Herpes gingivostomatitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Herpesgingiva.jpg|thumb|Herpes gingivostomatitis of mouth]] | |||
*Primary [[HSV-1]] infection of lips, gingiva, and tongue | *Primary [[HSV-1]] infection of lips, gingiva, and tongue | ||
**HSV-2 associated with genital disease | **HSV-2 associated with genital disease | ||
*Usually occurs in childhood<ref name="George">George AK, Anil S. Acute Herpetic Gingivostomatitis Associated with Herpes Simplex Virus 2: Report of a Case. Journal of International Oral Health : JIOH. 2014;6(3):99-102.</ref> | *Usually occurs in childhood<ref name="George">George AK, Anil S. Acute Herpetic Gingivostomatitis Associated with Herpes Simplex Virus 2: Report of a Case. Journal of International Oral Health : JIOH. 2014;6(3):99-102.</ref> | ||
*90% of population is seropositive by age 40<ref name="George" /> | *90% of population is seropositive by age 40<ref name="George" /> | ||
*Treatment does not affect dormant virus in nerve ganglions → recurrent disease remains possible | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 21:00, 26 April 2016
Background
- Primary HSV-1 infection of lips, gingiva, and tongue
- HSV-2 associated with genital disease
- Usually occurs in childhood[1]
- 90% of population is seropositive by age 40[1]
- Treatment does not affect dormant virus in nerve ganglions → recurrent disease remains possible
Clinical Features
- Prodrome of fever, myalgias, and cervical adenopathy[2]
- Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa)
- Can be extremely painful and → odynophagia
- Lasts approx 1-4 weeks without treatment, course shortened with treatment
Differential Diagnosis
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
Diagnostic Evaluation
- Clinical diagnosis, based on history and physical exam
- Available laboratory studies (not required for diagnosis)[2]:
- Viral culture (gold standard)
- Direct immunofluorescence
- Tzanck smear (poor specificity)
Management
Anti-viral Treatment
Normal Host
- Options:
- Acyclovir
- Famciclovir 500mg PO BID x 7 days OR
- Valacyclovir 2g PO q12h x 1 day
Immunocompromised
- Options:
- Acyclovir
- Famciclovir 500mg PO BID x 7 days OR
- Valacyclovir 500mg PO BID x 5-10 days
- Analgesia (e.g. Acetaminophen and/or Ibuprofen)
- PO intake is important
- Consider viscous lidocaine before meals[1]
Disposition
- Discharge
See Also
External Links
References
- ↑ 1.0 1.1 1.2 George AK, Anil S. Acute Herpetic Gingivostomatitis Associated with Herpes Simplex Virus 2: Report of a Case. Journal of International Oral Health : JIOH. 2014;6(3):99-102.
- ↑ 2.0 2.1 Mohan RPS, Verma S, Singh U, Agarwal N. Acute primary herpetic gingivostomatitis. BMJ Case Reports. 2013;2013:bcr2013200074. doi:10.1136/bcr-2013-200074.