Diseases in Pathfinder RPG: How They Really Work

“Sickness comes on horseback, but departs on foot.” – Dutch Proverb.

One of the more terrifying of the afflictions possible in the Pathfinder RPG, Diseases are a very potent item in a Dungeon Master’s Arsenal of Hazards to throw at their players.

Disease is potent in not just a rule format. Of course, rules are very important, but sickness and disease is a very visceral and poignant reminder of the mortality of both the players and the characters.

It is a reminder that anyone can be struck down without warning. In the year of our lord, 2022, this note rings doubly true.

In a magical world, disease and affliction can get any worse than our run of the mill average world. The question is how can someone actually represent that in an RPG?

Pathfinder Pathogens

Pathfinder 1st Edition tracks Diseases very similar to the way it tracks poisons. Almost exactly the same even, with similar terms and everything.

To break it down to readable format and show how to use them mechanically, let’s start with a made up disease from the SRD, Demon Fever:

Demon Fever

Type disease, injury; Save Fortitude DC 18

Onset 1 day; Frequency 1/day

Effect 1d6 Con damage, target must make a second Fort save or 1 point of the damage is drain instead; Cure 2 consecutive saves

As my therapist said when I explained to them exactly what I did to my players in the last game session, let’s break this down now.

The Type here is the type of affliction we have. In this case, it is a Disease (obviously) and it is an “injury” type. That means the primary point where you contract the affliction.

The different contraction types are contact (touching the skin), ingestion (eating or drinking), inhalation (breathing it in), injury (contact through a wound), spell (contact through magic), and finally trap (contact from a trap).

Save is the saving throw you have to make to avoid the initial effect of the disease or any additional effects. This is also the save made later in the Cure section.

Onset is how long the affliction takes to set in. In our world, this is also known as an incubation period. Poisons will have these as well, but they are often shorter.

You will still need to make a save the moment you make contact with the disease vector. If you succeed at this initial save, you don’t contract the disease. If you fail though, you won’t see any effects until after the onset is over.

Frequency is how often you can make a saving throw to shake off the effects of the affliction. This is also how often secondary effects will hit you as well.

Effect is the actual effect of the affliction. This could also detail a secondary effect as well. One thing of note is that if a disease/affliction causes damage or ability drain, it cannot be healed until after the disease has been removed.

Finally we have Cure.

The Cure section details any special rules for getting rid of the disease beyond something like a Remove Disease spell. In this example of Demon Fever, to fight off the disease you need to make 2 consecutive Fortitude Saves at DC 18.

That might take a while because the saves can only be made on the Frequency rate. So it would take at minimum 2 days to fight off Demon Fever.

Curing Disease

When it comes to fighting sickness in Pathfinder, there are a few different options.


One of the non-magical options is the Heal skill. With the Heal skill, you can take 10 minutes to treat the target using mundane methods like a cold compress for fever, bandaging sores, bundling up to treat chills, etc.

After taking that option, you can make a Heal check with a DC equal to the Disease’s saving throw. If the Heal check succeeds, the next time they get to make a saving throw against the effects of the disease, they will get a +4 bonus on their saving throw against the disease.


There are also magical means of resisting or curing diseases in a player character’s arsenal. This is by no means a completely exhaustive list, but some example spells that players could use:

Remove Disease, listed above, completely removes the effect of a disease on the spell’s target, but requires a caster check (1d20+caster level) to overcome the DC of the Disease.

Other spells exist to assist in the curing of diseases as well:

Diagnose Disease can help to identify which pathogen affects a target and provides a +4 bonus on the Heal check to treat the disease. 

Remove Sickness will suppress the effects of sickness for a short duration, and provide the target with a +4 bonus to their save to throw off the sickness.

Delay Disease makes a target immune to disease for a period of time, but will cause any diseases they interact with during the duration of the spell to hit them all at once when the duration ends.

Accept Affliction will move the target’s afflictions from them onto you. This could be helpful if you knew you could save better, or you might be able to get a Remove Disease spell quicker. Though you will still need to save against the disease the moment the spell goes off.

Persistent Vigor will allow one saving throw to count for multiple cumulative saves, meaning the target can recover faster from the disease’s effects.

The Heal spell is an overpowered cure-all spell that takes care of diseases and any other affliction that might be affecting the target at the same time. I like to think of it as a magical factory reset button.

It would also be possible to purchase scrolls, wands, or potions of almost any of these spells, though Remove Disease or Remove Sickness would be the most common.

One time use of the Heal spell might be cost prohibitive to craft or purchase from any vendor.

Curing services may also be available from a local temple or itinerant priest/cleric. Some may be free, but other more worldly churches will often request “donations” or require visits during religious services.

This would be a great role playing opportunity for the players, especially if the players are opposed to any of a church’s stated dogma.

Stay Clean and Safe, Pathfinder!