Herpes zoster — RACGP Fellowship MCQ

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ModerateDermatologyHerpes zosterRACGP Fellowship

A 64-year-old immunocompetent man presents with unilateral painful vesicles in a dermatomal band on the right chest for 36 hours. There is no eye involvement. What is the most appropriate management?

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Correct answer: B — Start oral antiviral therapy and provide analgesia

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

The patient presents within the critical 72-hour window for antiviral therapy initiation (36 hours into illness). Systemic antiviral therapy—aciclovir, valaciclovir, or famciclovir—is the evidence-based standard for immunocompetent adults with acute herpes zoster and should be combined with analgesia. Topical agents alone are inadequate for systemic disease (A); delaying treatment reduces efficacy and increases risk of post-herpetic neuralgia and other complications (B); antibiotics are adjunctive only for secondary bacterial infection, not first-line (C); live zoster vaccine is contraindicated during acute infection and is preventive, not therapeutic (D). Option E correctly combines early systemic antiviral therapy with pain management, aligning with Australian PBS criteria and international consensus guidelines.

Reference: Australian Prescriber & PBS Schedule (via ATAGI 2022 Targeted Review); supported by international S2k consensus (Gross et al. J. Dtsch. Dermatol. Ges. 2020) on herpes zoster acute management. https://www1.health.gov.au/internet/main/publishing.nsf/Content/458DD8840E8C9332CA25891F0015C89D/$File/atagi_targeted_review_2022_vaccination_for_prevention_of_herpes_zoster_in_australia.pdf