Herpes Zoster (Shingles)
Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using. Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficienc
Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.
Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026
B20.3 + (B02.0-3/B02.7-9)
DESCRIPTION
Painful vesicular rash in a dermatomal distribution, usually presenting as a band on one side of the body, due to recrudescence of the varicella-zoster virus that causes chickenpox. The surrounding skin is inflamed and the vesicles often contain cloudy fluid
Secondary bacterial infection is very uncommon.
The elderly and PLHIV are most affected.
Severe pain can occur after shingles has healed (post-herpetic neuralgia).
Shingles is less infectious than varicella (chickenpox) and isolation is not warranted.
MEDICINE TREATMENT
If fresh vesicles are present:
- Antiviral (active against herpes zoster) e.g.:
- Aciclovir, oral, 800 mg five times daily for 7 days (4 hourly missing the middle of the night dose).
LoE:IIa43
If secondary infection is present:
ADD
- Flucloxacillin, oral, 500 mg 6 hourly for 5 days.
Pain:
- Paracetamol, oral, 500 mg-1 g, 4–6 hourly as required (maximum of 4g in 24 hours)
- Maximum dose: 15 mg/kg/dose.
If inadequate pain relief:
ADD
- Tramadol, oral, 50 mg 6 hourly (Doctor prescribed).
For prolonged pain occurring after shingles has healed (post-herpetic neuralgia), or if pain not responding to paracetamol and tramadol:
- Amitriptyline, oral, 25 mg at night.
- Increase dose to 50 mg after two weeks if needed.
- Increase further to 75 mg after a further two weeks if needed.
REFERRAL
- Involvement of the eye.
- Disseminated disease (many vesicles extending beyond the main area).
- Features of meningitis (headache and neck stiffness).
- Severe post-herpetic neuralgia not responding to amitriptyline.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024
Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_11.3 Opportunistic Infections, Treatment in Adults_11.3.11 Herpes Zoster (Shingles)