VZV, HSV, HPV — Oh My!

VZV, HSV, HPV — Oh My Indeed!

A point of confusion for many patients (because it is legitimately confusing) is the difference between VZV, HSV, and HPV viruses.  First, let’s clarify these acronyms.

VZV = Varicella Zoster Virus

HSV = Herpes Simplex Virus

HPV = Human Papillomavirus

So the reason it is confusing is because A) the acronyms sound somewhat similar, B) VZV and HSV are both part of the Herpes family of viruses (Herpesviridae), and C) VZV can cause a diagnosis called herpes zoster which has the word herpes in it. Herpes zoster is not caused by the Herpes Simplex Virus.

So let’s do a quick synopsis of each one.

VZV = Varicella Zoster Virus

Conditions it causes: Chickenpox, Herpes zoster – aka Shingles

Chickenpox is something most of us are familiar with (at least those of us old enough to remember having had it). These days, most kids are immunized to it in the US when they are young.  It is characterized by little blisters with some surrounding redness, along with fever and feeling tired.  For those who want a descriptive analogy of what the rash looks like, check out “dew drops on a rose petal.”

Herpes zoster, aka Shingles, is something that occurs most frequently in adulthood. Classically, it occurs on one side of the body, with the same little blisters which can be grouped together. It can be burning, stinging, painful or itchy.  There is a vaccine that is recommended for most people over 60 years of age since the risk of getting this rash is more frequent with increased age.  Shingles occurs because the varicella zoster virus reactivates.  After initial exposure, the virus lays dormant in the nerves and with some trigger or waning immunity, it can reactivate and cause shingles.

HSV = Herpes Simplex Virus

Conditions it causes: Cold sores/oral herpes/herpes labials/fever blisters, Genital herpes/Anogenital herpes, herpes simplex

There are two types of the herpes simplex virus – HSV1 and HSV2.  Generally, HSV1 favors the oral area and HSV2 favors the genital area.  That being said, either could be found in either place.  Herpes can also infect skin besides the oral area or the genital area.

Like the Varicella Zoster Virus, the herpes virus can reside in the nerves  after initial infection. Then, it can reactivate (e.g. during times of trauma, stress, decreased immunity or otherwise), and show up.  Like shingles, it also shows up with little blisters. These tend to be small clustered blisters.  More on herpes in a future post to follow.

HPV = Human Papillomavirus

Conditions it causes: Warts including warts on the skin and genitalia, can also cause cancer like cervical cancer, penile cancer, and other cancers

Most commonly, the HPV virus causes common warts. These could be on the hands, fingers, soles of feet, or other areas.  However, HPV viruses can also cause cancers in various areas including the anal canal, cervix, vulva and vagina in women and the anal canal or penis in men (thus the need for Pap smears, and the development and recommendation of the HPV vaccine).  There are many different strains of HPV, with some considered relatively benign strains (e.g. those commonly causing warts) and some considered higher risk strains (e.g. those responsible for HPV induced cancers).  Check out this link from the CDC for more info and more on HPV in a future post to follow.



Pain after shingles? Sounds like post-herpetic neuralgia

Resolving shingles/zoster/herpes zoster. Post-herpetic neuralgia is pain that lasts after the rash heals. Imagine courtesy of Wikipedia user Mariegriffiths.

Post-herpetic neuralgia refers to the pain that follows the shingles (aka zoster or herpes zoster) outbreak. Even after the rash subsides, you can be left with pain. The pain can be burning, deep, aching or shooting and cutting. Some individuals will also feel pain when the area is touched.

Post-herpetic neuralgia is more common in older individuals and the pain in these individuals can last for a while — even more than a year.

What treatments can help post-herpetic neuralgia? Early on in the outbreak, oral antiviral agents are helpful in decreasing the duration and severity of the shingles outbreak. Pain control can be achieved by the usual pain medications such as acetaminophen (Tylenol), NSAIDS (e.g. Motrin) or even stronger pain medications such as those with opiates (e.g. oxycodone, codeine, Percocet, etc.) Short term relief can be achieved with topical anesthetic such as lidocaine patches, gel or cream or with topical capsaicin (a compound from peppers). Some oral medications that may be helpful also include gabapentin (aka Neurontin), amitriptyline, nortriptyline or desipramine. Botox (botulinum toxin) injections have also been noted to help with the pain in a few cases.

What is shingles? (aka zoster or herpes zoster)

Shingles of the chest. Shingles is also known as zoster or herpes zoster. Blisters and a painful red rash are present. Courtesy of wikipedia use Fisle.

Shingles is also known as zoster or herpes zoster. It is caused by a virus called the Varicella Zoster Virus (VZV) — the same virus that causes chicken pox. The name “herpes zoster” is sometimes confusing because people usually think of the Herpes Simplex Virus (HSV) which causes genital herpes, oral herpes, etc. when they hear of herpes. However, both the Herpes Simplex Virus (HSV) and the Varicella Zoster Virus (VZV) belong to the herpes family of viruses. So just a bit of confusing terminology and names.

Why does shingles occur? After prior chicken pox or vaccination, VZV virus stays in your cells. Often with increasing age or when your immune system is down, the virus can reassert itself. That’s why singles is more common in older individuals and in those with a weak immune system (such as in HIV patients).

What does shingles look like? Individuals can actually feel tingling, numbness or pain before the rash even starts. The rash then manifests as red patches or bumps which then develop blisters. The blisters can then pop and crust over. Because the virus travels from nerve roots, the rash will often be in a localized area of just one half of your body (called a dermatome). Shingles can be quite painful and the pain can last even after the rash subsides (aka postherpetic neuralgia).

Is shingles contagious? As long as your blisters remain, you are contagious and you will “shed” the VZV virus. Stay away from older individuals, newborns and young babies, and those with weakened immune systems (patients getting chemotherapy, HIV patients, individuals taking medications that suppress the immune system, etc.) Because the blisters contain virus, don’t pop them or scratch them and spread the virus to other areas.

Is shingles serious? What are some complications? See your doctor if you are concerned you may have shingles. Shingles involving the eye can lead to blindness. Shingles involving the bones around your mouth can lead to destruction of those bones and cause you to lose teeth. Shingles can also affect the ear causing deafness. One important complication is called postherpetic neuralgia where pain lasts after the rash disappears. More on this on a separate post.

What is the treatment for shingles? There are medications that fight the virus. Some that are often used are acyclovir, valacyclovir or famciclovir. They can decrease the length of time you have shingles and can decrease the severity of your outbreak.