Internal Shingles: Symptoms, Causes, Risk Factors, Treatments, And Prevention

Shingles is a well-known painful infection that typically causes rashes and blisters on the skin. According to the CDC,¹ approximately one in three people in the US will develop shingles in their lifetime. About one million people in the US are diagnosed with shingles each year.

While its characteristic rash is the most common symptom, shingles is more than a skin condition and may cause symptoms affecting other parts of the body. A shingles infection affecting the internal parts of the body is called systematic or internal shingles. 

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What are internal shingles?

Internal shingles is a reactivation of the varicella-zoster virus without a rash. The varicella-zoster virus responsible for chickenpox remains in the body even after recovering from chickenpox. As the name implies, internal shingles affects parts of the body we can’t see. The condition is rare but can be life-threatening if left untreated. 

Symptoms of internal shingles 

Internal shingles symptoms depend on which bodily system and nerves are affected by the virus. The distinguishing factor between the primary type of shingles and internal shingles is that the rash isn’t present in internal shingles. 

People with internal shingles may experience general symptoms of shingles, including:

  • Pain or sensitivity in a specific area

  • General aches 

  • Chills

  • Swelling of the lymph nodes (proof that your immune system is fighting the virus)

  • Numbness and tingling

  • Fever

  • Fatigue

  • Headache

Causes of internal shingles

The varicella-zoster virus is responsible for shingles. Since this virus also causes chickenpox, it is present in most people from childhood. Once you get chickenpox, the varicella-zoster virus is with you for life. In some people, the virus never triggers a shingles outbreak.  

Unfortunately, doctors and medical experts don't understand why the virus reactivates in some people and not others, but poor immunity plays a role. A weakened immune system leading to viral reactivation can be linked to:

  • Emotional and physical stress

  • Advancing age

  • Conditions compromising one's immunity, such as HIV/AIDS

  • Treatments or medications suppressing the immune system

Risk factors for internal shingles

Anyone can get shingles (internal or other forms); however, some people face a significantly higher risk. Risk factors for internal shingles include:

  • Advancing age. People over 50 are more likely to develop shingles.

  • A weakened immune system due to illness or treatments that affect immunity, such as chemotherapy and medications used to reduce the risk of transplant rejection. 

  • Not getting vaccinated. The Shingrix vaccine effectively reduces the risk of developing shingles. 

Transmission of internal shingles

Shingles cannot be spread from one person to another. However, the virus responsible for shingles may cause chickenpox in someone who has never had the condition. 

The virus usually spreads through direct contact with the fluid from shingles blisters. So, if you have shingles blisters, you should keep them covered, wash your hands often, and take the appropriate precautions to ensure people who haven’t had chickenpox (or the chickenpox vaccine) don’t come in contact with the fluid from your blisters. 

Because internal shingles isn’t associated with a rash, it doesn’t spread through skin contact. However, there’s evidence² the virus may spread through infected respiratory droplets, but more research is needed to confirm.  

Complications associated with internal shingles

When shingles affects internal organs, it can lead to severe complications, including:

  • Blood vessel problems

  • Myelitis³ (inflammation of the spinal cord) 

  • Meningitis (inflammation of the membranes surrounding the brain and spinal cord)

  • Encephalitis⁴ (inflammation in the tissue surrounding the brain)

  • Pneumonia, if it spreads to the lungs

Additionally, any shingles infection can cause complications linked to nerve damage, including:

Postherpetic neuralgia 

Shingles infection travels along specific nerves. Once a shingles infection resolves, pain may persist in the nerves affected by the infection. Postherpetic neuralgia (PHN) is among the most common complications of shingles, affecting about 10 to 18%⁵ of people with the condition.

PHN can persist for years, and pain can be severe, leading to insomnia, anxiety, depression, and unintentional weight loss.

Ramsay Hunt syndrome

Ramsay Hunt syndrome⁶ is a rare complication of shingles that can result in balance or hearing challenges, dizziness, facial paralysis, or earaches. The rate of recovery depends on the severity of the symptoms. People who seek treatment early face a significantly lower risk of long-term complications.

