 This is the critical endpoint - not an arbitrary time period. 1

Key Points About Viral Shedding:

• Viral shedding peaks in the first 24 hours after lesion onset when vesicles are present 1
• Transmission occurs through direct contact with vesicular fluid, not through respiratory droplets 2, 3
• Once all lesions have scabbed/crusted, the patient is no longer contagious 1

Common Pitfalls to Avoid

Do not confuse shingles transmission with chickenpox transmission. Shingles patients cannot give someone else shingles - they can only transmit VZV to cause primary varicella (chickenpox) in susceptible individuals. 2, 3

Do not assume all adults are immune. While most adults have had chickenpox, approximately 5% of adults aged 50+ remain seronegative. 6 If immunity status is uncertain and the husband is immunocompromised, serologic testing for VZV IgG should be considered. 4

Sexual intercourse itself does not increase transmission risk unless there was direct genital contact with the rash lesions. 2 The virus is not transmitted through semen, vaginal secretions, or saliva in the context of shingles (unlike HSV or CMV). 4

Prevention Considerations

The recombinant zoster vaccine (Shingrix) is recommended for all adults aged 50 years and older, regardless of prior herpes zoster episodes. 1 This applies to both the wife (after recovery) and the husband for future prevention. 1