Can You Get Shingles More Than Once?

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Shingles is a severe skin rash caused by the herpes zoster virus, which also causes chickenpox. Those affected typically only experience the condition once (like chickenpox). However, in rare cases, shingles recurs.

Estimates vary as to how common recurrence is. Some populations, including those that are immunocompromised, are more prone to it. One wide-ranging study found that as many as 5% of those who experience the condition develop it again within eight years.

Clearly, it’s worth looking at why this happens, what the risk factors are, as well as how to prevent shingles relapse.   

shingles virus

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Why It Recurs

To understand why shingles can flare up again after remission, it’s important to understand how this disease works. Basically, when you first get infected by the herpes zoster virus, you have chickenpox; however, the virus is still present even after this disease resolves.

Shingles, and all subsequent relapses, are essentially a reactivation of virus already present in the body. Treatment and the body’s own immunity typically succeed in managing the condition and stopping issues from cropping up again. However, having had shingles is no guarantee that you won’t have it again. There’s always a risk of relapse.

How Long Between Shingles Attack and Recurrence?

The time between an initial shingles case and its relapse can vary a great deal, and there is no established figure. However, researchers have noted most of these flare-ups arise in the four- to eight-year window following an initial attack. Recurrence within three years is much rarer.

Factors such as overall health status and the presence of other diseases can spur attacks, and there are preventative medications and approaches.

Risk Factors

Having shingles more than once is comparatively rare, although some people are at a greater risk of relapse. The chances directly relate to the overall state of the immune system, with those who are immunocompromised especially prone to relapse.

The following have been identified as specific recurrence risk factors:

  • Age: Patients over 50 tend to have weaker immune systems and are at higher risk of relapse.
  • Sex: Women are more likely to experience a relapse of shingles, accounting for about 60% of cases.
  • Immunosuppressive therapies: Immune health can become suppressed by certain drugs, especially chemotherapy drugs (such as Adriamycin [doxorubicin], Ellence [epirubicin], Taxol [paclitaxel], and others), prednisone, and Adoport (tacrolimus), among others.  
  • Cancers: The presence of solid cancer, cancer in the blood, as well as radiation treatment, can also significantly impact the immune system.
  • Autoimmune diseases: These diseases specifically affect immune function and include HIV/AIDS and systemic lupus erythematosus (commonly known as “lupus”), among others.
  • Chronic conditions: Persistent diseases and states—such as diabetes, hypertension (high blood pressure), chronic obstructive pulmonary disease (COPD), and hypothyroidism—are associated with recurrence.
  • Anxiety and stress: Mental conditions such as anxiety and depression are also associated with onset and relapse of shingles.
  • Increased pain: Higher levels of pain due to initial cases of shingles are correlated with higher chances of the condition returning.

Symptoms

Initial cases of shingles arise as painful rashes that scab over within seven to 10 days, with most cases clearing up entirely within two to four weeks. These attacks are characterized by:

  • Rash (usually a single stripe on one side of the body or face)
  • Itchiness, pain, and discomfort on the rash
  • Fever
  • Headache
  • Chills
  • Indigestion

Relapses are similar—arising first as a rash and then scabbing over and blistering—and are particularly characterized by pain as inflammation spreads to the skin and nerves. Notably, one in 10 adult shingle cases—whether initial or a relapse—lead to long-term pain even after the attack resolves, a condition called post-herpetic neuralgia.

Are there differences between episodes? Recurrences lead to the same class of symptoms, however the specific location of the rash will be different. Notably, too, blistering associated with relapse can make skin particularly sensitive and painful to the touch.

Is Treating Relapse the Same?

The approaches to treating shingles and any relapse are the same. In the latter case, healthcare providers may become particularly interested in isolating the cause of the weakened immunity that’s causing the recurrence. That said, there is no outright cure for this disease, so treatment focuses on managing symptoms.

These approaches include:

  • Antiviral medications, such as Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir), can help, especially if given within 72 hours of symptom onset.
  • Over-the-counter drugs like Tylenol (acetaminophen) or Motrin or Advil (ibuprofen) can also help manage discomfort and pain.
  • Compresses and creams are among other approaches that help relieve itching; these include applying wet compresses, using calamine lotion, and taking colloidal oatmeal baths.

Prevention

What can you do to prevent shingles from relapsing? The approaches here can be broken into self-care to boost immunity, and taking a vaccine. Here’s a quick breakdown of some methods of the former:

  • Get good sleep: Keep regular hours when you’re in bed—even on weekends—and aim for seven to nine hours of rest a night.
  • De-stress: Since anxiety and stress can trigger attacks, managing these can be very beneficial. Regular meditation, yoga, or even light exercise can help.
  • Healthy habits: Among the many benefits of eating well, getting regular exercise, and avoiding smoking is that these habits help prevent shingles.

Along with the above, vaccination is an option to prevent shingles relapse. In the United States, the primary approach is Shingrix (recombinant zoster vaccine). This two-dose treatment—injected into the upper arm between two and six months apart—is 90% effective in preventing relapse and is recommended for all adults above 50.

Until recently, an older option, Zostavax, was recommended for seniors to vaccinate against shingles. However, this medication is significantly less effective than Shingrix and, as of November 2020, has been discontinued in the United States.

A Word From Verywell

While there are effective means of preventing and managing shingles—and while an overwhelming majority of those who experience it only do so once—it’s always a good idea to be vigilant and mindful of this infection. While it can be tempting to believe that you’re in the clear if you’ve already had it, this is simply not the case.

An awareness of what can lead to a recurrence of shingles, as well as what can be done about it, will help prepare you for this possibility. If you suspect that this condition is coming back, don’t hesitate to reach out to your healthcare provider for help. The more proactive you are about your health, the better off you’ll be.

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Article Sources
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