Pestilence embodies the diseases and vermin that plague civilization—viewed as “bad air,” divine punishments, curses, or even demons lurking within the body to corrupt it from within. Deities with this domain may be both healers and killers, striking the unworthy with afflictions while blessing their flock with health. Deities of any alignment may claim this domain, though the good-aligned ones focus more on ameliorating disease while evil ones prefer to wield pestilence as a weapon. Examples of plague deities in real-world mythology include the Greco-Roman Apollo, the Aztec Chalchiuhtotolin, and the Mesopotamian deities Nergal and Pazuzu.

Level	Pestilence Domain Spells
1st	detect poison and disease, plague doctor’s call*
3rd	conjure vermin*, poisonous flesh**
5th	cloak of vermin**, plague walk*
7th	blight, death toll*
9th	contagion, insect plague

* This spell is described in this series.

**This spell is described in Deep Magic.

Remedies Foul and Fair

When you choose this domain at 1st level, decide whether your remedies cause a curse or a blessing. Once made, this choice is permanent. You can use your action to touch a creature, including yourself, with an ointment of herbs that smells both foul and sweet. If this is a blessing, the creature gains advantage on Constitution saving throws against disease and poison. If this is a curse, the creature instead has disadvantage on Constitution saving throws against disease and poison. Regardless, this effect lasts for 1 hour or until you use this feature again.

Channel Divinity: Mark of the Unclean

Starting at 2nd level, you can use your Channel Divinity to mark those infected with disease or poison, so they may be more easily treated, avoided, or purged.

As an action, you brandish your holy symbol and evoke incantations of mercy (or retribution) against plaguebearers and the sickly. All poisoned and disease-infected creatures within 30 feet of you radiate a green, sickly aura. One of these creatures of your choice manifests a green sigil of sickness in an obvious location, such as the forehead. You must concentrate to maintain the mark, but you gain advantage on attack rolls, Wisdom (Medicine) skill checks, and saving throws against a marked creature. Marked creatures have disadvantage on Charisma-based skill checks other than Charisma (Intimidation) checks. The mark persists for up to 10 minutes while you concentrate.

Channel Divinity: Manifest Pestilent Spirit

At 6th level, you can use your Channel Divinity to force the malevolent energy of a disease or poison to manifest into a fiendish physical form.

As an action, you present your holy symbol before a creature afflicted by poison or disease and command the pestilent spirit to show itself. The spirit takes 1 round to manifest, coalescing into a vaguely humanoid shape with the characteristics of its affliction. (A plague spirit exhibits boils, a poison spirit may have black-and-green flesh, and so on.)

A manifested spirit of pestilence is a fiend, using the statistics of a mummy except its attacks inflict the disease or poison the creature manifested from instead of mummy rot. It gains a proficiency bonus to its AC, attack rolls, saving throws, skill checks, and save DCs equal to the disease or poison’s DC to resist − 10. Spirits born from a magical disease or poison double this bonus.

These spirits are enraged by their forceful manifestation and attempt to attack and infect you and any noninfected living creature nearby. They cannot communicate. Defeating a spirit of pestilence cures the victim it manifested from and any other creature suffering from the same affliction within 60 feet.

You may also attempt to compel the pestilent spirit to obey you. This takes another use of Channel Divinity, and the pestilent spirit makes a Charisma saving throw against your spell save DC. If it fails, it will not attack you or anyone you designate but will strike any other living creature to attempt to infect them.

Divine Strike

At 8th level, you gain the ability to infuse your weapon strikes with corruption and disease. Once on each of your turns when you hit a creature with a weapon attack, you can cause the attack to deal an extra 1d8 necrotic damage. When you reach 14th level, the extra damage increases to 2d8.

Poxcaster

At 17th level, you gain immunity to poison and disease. Additionally, you can use Channel Divinity to cast contagion on a target you can see with a ranged spell attack. If you succeed, that creature has disadvantage on all Constitution saving throws made to resist the contagion.

New Magic Item

Those of the Pestilence domain often wear plague masks.

Plague Mask of Remedy

Wondrous Item, Uncommon (Requires Attunement)

Usually seen on the grim faces of plague doctors treating diseased patients, this mask covers the top half of your face with stiff, black leather—an elongated beak extending out from your nose.

When you don the mask, you smell an assortment of pungent, almost-sweet herbs and flowers stuffed into the beak and magically held there and preserved. You have disadvantage on scent-based Wisdom (Perception) checks due to the strength of the scented remedies, but you gain advantage on your saving throws against scent- and gas-based attacks, including stinking cloud and cloudkill.

Once per long rest, you can spend an action to focus on breathing in the aromas to soften your fatigue and remove one level of exhaustion. 

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