Can a person develop shingles (herpes zoster) more than once?

Can You Get Shingles Twice?

Yes, you can absolutely get shingles more than once, though recurrence is generally uncommon in people with healthy immune systems. 1

Understanding Shingles Recurrence

Shingles (herpes zoster) results from reactivation of the varicella-zoster virus (VZV) that remains dormant in your nerve ganglia after you've had chickenpox. 2, 3 There is no defined maximum number of times a person can develop shingles—each episode represents a separate reactivation of the latent virus from your dorsal root or trigeminal ganglia. 1

Who Is at Higher Risk for Recurrence?

The likelihood of getting shingles multiple times depends heavily on your immune status:

Immunocompetent individuals (healthy immune systems):

• Recurrence is generally uncommon 1
• Overall lifetime risk of shingles is approximately 30%, with up to 50% of those aged 80 years or older experiencing at least one episode 2

Immunocompromised patients face significantly higher recurrence risk, including: 1

• HIV-infected individuals
• Cancer patients, especially those on chemotherapy
• Organ transplant recipients
• Patients on chronic immunosuppressive medications (biologics, high-dose corticosteroids >40 mg prednisone daily, JAK inhibitors)
• Patients with diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, or inflammatory bowel disease 4

Prevention Strategies After Your First Episode

Vaccination: The Most Effective Prevention

The recombinant zoster vaccine (Shingrix) is strongly recommended for all adults aged 50 years and older, regardless of whether you've already had shingles. 1 This vaccine:

• Provides over 90% efficacy in preventing future shingles episodes 5
• Should be administered after recovery from your current episode 5
• Requires a two-dose series for optimal protection 5
• Is superior to the older live attenuated vaccine (Zostavax) 6

Critical timing: If you're on B-cell depleting therapies (like ocrelizumab or rituximab), the vaccine should be given at least 4 weeks prior to your next scheduled dose to maximize effectiveness. 5

Antiviral Suppressive Therapy for Frequent Recurrences

If you experience frequent or severe recurrences, daily suppressive therapy may be warranted: 1

Dosing options:

• Acyclovir: 400 mg orally twice daily (documented safe for up to 6 years of continuous use) 1
• Valacyclovir: 250 mg twice daily, 500 mg once daily, or 1,000 mg once daily (documented safe for up to 1 year) 1
• Famciclovir: 250 mg orally twice daily (documented safe for up to 1 year) 1

Important consideration: Reassess the need for continued suppressive therapy after 1 year to determine if recurrence rates have decreased. 1

Common Pitfalls to Avoid

• Don't assume one episode provides immunity—unlike chickenpox, having shingles once does not prevent future episodes 1
• Don't skip vaccination after recovering from shingles—the vaccine significantly reduces your risk of recurrence even if you've already had the disease 5, 1
• Don't use inadequate dosing for suppressive therapy if you have very frequent recurrences—ensure proper dosing as outlined above 1
• Don't confuse shingles recurrence with herpes simplex virus (HSV)—the evidence provided about genital herpes recurrence 7 relates to a different virus entirely and does not apply to shingles

Special Populations

Pregnant women: There is no specific approach for preventing shingles recurrence during pregnancy, but varicella-zoster immune globulin (VZIG) is recommended within 96 hours after exposure to active VZV infection. 1

Acyclovir-resistant cases: For the rare patient with acyclovir-resistant recurrent shingles (more common in immunocompromised patients), intravenous foscarnet is the treatment of choice. 1