Shingles vs. Herpes: What’s the Difference?

Both genital herpes and shingles are conditions caused by viruses from the herpesvirus family. But they are caused by two separate viruses and are different conditions.

Genital herpes is caused by herpes simplex virus-1 (HSV-1) or herpes simplex virus-2 (HSV-2). Shingles is caused by the varicella-zoster virus (VZV). Shingles is also called herpes zoster. Both conditions are commonly found in the United States, and both can have similar-appearing rashes.

Over 500,000 new cases of genital herpes are recorded each year in the United States. It is estimated that 1 in 3 people will develop shingles during their lifetime, and there are about 1 million cases circulating in the United States each year.

This article will review the differences between genital herpes and shingles, the symptoms and treatments for each, and how each is diagnosed. 

Key Differences

The biggest difference between genital herpes and shingles is that the conditions are caused by different viruses. Genital herpes is most often caused by the HSV-2 virus, but can be caused by HSV-1 as well. Shingles is caused by the VZV virus. 

The areas of the body that can be affected by a genital herpes infection include the genitals, buttocks, rectal area, and thighs. Once the virus has entered your body, it can cause outbreaks of rashes and lesions throughout the rest of your life. 

Shingles can affect the skin anywhere on the body but usually appears on only one side of the body and in a band. It often develops on the torso or face and only rarely in the genital area. Though the virus continues to remain in the body, most people do not get multiple shingles outbreaks.

Herpes

The HSV-1 and HSV-2 viruses are responsible for causing herpes infections. When the infection affects the mouth or lips, it is usually referred to as a cold sore and is often caused by HSV-1. Both viruses can cause genital herpes, but it is most often caused by HSV-2.

HSV viruses are passed through contact with a herpes sore, saliva, genital fluids, or skin contact with a partner who has oral or genital herpes (and may not have a visible sore).

Symptoms

Someone with genital herpes may have no symptoms or very mild symptoms that they don’t even notice. Symptoms of genital herpes can include:

• Blisters around the genitals or rectum
• Pain around the blisters
• Flu-like symptoms (with first outbreak)

Usually, the first outbreak is the worst and causes the most symptoms. As time goes on, outbreaks usually become less severe.

Treatment

Genital herpes can’t be cured. Once the virus has entered the body it can’t be removed. But it is treatable with daily antiviral medications such as Valtrex (valacyclovir) or Sitavig or Zovirax (acyclovir). These suppress the virus activity in the body, making it less likely to cause an outbreak or be spread to a partner.

If daily treatment is not wanted, someone with genital herpes can take those same medications for a short period of time during an outbreak. Taking it this way doesn’t keep an outbreak from happening but shortens an outbreak once it’s occurred.

Shingles

The virus that causes shingles, or herpes zoster, is the VZV virus. When the virus first enters the body, it produces chicken pox. It is spread not only through skin contact with fluid from the lesions but also by aerosols, and it's extremely contagious.

Following that infection, the virus remains in the body. Years to decades later, the virus can reactivate and cause shingles. Shingles also cannot be cured but can be prevented by vaccines.

Symptoms

Shingles outbreaks usually happen in a line, along the affected nerve, and only on one side of the body. In the days leading up to a shingles outbreak, the area affected may become painful or itchy. A few days later, small blisters may appear. These can be very painful and may feel like a burning sensation.

Over the next few days, these small blisters will begin to dry up and develop a crust over them before going away. The pain after the blisters go away can last for some time, usually months but even years. This is called postherpetic neuralgia. 

It is possible for shingles to become disseminated, affecting three or more areas (called dermatomes, areas of skin supplied by one spinal nerve). This is not common and is mostly found in people who have a weakened immune system.

Other symptoms of shingles are:

• Fever and/or chills
• Headache
• Nausea

Treatment

Shingles is treated with antiviral medications such as acyclovir or valacyclovir after it has started. The sooner the medication is begun after the rash appears, the more effective it will be. 

Other Possible Causes

Usually the location, symptoms, and appearance of the painful rash are enough for a healthcare provider to make a correct diagnosis of genital herpes or shingles. Although rare, a shingles outbreak could occur on the genitals, making it look like genital herpes. 

There could be other health conditions that may cause similar rashes and symptoms, but healthcare providers rarely confuse these with shingles or herpes, including:

• Impetigo (bacterial infection of the skin)
• Dermatitis (inflammation of the skin)
• Allergic reaction
• Insect bites or stings
• Folliculitis (inflammation of hair follicles)
• Erysipelas (bacterial skin infection)

Diagnosis

Often the diagnosis of either genital herpes or shingles is made after a healthcare provider performs an examination of the affected area and obtains a history of the symptoms. Additional tests may be needed to make an accurate diagnosis in some cases. 

Herpes

Genital herpes sometimes can be difficult to diagnose if the lesions have resolved before seeing a healthcare provider. If lesions are present, though, a sample can be removed. This will then be evaluated in a lab to determine the cause, as HSV-1 and HSV-2 genital herpes infections have different rates of outbreaks. 

There are also blood tests that can be done to check for antibodies to the virus. People may also be tested for human immunodeficiency virus (HIV) as well.

Shingles

The way the rash looks to the healthcare provider is usually the way shingles are diagnosed. There can be additional testing, if needed. Samples of the fluid from one of the blisters can be collected on a swab and checked to determine the cause. 

Blood tests may not be accurate in detecting an active shingles infection.

When to Talk to Your Healthcare Provider

If you have symptoms of either genital herpes or shingles, it is important to contact your healthcare provider right away. Both conditions can improve more quickly with early treatment. 

Summary

Although herpes and shingles both have similar-appearing rashes, the viruses that cause these conditions are different. They are both treatable but not curable. Herpes outbreaks can be treated with antiviral medications, or antiviral medications can be given daily to help prevent outbreaks from happening. 

Shingles is also treated with antiviral medications once the rash has developed. Shingrix vaccine is available to help prevent a shingles outbreak.

A Word From Verywell

If you suspect that you have herpes, do not be embarrassed to seek treatment as herpes is common in the United States. Also, there are medications available that can help you prevent outbreaks.

If you have symptoms of a painful, itchy, blistering rash any place on your body, it’s important to get that checked out quickly. There are treatments available that can help you feel better, and the sooner you start, the quicker you'll get relief.