Viral Skin Conditions: Shingles, Cold Sores and Warts

Three viral skin conditions account for a steady stream of Auckland GP visits each year: shingles, cold sores, and warts. They look very different, are caused by different viruses, and need different treatments, but they share one feature: catching them early at a GP visit usually leads to a quicker, simpler recovery. This guide explains what each one is, how it spreads, when to see a GP, and what treatment looks like at CityMed.

Quick note before we start. All three conditions are caused by viruses, but the viruses are not related. Shingles comes from the chickenpox virus reactivating, cold sores come from the herpes simplex virus, and warts come from human papillomavirus (HPV). Each behaves differently and needs its own approach.

Shingles (herpes zoster)

Shingles is a painful rash caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox. After someone recovers from chickenpox, the virus stays dormant in nerve tissue and can reactivate years or decades later, usually triggered by ageing, stress, or a weakened immune system. About one in three people will develop shingles in their lifetime, and the risk rises sharply after age 50.

Symptoms of shingles

• A burning, tingling, or sharp pain in one area of skin, often before any rash appears
• A red rash that develops one to five days after the pain starts
• Fluid-filled blisters that follow the path of a single nerve, almost always on one side of the body
• Most often on the chest, abdomen, or face, including around one eye
• Itching, fever, headache, and feeling generally unwell
• Blisters crust over in 7 to 10 days and usually heal within 2 to 4 weeks

Who is at higher risk

• Adults aged 50 and over
• People with weakened immune systems (cancer treatment, HIV, long-term steroids, organ transplant)
• Periods of significant stress or illness
• Anyone who has had chickenpox, although the risk is much lower in people who have received the vaccine

Seek same-day GP review or urgent care if:

- The rash is on your face, especially near the eye, nose, or forehead (risk of eye complications)

- The rash affects the ear or causes facial weakness (Ramsay Hunt syndrome)

- You have a weakened immune system

- You are pregnant, or in close contact with someone pregnant or with a newborn

- The rash is spreading rapidly or covering a large area

How a GP treats shingles

• Antiviral medication (aciclovir, valaciclovir, or famciclovir) is most effective when started within 72 hours of the rash appearing, so early review matters
• Pain relief with paracetamol or ibuprofen, with stronger options available if pain is severe
• Cool compresses and calamine lotion to ease itching and irritation
• Keeping the rash covered with a dry dressing to reduce the spread of varicella to people who have never had chickenpox
• Review of nerve pain that lasts beyond rash healing (postherpetic neuralgia), which may need additional medication such as gabapentin or amitriptyline

The Shingrix vaccine is funded in New Zealand for adults aged 65 and immunocompromised adults from age 18, and is highly effective at preventing shingles and complications. Your GP can confirm eligibility and book the two-dose course.

Cold sores (herpes simplex virus)

Cold sores are small fluid-filled blisters caused by herpes simplex virus type 1 (HSV-1), usually around the lips or mouth. Once a person is infected, the virus stays in the body for life and can reactivate during stress, illness, sun exposure, or hormonal changes. HSV-1 is extremely common and is often picked up in early childhood.

Symptoms of cold sores

• Tingling, itching, or burning around the lips one to two days before a blister appears
• Small fluid-filled blisters, often in clusters, on or near the lip border
• Blisters break open, weep, then crust over within several days
• Healing typically takes 7 to 10 days
• The first outbreak is usually the most severe and may come with fever, sore throat, and swollen glands

Common triggers

• Stress, fatigue, or illness
• Sun exposure on the lips
• Hormonal changes, including menstruation
• Cold weather or wind exposure
• Dental procedures or facial injury

How a GP treats cold sores

• Topical antiviral cream (aciclovir or penciclovir) applied at the first tingling stage shortens an outbreak
• Oral antivirals (aciclovir or valaciclovir) for severe or frequent outbreaks, or for people with weakened immune systems
• Paracetamol for discomfort and lip protection with SPF balm to reduce sun-triggered recurrences
• Avoidance of touching, picking, or sharing lip products, towels, or utensils during an outbreak
• Discussion of suppressive antiviral therapy for people with 6 or more outbreaks per year

When cold sores need urgent review. Seek same day care if cold sores spread to the eye (risk of HSV keratitis), affect a baby under 6 weeks old, or appear in someone with eczema (risk of eczema herpeticum). These can lead to serious complications and need prompt treatment.

Warts (human papillomavirus)

Warts are small, rough growths on the skin caused by human papillomavirus (HPV). They are very common, especially in children and teenagers, and most clear up on their own within months to a couple of years. They spread by direct skin contact and through shared surfaces such as gym floors, pool decks, and shared towels.

