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 lymphadenopathy[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:

Disposition
  • Discharge if uncomplicated
  • Consider admission if immunocompromized, critically ill, or with large necrotic ulcers

See Also


References
  1. 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. Mohan RPS, Verma S, Singh U, Agarwal N. Acute primary herpetic gingivostomatitis. BMJ Case Reports. 2013;2013:bcr2013200074. doi:10.1136/bcr-2013-200074.
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