Herpes Outbreak Triggers | The Surprising Details of HSV Recurrence

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Walk away today knowing the major herpes outbreak triggers, and important details most people don’t catch. For one, did you know it’s not stress, but certain kinds of stress that cause outbreaks? Learn the triggers of both genital herpes and cold sores from HSV-1 or HSV-2. You’ll also get tips to prevent them.

illustration of matches as triggers for herpes outbreaks in purple

Herpes Outbreak Triggers

Common herpes triggers include stress, sunlight, and diet. Those triggers are well-known, but they can be more complicated than they seem.

1. Mental Stress and Fatigue

There’s a strong correlation between stress and herpes outbreaks. The American Academy of Dermatology lists stress as a common herpes outbreak trigger. (1) Cold sores and genital herpes outbreaks could happen because stress weakens the immune system.

Herpes outbreak recurrences are worsened by long-term stress. A 1999 study followed 58 women with HSV and found that persistent stress led to outbreaks. It suggested that the duration and intensity of stress matters. (2) Other studies seem to suggest the same:

Specific groups under great pressure were shown to have higher antibody levels to HSV than others. For example, people in low socioeconomic groups as well as caregivers of dementia patients showed HSV antibody levels greater than control groups. (3, 4)

Even more interesting, another study suggested a person’s individual coping style to stress determines outbreaks. The authors of the 1997 study said neuroticism was more associated with outbreak recurrence than the stress itself. (5)

It’s important to practice healthy coping skills, get social support, and not to let an HSV diagnosis take over our thoughts. Counseling can be helpful to improve coping skills.


2. Sunlight and UV Rays

UV Rays can suppress the immune system and possibly lead to cold sores. A Kobe University Graduate School of Medicine study found that 10.4% of people with HSV-1 reported cold sores after sun exposure. Even more, the number of reports doubled in summer months. The UV related outbreaks were more common in younger subjects. (6)

Scientists believe it happens because UV rays suppress the immune system. (7)

Sunlight and UV-rays can also cause outbreaks of sacral and genital herpes outbreaks. A study in the Journal of the American Academy of Dermatology tested this by exposing patients to UV light. A small number of subjects with recurrent herpes outbreaks on the buttocks or sacrum were exposed to UV light. The researchers concluded that they could cause outbreaks in the experimental conditions using UV light. (8)

To avoid this, use normal sun protection measures like sunscreen, wide-brim hats, and shade. A small study showed that subjects who used sunscreen on their faces didn’t get cold sores from UV light as opposed to subjects who didn’t use sunscreen. (9)


3. Colds, Fever, and Immunity Busters

Getting another illness like the common cold can bring on herpes outbreaks because your immune system is busy fighting the new thing.

A fever is popularly known to cause HSV-1 outbreaks, or cold sores, giving them the name “fever blisters.”

Those with compromised or taxed immune systems will have more frequent herpes outbreaks. After all, that’s the reason things like UV light, which affects immunity, and fighting off other illnesses are outbreak triggers at all.

An immune system compromised by receiving chemotherapy can lead to more outbreaks, as can an immune system weakened by HIV.


4. Sex and Physical Irritation

Friction from intercourse can irritate tissue and trigger a herpes outbreak.

Obviously, that doesn’t mean to avoid having sex forever or that you’ll break out if you do.

But it does mean if you’re having early warning signs that an outbreak is coming on, like sensitivity or tingling, then wait for them to pass.

They may be prodrome symptoms that signal contagiousness and an impending outbreak. And making them worse might encourage the outbreak to happen.

So since sex can sometimes trigger outbreaks, just be careful to minimize irritation. Try using a water-based lubricant. However, lubricants that contain the spermicide nonoxynol-9 can irritate soft tissue of the vaginal walls. (Safe sex when a partner has herpes.)

Other physical irritations can cause herpes outbreaks:

  • Surgery
  • Tattoos
  • Dental work

5. Foods and Diet

You may have heard that you should avoid foods like almonds, chocolate, and coffee because they’re herpes outbreak triggers. However, that could be an oversimplification.

