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Herpes Zoster A005

Last amended 
25 June 2015

In this section

Current RMA Instruments:
Reasonable Hypothesis SOP
47 of 2015
Balance of Probabilities SOP
48 of 2015
Changes from Previous Instruments:

SOP Bulletin 181

ICD Coding:
  • ICD-9-CM: 053
  • ICD-10-AM: B02
Brief description:

Herpes zoster, also known as shingles, is a painful skin rash on one side of the body.  It is due to reactivation of latent Varicella-Zoster virus, which has been lying dormant in the nervous system following an earlier chicken pox infection.

Confirming the diagnosis:

Diagnosis is usually made on the clinical presentation.  The virus can be detected on testing of vesicle fluid or on serology.  The relevant medical specialist is an infectious diseases physician, but a specialist report will not generally be required.

Additional diagnoses covered by these SOPs:
  • Post herpetic neuralgia
  • Ramsay Hunt Syndrome
  • Shingles
  • Vaccine strain Herpes zoster
  • Zoster ophthalmicus
Conditions excluded from these SOPs:    [Other SOP for that condition]
  • Chicken pox    Chicken pox
  • Cold sores    Herpes simplex
  • Genital herpes    Herpes simplex
  • Herpes simplex I or II    Herpes simplex
  • Varicella    Chicken pox
Further notes and comments

Following a chickenpox infection, the varicella zoster virus remains latent in nerve cell bodies of the dorsal root, cranial nerve or autonomic ganglia.  Years or decades after the initial infection, the virus may reactivate and cause infection of the skin (or mucous membrane) in the region supplied by the nerve (a dermatome). The infection causes a painful rash with vesicles (small blisters). The rash usually heals within two to four weeks, but some sufferers may experience residual nerve pain for months or years (post herpetic neuralgia).  The infection can involve the face, mouth, eye or tongue.

Reactivation of the latent infection generally occurs when the immune system becomes compromised. Recurrent episodes of Herpes Zoster are rare except in immunosuppressed patients.