Herpes Zoster A005

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Last amended
25 June 2015

In this section

Rulebase for herpes zoster

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:

Chicken pox

Cold sores

Genital herpes

Herpes simplex I or II

Varicella

[Other SOP for that condition]

Chicken pox
Herpes simplex
Herpes simplex
Herpes simplex

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