The origin of this idea is that arginine allows HSV to replicate. Foods like almonds and chocolate are high in this amino acid. However, many foods are! So what is the real trick?

What many people do is not only reduce arginine, but consume more lysine. Lysine is another amino acid — one that competes with arginine for absorption by the body. That makes the job a lot easier.

Even better, lysine has been associated with reduced anxiety levels in human studies. It improves anxiety and stress by boosting serotonin levels. (10)

Read here about foods for preventing outbreaks.


6. Menstruation and Hormones

Some people feel more herpes symptoms during menstruation, either from the hormonal changes or the associated stress. (11)

There may be slightly higher HSV viral shedding during your period, according to a 2019 study in Sexually Transmitted Diseases. However, the study found no increase in the appearance of sores during periods. (12)

That could explain why some people experience vague discomfort, “tingling”, nerve sensitivity,  and other prodrome symptoms during their period.

The same study noted that hormonal birth control didn’t appear to have any effect on outbreaks.

Track your cycle and prepare with some self-care. Make sure you’re eating healthily, drinking enough water, and taking time to relax.

Herpes Outbreak Triggers Infographic with recurrence causes, warnings and tips

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Warning Signs of an Outbreak

Before a full outbreak occurs, many people go through prodromal herpes symptoms, or the signs that an outbreak is about to start.

  • One may feel abdominal pressure, general aches and pains in the muscles, burning, tingling, or itching sensations and general tenderness around the infected area.
  • More acute symptoms cause pain in the groin or inner thighs, painful urination, and unusual or heavy vaginal discharge.

These various symptoms will often be preceded by more common, flu-like symptoms of infection. Swollen lymph nodes, fever, chills, fatigue, nausea and a general body ache could mean you’ve contracted something more than the flu.

If you get these prodrome signs, take extra care to avoid HSV recurrence triggers. And avoid sex until they are completely gone so you don’t pass HSV to your partner.


Tips to Prevent Herpes Outbreaks

Upgrading your habits to healthier ones can prevent herpes recurrences. Based on the studies and factors above, here are some tips:

Get Restful Sleep

Get good sleep. It’ll impact every aspect of your life, your focus, your health, and your emotions. Not only should you get plenty of sleep, but make sure to allow yourself relaxation time.

Do a Food Makeover

Switch out processed foods and fast food for whole ones. Get plenty of veggies, lean meats, and healthy fats. Wholesome meals can be easy to prepare at home.

Similarly, foods high in lysine may help to counter the replication of the herpes virus. High-lysine foods include fish, cheese, and yogurt. For more about lysine and arginine, you can get our complete food charts here. You can also try lysine supplements if they’re right for you.

Consider Supplements

Speaking of supplements, there are several that are popular for preventing outbreaks. While studies backing them are usually limited in their scope, and they aren’t evaluated by the FDA, some studies do look promising.

  • Lysine
  • Red marine algae
  • Olive leaf
  • Lemon balm

Here’s a complete herpes supplement guide.

Practice Mindfulness

The stress studies we went over earlier suggest that not just any stress, but long-term stress, coping problems, or neuroticism could exacerbate and trigger herpes outbreaks.

Try healthy coping skills like mindfulness to counter anxiety and repetitive negative thoughts. Meditation and exercise can be positive outlets. Similarly, the skills taught in cognitive behavioral therapy may be useful for some people.

Suppressive Therapy

Antiviral medicines like valacyclovir (generic Valtrex) can stop herpes outbreaks when they occur. But another way to use them is with suppressive therapy. Suppressive therapy means taking the drug every day in order to prevent outbreaks and also reduce the likelihood of giving herpes to a sex partner. Ask your doctor about this method if your outbreaks are frequent or severe.


Herpes Outbreak Triggers: Takeaways

  • Stress that is long-term, or stress accompanied by poor coping habits, can cause outbreak recurrences.
  • Sun can bring about cold sores, so sun protection can help.
  • The friction of sex can exacerbate herpes. Be wary if prodrome signs are present.
  • Menstruation correlates with slightly higher rates of prodrome symptoms, but not necessarily outbreaks with sores.