Do herpes, shingles, and chickenpox, which come from the same herpesvirus family, have the same treatment?

Relationship and Treatment of Herpes, Shingles, and Chickenpox

Yes, herpes simplex virus (HSV), shingles (herpes zoster), and chickenpox (varicella) all belong to the herpesvirus family, but they are caused by different viruses and require different treatment approaches. 1, 2

Viral Classification

• Chickenpox and shingles are caused by the same virus: varicella-zoster virus (VZV), which is an alphaherpesvirus 2, 3
• Herpes simplex is caused by a different virus (HSV-1 or HSV-2), also an alphaherpesvirus, but distinct from VZV 1, 2
• Chickenpox represents the primary VZV infection, while shingles is the reactivation of latent VZV from dorsal root ganglia 4, 2

Treatment Differences

For Herpes Simplex Virus (HSV)

Acute episodes can be treated successfully without requiring chronic suppressive therapy in most cases. 1

• Oral acyclovir is the standard treatment for acute HSV episodes 1
• Daily suppressive therapy with oral acyclovir is reserved only for patients with frequent or severe recurrences 1
• Intravenous foscarnet or cidofovir is used for acyclovir-resistant HSV isolates 1

For Chickenpox (Primary VZV Infection)

Oral acyclovir is indicated for treatment of chickenpox (varicella). 5

• Treatment is most effective when initiated early in the disease course 2
• Varicella-zoster immune globulin (VZIG) should be administered within 96 hours after exposure for prophylaxis in susceptible high-risk individuals 1

For Shingles (Herpes Zoster)

Oral acyclovir, valacyclovir, or famciclovir should be initiated within 72 hours of rash onset and continued until all lesions have scabbed. 6, 5, 4

• Standard dosing: Acyclovir 800 mg orally 5 times daily for 7-10 days, or valacyclovir 1000 mg three times daily, or famciclovir 500 mg three times daily 6, 4
• Treatment must continue until all lesions have completely scabbed, not just for an arbitrary 7-day period 6
• Intravenous acyclovir 10 mg/kg every 8 hours is required for disseminated or invasive herpes zoster, particularly in immunocompromised patients 6, 7

Key Treatment Distinctions

The dosing and duration differ significantly between HSV and VZV infections:

• HSV typically requires lower doses (acyclovir 400 mg for suppression) compared to shingles (800 mg five times daily) 1, 6
• Shingles requires treatment until complete lesion crusting, which may extend beyond the standard 7-10 day course in immunocompromised patients 6
• Topical antiviral therapy is substantially less effective than systemic therapy for both conditions and is not recommended 6

Common Pitfalls

• Do not use HSV dosing regimens for shingles - the 400 mg dose appropriate for genital herpes is inadequate for VZV infection 6
• Do not stop treatment at exactly 7 days if lesions are still forming or have not completely scabbed 6
• Immunocompromised patients with shingles may require intravenous therapy rather than oral treatment due to high risk of dissemination 6, 7
• Foscarnet 40 mg/kg IV every 8 hours is the treatment for acyclovir-resistant VZV, as all acyclovir-resistant strains are also resistant to valacyclovir and most to famciclovir 6