This article is more than 5 years old. Information may no longer be current.

Recurrent herpes zoster associated with milder symptoms vs. primary herpes zoster

Patients with recurrent herpes zoster exhibited milder clinical symptoms than patients with primary herpes zoster, most likely due to stronger varicella-zoster virus–specific cell-mediated immunity among patients with recurrence, according to study results.

“After infection occurs, [varicella-zoster virus] remains latent in the sensory nerve ganglia throughout the lifetime of the host, with reactivation caused by impairment of immunity, aging, or stress resulting in herpes zoster (HZ),” Yuki Nakamura, MD, of the dermatology department of Nara Medical University School of Medicine, Nara, Japan, and colleagues wrote. “Although the plausibility, actual occurrence, and frequency of recurrent HZ have been debated, there have been few large scale studies examining recurrent HZ.”

The researchers analyzed data obtained from a large-scale community- based prospective cohort study on HZ, including 12,522 participants aged 50 years or older in Shozu County, Japan over the follow-up period of 3 years. They compared the characteristics of recurrent HZ with primary HZ, such as incidence of postherpetic neuralgia, severity of skin lesions and acute pain, cell-mediated immunity, and varicella-zoster virus–specific antibody titer.

Of the total participants, 401 developed HZ with 341 having primary HZ and 60 having recurrent HZ. In patients aged 50 to 79 years with recurrent HZ, acute pain and skin lesions were notably milder and the incidence of postherpetic neuralgia was lower than those with primary HZ.  Nakamura and colleagues found that varicella-zoster virus skin testing produced a greater reaction in those aged 50 to 79 years with recurrent HZ compared with patients with primary HZ.

“Because the risk of HZ increases as the population ages and the proportion of elderly persons in the population is continuously increasing in Japan, the incidence of recurrent and primary HZ are expected to rise substantially in the future,” Nakamura and colleagues wrote. “Identification of factors associated with recurrent HZ is required to allow the implementation of preventive measures.”– by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.