Outbreaks and triggers

What an outbreak is

An outbreak is a flare of the virus on the skin — usually a patch of small blisters or sores that come up, scab over, and settle on their own over a week or two. Between outbreaks, herpes is dormant. That quiet stretch is the ordinary state — the interval between — not the outbreak.

Most outbreaks are minor and predictable once you know your own pattern. The first one is usually the most noticeable; the ones after that are typically shorter and milder. If you're still in the first few weeks after a diagnosis, just diagnosed is the calmer place to start.

The prodrome — the early warning

Many people get a prodrome: the tingling, itching, or aching in the area that can arrive a day or two before an outbreak actually shows. It's the body's early warning.

The prodrome is worth learning to recognise, because it's the moment a plan does the most good. Starting an episodic course at the first sign — rather than once the outbreak is in full swing — is when it tends to help most. More on that below.

What commonly brings one on

Triggers vary a lot from person to person, and plenty of outbreaks have no obvious cause at all. The list below is drawn from what people commonly report, not from a fixed rule — think of it as patterns to watch for in yourself, not certainties.

How recurrences change over time

For most people, the pattern eases. Recurrences tend to become less frequent and less intense as the years go on, though the pace is different for everyone — some people get them rarely, others more often for a while. There's no single timetable, and a busy year for outbreaks doesn't undo the longer trend.

Knowing your own rhythm is the useful thing. Once you can see roughly how often outbreaks come and what tends to precede them, managing them becomes far more routine than it feels at the start.

How a plan helps

A plan won't remove the virus — nothing does. What it can do is make outbreaks less frequent and help them settle sooner. There are two broad approaches, and many people move between them as their pattern changes.

Episodic — a rescue pack at home

An episodic approach means keeping a short rescue pack at home and starting it the moment a prodrome or outbreak begins. Because timing matters, having it already at home beats waiting on a delivery when an outbreak is underway. It's a good fit if your outbreaks are occasional and you mainly want to shorten and soften each one.

Daily suppression

Daily suppression means taking a daily plan to reduce how often outbreaks happen. Taken consistently, it can also lower the risk of passing herpes on — though it does not remove that risk. It's usually considered when:

• outbreaks are frequent or particularly bother you;
• the unpredictability is affecting daily life;
• or reducing the risk of passing it on to a partner matters to you.

Whether daily suppression is right, and when to review it, is a conversation with a clinician — and it can be revisited as your pattern settles. The reduction-in-transmission side is covered honestly, with the numbers, in suppression and transmission.

This page is educational and is not medical advice. Which plan suits you depends on your own history and is decided with a clinician. If you'd rather use the NHS, that's a good, free option — see NHS or Interval. New to all of this? Start with herpes, explained.