OBJECTIVES: This study aimed to identify predictors for the presence of Post Herpetic Neuralgia (PHN) at 3 months in Herpes Zoster (HZ) patients aged 50 and over in Italy. METHODS: General Practitioners (GPs) from regions throughout Italy included immunocompetent patients over 50 years old with a new HZ diagnosis and followed them during 6 months with visits (V) at 0, 1, 3 and 6 months. Occurrence and level of pain using a 0 to 10 visual analogic scale (VAS), clinical symptoms, patients' quality of life (QoL) and their health care resources utilization were recorded. A multivariate regression model was run to assess the predictor factors for the presence of PHN at 3 months. Univariate analysis was first undertaken on each variable to identify possible associations with PHN (level of significance, 25%) to be considered in the multivariate regression model. RESULTS: From March 2009 to July 2010, 108 GPs included 413 patients (148 Males and 265 Females) with HZ aged 67.9 y± 10.7 years.  Most of them (89.6%) had pain at V0 (VAS score:5.8/10) and 91.5% received systemic antivirals, 70% within 72 hours after rash onset. During the follow-up, 52 patients consulted at least one specialist (dermatologist, neurologist, ophthalmologist…) and no cases were hospitalized. At 3 month, 20.6% presented PHN (VAS score: 3.7/10), and still 9.2% at 6 months (VAS score: 3.7/10). By logistic regression analysis a VAS score over 3, the presence of more than 50 vesicles and the gender male were the main predictive factors at the initial visit that were significantly associated with the presence of PHN at 3 months. CONCLUSIONS: Even if most of patients with HZ received the standard of care, many experienced intense and long-lasting pain. This study identified specific factors at presentation that could help identify patients who will develop PHN.