Common types of warts

• Common warts: rough, raised growths most often on the hands, fingers, or knees.
• Plantar warts (verrucas): hard, flat warts on the soles of the feet, often with small black dots in the centre. Can be painful when walking.
• Flat warts: small, smooth warts that appear in groups, common on the face, arms, or legs.
• Filiform warts: long, thin, finger-like warts, often around the eyes, lips, or neck.
• Genital warts: soft growths in the genital or anal area caused by sexually transmitted HPV. These need a specific GP assessment and treatment.

How warts spread

HPV enters through small breaks in the skin. Warts spread by direct contact, by touching a wart and then another part of your body, and through contaminated surfaces in shared spaces. Wet, warm environments such as swimming pools and locker rooms are common sources of plantar warts.

How a GP treats warts

• Watchful waiting, since most warts resolve on their own without treatment
• Topical salicylic acid applied daily for several weeks, suitable for most common and plantar warts
• Cryotherapy (freezing with liquid nitrogen) at the clinic, usually requiring 2 to 4 sessions spaced 2 to 3 weeks apart
• Combination therapy with salicylic acid and cryotherapy for stubborn warts
• Referral for cautery, laser, or specialist dermatology review when warts do not respond, are painful, or affect daily activities
• Specific GP assessment for genital warts, often including a sexual health check and discussion of the HPV vaccine

Quick comparison

When to see a GP

Book a GP appointment if:

• You suspect shingles, especially within 3 days of rash appearing (antivirals work best when started early)
• Cold sores are spreading, severe, or recurring more than 6 times a year
• Warts are painful, bleeding, spreading, or affecting daily activities
• You notice growths in the genital area, on the eyelids, or inside the mouth
• You are pregnant or immunosuppressed and notice any new viral skin lesion
• You are unsure whether a skin lesion is a wart, a mole, or something else

Seek urgent care at ED or call 111 for:

- Shingles affecting the eye, ear, or face with weakness

- Cold sores spreading to the eye, or appearing in a newborn

- Severe rash with high fever, confusion, or rapidly spreading blistering

- Anyone with a weakened immune system who develops a new viral rash

How a GP diagnoses viral skin conditions

At CityMed, the consultation typically includes:

• A full history: when symptoms started, distribution of the rash, any triggers, prior episodes, and underlying health conditions
• Visual examination of the affected area, which is usually sufficient to confirm shingles, cold sores, or warts
• Swabs of blister fluid in unclear or atypical cases, sent for viral PCR
• Blood tests when systemic illness or immune problems are suspected
• Referral for dermoscopy or specialist review when a lesion does not look typical

Prevention

• Wash hands regularly, especially after touching skin lesions
• Avoid sharing towels, razors, or lip products during a cold sore outbreak
• Wear footwear in public showers, pool decks, and gym changing rooms
• Use SPF lip balm to reduce sun-triggered cold sores
• Consider the Shingrix vaccine if you are aged 65 or immunocompromised (funded in NZ for eligible groups)
• Consider the HPV vaccine for adolescents and young adults to reduce genital warts and HPV cancer risk
• Cover cuts and scratches in shared environments to reduce wart spread

Frequently asked questions

Are shingles contagious?

Shingles itself is not contagious, but the fluid in shingles blisters contains the varicella virus, which can cause chickenpox in someone who has not had it. Keep the rash covered, avoid contact with newborns, pregnant women, and immunocompromised people until the blisters have fully crusted over.

Can I get shingles more than once?

Yes, but it is uncommon. Most people who have had shingles do not get it again. The Shingrix vaccine reduces the risk of a future episode and is funded for adults aged 65 and certain immunocompromised groups in New Zealand.

Do cold sores need treatment, or will they go away?

Most cold sores heal in 7 to 10 days without treatment. Topical antivirals at the first tingling stage can shorten an outbreak by a day or two. If you have frequent or severe outbreaks, your GP can discuss oral antivirals or suppressive therapy.

Will my warts come back after treatment?

Warts can recur even after successful treatment, especially while your immune system is still building a response to HPV. A second course of salicylic acid or cryotherapy is often needed. Persistent warts after several courses warrant GP review and possible specialist referral.

Should I worry if a wart changes colour or bleeds?

Yes. Any growth that changes shape, colour, bleeds, or grows rapidly should be checked by a GP. Most are still warts, but occasionally a skin cancer can look like a wart, especially in older adults. Same-day skin checks are available at CityMed.

Need a skin assessment in Auckland?

CityMed Medical Centre offers same-day GP appointments in Auckland CBD for shingles, cold sores, warts, and other viral skin conditions, including same-day antiviral prescriptions where appropriate.

If you suspect shingles, book within 72 hours of the rash appearing to get the most benefit from antiviral treatment.

Book online at citymed.co.nz or call our reception.