Unfortunately, even with treatment, some people have lasting facial paralysis and hearing loss.

Vision loss and eye problems

The shingles virus can affect the nerves leading to the eyes, especially if a person has shingles near the eyes or nose. When shingles affect the eyes, doctors call it ophthalmic or ocular shingles. Possible complications include:

  • Vision problems

  • Pink eye

  • Uveitis (inflammation of the middle layer of the eye)

  • Scleritis (inflammation of the white part of the eye)

  • Increased intraocular pressure (fluid pressure inside the eye)

  • Temporary or permanent damage to the cornea (outer layer of the eye) 

A shingles rash around the eyes or nose should prompt an urgent visit to your doctor. Likewise, if you have internal shingles and notice signs of eye (or eyelid) irritation, see your doctor. They’ll refer you to an ophthalmologist (eye specialist) if necessary. 

Diagnosing internal shingles

Because the condition’s characteristic rash is not apparent in internal shingles, doctors rely on testing to confirm the presence of the virus.

If your doctor suspects you have internal shingles, they’ll use a polymerase chain reaction (PCR) saliva test to check for the presence of viral DNA. 

In some cases, additional testing may be necessary.

Treatment options for internal shingles

There’s no cure for shingles, but treatments accelerate recovery and reduce the risk of complications. Treatment options for shingles include:

Antiviral treatments

Antiviral medications, such as valacyclovir and acyclovir, are effective in treating internal shingles. 


In most cases, the pain associated with a shingles infection can be managed with over-the-counter painkillers. However, if the pain is severe, a doctor may prescribe something more potent.

At-home management

Home treatments for internal shingles will depend on your symptoms. General aches and fatigue are common, regardless of which part of the body the shingles virus attacks. Don’t underestimate the value of relaxation and good quality sleep. A warm compress or relaxing bath may help with body aches. 

Preventing internal shingles

The most effective way to prevent shingles and their associated complications is vaccination. The CDC recommends shingles vaccination for all people 50 and older and adults 19 or older with compromised immunity. 

Additionally, keeping your immunity up by eating well and getting enough sleep may help reduce your risk of developing infections like shingles. 

If you have shingles, you can spread the virus and trigger a chickenpox infection in people who haven’t had chickenpox or the chickenpox vaccine. While you have an active shingles infection, you should avoid people who haven’t had chickenpox or the vaccine, as well as those with compromised immune systems through illness or treatments.

The lowdown

All forms of shingles are caused by the varicella-zoster virus. A shingles infection without a rash is no less severe, and internal shingles can lead to complications if left untreated. 

Fortunately, treatments are effective in reducing the severity of symptoms and limiting the risk of complications. 

If you suspect you have internal shingles, see your doctor right away. They’ll rule out other causes of your symptoms and prescribe the necessary treatments to aid in recovery.

Frequently asked questions

Can you have shingles without a rash?

While shingles infection without a rash is less common, it is possible. In some cases, the infection can affect the inside of the body in a condition known as internal shingles. 

How long do internal shingles last?

Internal shingles can last two to five weeks. However, it could be longer in more severe cases. 

What does internal shingles pain feel like?

Many people with internal shingles experience pain or sensitivity in one particular area. A person with the condition may also feel tired and struggle with fevers, headaches, and body aches. 

What can be done for internal shingles?

Like other types of shingles, internal shingles are treated with antiviral drugs. Painkillers can help you feel better if you’re experiencing pain related to your shingles infection. 

What is the outlook for internal shingles?

Shingles is a common infection, and most people recover fully. However, since internal shingles infection doesn’t cause the characteristic rash that most people associate with shingles, people with this subtype may be less likely to seek treatment and may face a higher risk of complications.

  1. Shingles (Herpes zoster) | Centers for Disease Control and Prevention

  2. Zoster sine herpete: A review (2020)

  3. Neurological complications of VZV reactivation (2015)

  4. Varicella zoster virus encephalitis (2019)

  5. Complications of shingles | Centers for Disease Control and Prevention

  6. What to know about Ramsay hunt syndrome | Health University of Maryland Medical System

Other sources:

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