Herpes gingivostomatitis
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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 approximately 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
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
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 if uncomplicated
- Consider admission if immunocompromized, critically ill, or with large necrotic ulcers
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.