Herpes zoster: when do patients present and who gets antiviral treatment?

Herpes zoster and its sequelae can have a serious impact on quality of life, particularly in the elderly. The duration and severity of herpes zoster symptoms can be reduced with antiviral treatment. Early treatment is most effective.

To identify how soon after onset of herpes zoster symptoms adults presented to a suburban Dunedin general practice and to describe which patients received antiviral treatment.

Adult herpes zoster cases were identified from a large suburban general practice from 2004 to 2009. Duration of symptoms at presentation and antiviral prescription were identified from medical records and described by patient characteristics.

We identified 278 incident cases. Approximately one-third presented within three days of symptoms, one-third after three days, and in one-third of cases the duration of symptoms was not documented. A higher percentage of patients with ophthalmic herpes zoster presented within three days (45%), while a lower percentage of men (24%) and patients from the lowest socioeconomic quintile (25%) presented within three days. Most incident cases received antiviral treatment. A higher percentage of patients with ophthalmic herpes zoster and patients who presented within three days of symptoms received antiviral treatment. Some patients who presented after seven days of symptoms also received treatment. Antiviral prescribing did not increase with patient age.

Despite many adults with acute herpes zoster presenting after three days of symptoms, most received antiviral treatment. It is not known why many presented late. It is not known whether late treatment is effective.