Herpes gingivostomatitis

Background

Herpes gingivostomatitis of mouth
  • 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

Oral rashes and lesions

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
      • 400 mg PO 5x/day (q4hrs while awake) x 5 days, OR
      • 40-80mg/kg PO divided in 3-4 doses for 5-7 days, OR
        • Can also be used as a cream or oral suspension (swish and swallow)[2]
    • Famciclovir 500mg PO BID x 7 days, OR
    • Valacyclovir 2gm PO q12 x 1 day

Immunocompromised

  • Options:
  • 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. 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. 2.0 2.1 2.2 Mohan RPS, Verma S, Singh U, Agarwal N. Acute primary herpetic gingivostomatitis. BMJ Case Reports. 2013;2013:bcr2013200074. doi:10.1136/bcr-2013-200074.