Herpes gingivostomatitis

Background

• Primary HSV-1 infection of lips, gingiva, and tongue
  • HSV-2 associated with genital disease
• Usually occurs in childhood
• 90% of population is seropositive by age 40

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 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):
  • Viral culture (gold standard)
  • Direct immunofluorescence
  • Tzanck smear (poor specificity)

Management

Anti-viral Treatment

Normal Host

• Options:
  • Acyclovir
    • Acyclovir 400 mg PO 5x/day (q4hrs while awake) x 5 days OR
    • Acyclovir 40-80mg/kg PO divided in 3-4 doses for 5-7 days OR
    • Can also be used as topical cream 5x per day
  • Famciclovir 500mg PO BID x 7 days OR
  • Valacyclovir 2g PO q12h x 1 day

Immunocompromised

• Options:
  • Acyclovir
    • Acyclovir 5 mg/kg IV q8h x 7 days OR
    • Acyclovir 400mg PO 5x/day x 14-21 days
  • 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

Disposition

• Discharge

See Also

• Herpes Simplex Virus-1