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Herpetic Gingivostomatitis – Symptoms and Treatment

Herpetic gingivostomatitis is a painful inflammation of the oral mucosa and gums caused by herpes simplex virus type 1 (HSV-1), most commonly seen in young children.

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Things worth knowing about "Herpetic Gingivostomatitis"

Herpetic gingivostomatitis is a painful inflammation of the oral mucosa and gums caused by herpes simplex virus type 1 (HSV-1), most commonly seen in young children.

What is Herpetic Gingivostomatitis?

Herpetic gingivostomatitis is an acute, painful inflammation of the oral mucosa (stomatitis) and gums (gingivitis) caused by herpes simplex virus type 1 (HSV-1). It typically represents the primary infection with the herpes virus and most commonly affects children between 6 months and 5 years of age. However, adolescents and adults who have not previously been exposed to the virus can also develop the condition.

Causes

The condition is caused by primary infection with herpes simplex virus type 1 (HSV-1), and less commonly HSV-2. Transmission occurs through direct contact with infected secretions, such as saliva, kissing, or sharing utensils. The virus enters the mucosal cells and triggers a significant inflammatory response. After the primary infection, HSV-1 remains dormant for life in the trigeminal ganglion and can be reactivated during periods of immune suppression, most often manifesting as cold sores (labial herpes).

Symptoms

Herpetic gingivostomatitis presents with a range of characteristic signs and symptoms:

High fever (up to 40 °C / 104 °F), often the first sign of infection
Swelling and redness of the gums and oral mucosa
Painful blisters that burst and leave shallow, yellowish-coated ulcers (aphthae)
Bad breath (halitosis) due to bacterial colonization of the open wounds
Difficulty swallowing and pain when eating or drinking
Excessive drooling
Swollen lymph nodes in the jaw area
General malaise and irritability, especially in young children

The acute phase typically lasts 7 to 14 days. A particular risk is dehydration, as pain makes drinking difficult, especially in young children.

Diagnosis

Diagnosis is usually made clinically, based on the characteristic presentation and physical examination. The clinician assesses the appearance of the mucosal lesions and takes into account the age of the patient and the course of illness. In unclear cases or in immunocompromised patients, the following additional tests may be used:

PCR test (polymerase chain reaction) from a swab of the lesions to directly detect viral DNA
Viral culture from a mucosal swab
Serology: detection of HSV-specific antibodies in the blood (less commonly used in primary infection)

Differential diagnoses to be considered include herpangina (caused by coxsackieviruses), aphthous stomatitis, hand-foot-and-mouth disease, and mucosal changes associated with other infectious diseases.

Treatment

Treatment of herpetic gingivostomatitis is primarily symptomatic, aimed at relieving discomfort. In severe cases or in immunocompromised patients, antiviral therapy may be indicated.

Symptomatic Measures

Pain-relieving medications such as ibuprofen or paracetamol to reduce fever and pain
Topical anesthetics (e.g., lidocaine gel) for direct pain relief in the mouth
Adequate fluid intake: cold, soft, or liquid foods and beverages; in young children, popsicles or ice chips may help
Mouth rinses with antiseptic or anti-inflammatory solutions

Antiviral Therapy

Aciclovir (oral or intravenous) is the treatment of choice for severe cases, immunosuppression, or risk of complications. It should be started as early as possible, ideally within the first 72 hours of symptom onset.
Alternatively, valaciclovir may be used, particularly in older children and adults.

Inpatient Care

If a child is severely dehydrated or unable to drink adequately, hospital admission with intravenous fluid replacement may be necessary.

Complications

In most cases, herpetic gingivostomatitis resolves without lasting damage. Possible complications include:

Dehydration, especially in young children
Herpetic keratoconjunctivitis: spread of the virus to the eyes (conjunctiva and cornea)
Herpetic encephalitis: inflammation of the brain (rare but serious)
Secondary bacterial superinfection of open wounds
In immunocompromised individuals: disseminated herpes infections

References

Stoopler ET, Balasubramaniam R. - Gingivostomatitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK554776/
Nasser M et al. - Aciclovir for treating primary herpetic gingivostomatitis. Cochrane Database of Systematic Reviews 2008. DOI: 10.1002/14651858.CD006700.pub2
World Health Organization (WHO) - Herpes simplex virus. Geneva: WHO; 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

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