Can You Get Ramsay Hunt Syndrome Twice? Recurrence Risk

Yes, it is technically possible to get Ramsay Hunt syndrome (RHS) more than once, but it is uncommon ^[1]. Patients who have had RHS often fear a recurrence, but research indicates the chances are low. Getting the shingles vaccine can lower the risk of the virus reactivating again ^[2].

The Likelihood of Recurrence

Ramsay Hunt syndrome is a specific form of shingles (herpes zoster) that occurs when the varicella-zoster virus—the same virus that causes chickenpox—reactivates in a nerve cluster near the ear ^[3][4]. This reactivation often causes a painful rash on or inside the ear, along with one-sided facial paralysis and sometimes hearing or balance issues. While the virus remains dormant in your body even after you recover, it rarely wakes up in the same way a second time.

RHS-specific recurrence is uncommon, though its exact frequency and timing are not well established. A study following patients with various types of facial nerve palsy (including both Bell’s palsy and RHS) found that recurrent events occurred in about 6.8% of patients ^[1]. There are also rare medical case reports of patients developing RHS twice or experiencing symptoms on both sides of their face sequentially ^[5][6]. Because an exact percentage for RHS alone is not known, it is impossible to predict an individual’s exact risk, but it remains a rare event.

Because RHS is a manifestation of a shingles outbreak ^[3][7], taking steps to lower your risk of shingles will also help protect against a second episode of RHS.

The Role of the Shingles Vaccine

Getting vaccinated is recommended to lower the risk of a future shingles outbreak ^[2]. The recombinant zoster vaccine (commonly known by the brand name Shingrix) helps prevent the varicella-zoster virus from reactivating.

In a large clinical trial of adults who had previously recovered from an episode of shingles, no recurrent cases were observed in the vaccinated group during the follow-up period, while recurrences did occur in the unvaccinated placebo group ^[2]. While this shows the vaccine substantially reduces the risk, it does not guarantee 100% protection, and breakthrough cases can still occur.

The trial also demonstrated that having a prior shingles infection does not prevent your immune system from mounting a strong, protective response to the vaccine ^[8][2]. Because Shingrix is a non-live vaccine, it is generally recommended even for individuals whose immune systems are compromised ^[9][10]. However, you should still check with your doctor for individual contraindications, such as a severe allergy to a vaccine component.

When Should You Get Vaccinated?

If you have just recovered from Ramsay Hunt syndrome, you might be eager to get the vaccine. In the United States, the Centers for Disease Control and Prevention (CDC) recommends the two-dose Shingrix vaccine (usually given 2 to 6 months apart) for:

• Adults aged 50 and older ^[9][11].
• Adults aged 19 and older who have weakened immune systems due to disease or therapy ^[9][12].

There is no strict, mandatory waiting period (such as waiting six months or a year) required by CDC guidelines before you can receive the vaccine after an outbreak ^[11][9]. Vaccination is generally deferred during active shingles or a significant acute illness. Once the acute illness has resolved—meaning the blisters have cleared and you no longer have a fever—the vaccine can usually be scheduled ^[2][9]. Residual nerve symptoms and the completion of antiviral medications do not, by themselves, require waiting to get vaccinated.

Lingering Symptoms vs. New Outbreaks

It is completely normal to have lingering symptoms like facial weakness, hearing changes, or nerve pain long after the acute infection has passed ^[13][14]. These persistent symptoms often reflect lingering nerve injury from the initial attack, rather than a sign of active viral infection, and they should not prevent you from getting the vaccine ^[15]. Note that the vaccine helps prevent future outbreaks, but it does not treat current RHS or repair existing nerve damage.

When to Seek Immediate Care

Do not self-diagnose persistent or worsening symptoms. If you experience new or worsening symptoms—such as a new one-sided facial weakness, a new blistering rash in or around the ear or mouth, severe ear pain, new hearing loss, vertigo, or trouble closing your eye—seek urgent medical evaluation. Early assessment and treatment are critical for protecting your facial nerve and hearing ^[16][17].

(Note: Sudden facial weakness accompanied by arm or leg weakness, speech difficulty, or severe headache requires emergency evaluation for a possible stroke ^[18]).