Herpes gingivostomatitis

Background

• Primary HSV-1 infection of lips, gingiva, and tongue
  • HSV-2 associated with genital disease

Herpes gingivostomatitis of mouth

Clinical Features

• Prodrome of fever, myalgias, and cervical adenopathy
• Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa)
  • Can be extremely painful and → odynophagia
• Lasts approx 2-4 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):
  • Viral culture (gold standard)
  • Direct immunofluorescence
  • Tzanck smear (poor specificity)

Management

Treatment does not affect dormant virus in nerve ganglions → recurrent disease remains possible

• Antiviral drug
  • Acyclovir 40-80mg/kg PO divided in 3-4 doses for 5-7 days
    • Can also be used as a cream or oral suspension (swish and swallow)
  • Valacyclovir (significantly higher bioavailability than acyclovir)
  • Famciclovir
• Analgesia (e.g. Acetaminophen and/or Ibuprofen)
• PO intake is important

Disposition

• Discharge

See Also

• Herpes Simplex Virus-1