Brief Answer: stress, illness, fatigue most common factors Detailed Answer: HI, thanks for using healthcare magic It is understandable distressing for you. It is possible to be infected with herpes, have few or no initial symptoms and then have a recurrent outbreak years later. This is the reason it is often difficult to determine when the initial infection occurred. There are triggers that can cause the rash to reoccur, they may differ from one person to the next but in general they are: (1)any concurrent illness because the body's immune system is trying to deal with an illness and it is therefore impaired, infections like herpes can prop up (2)stress- emotional or physical stress can actually cause triggers. It is well known that stress can trigger these outbreaks (3)fatigue-this is also a known factor Any of these would be involved in recurrence of the rash. Your immune system is working to fight through the rash and while is it impaired , additional herpes outbreaks can occur. Additionally, most persons would be bothered by the appearance of these factors and this would be the emotional stress aspect that increases its incidence of recurrence. Though the valtrex topically would help to relieve any symptoms , it would not be able to suppress the outbreak as well as oral medication. I hope this helps, feel free to ask any additional questions

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