Herpangina is a common viral infection, typically seen in children, that causes painful sores and blisters in the back of the mouth and throat. It often presents with a sudden, high fever and a severe sore throat, making swallowing difficult. Many people wonder if they develop lasting protection or if they can contract it again. The answer is yes, you can get herpangina twice, and understanding the specific viral causes explains why recurrence happens.
The Viral Agents Responsible for Herpangina
Herpangina is caused by viruses belonging to the Enterovirus genus, part of the Picornaviridae family. The most frequent culprits are Coxsackieviruses, particularly those in Group A (such as A16, A5, and A10). Other enteroviruses, including some Group B Coxsackieviruses and Enterovirus 71, can also cause the illness.
Unlike illnesses caused by a single virus type, herpangina can be caused by over 20 different distinct strains, or serotypes, within the Coxsackievirus family. This variety of causative agents allows for repeated infections. The infection is highly contagious and spreads easily in settings like daycares, primarily through the fecal-oral route and respiratory droplets.
Strain-Specific Immunity and the Likelihood of Recurrence
When a person recovers from herpangina, their immune system develops a strong, long-lasting defense specific only to the exact viral strain that caused the infection. The body creates antibodies that recognize and neutralize that particular Coxsackievirus serotype.
This acquired immunity does not protect against the many other Coxsackievirus serotypes that can cause herpangina. If the individual is exposed to a different, non-cross-reactive strain, they are susceptible to a completely new infection. Since many causative strains circulate, multiple episodes of herpangina throughout childhood are common. This recurrence is due to a new infection, not a viral reactivation.
Recognizing Symptoms
The onset of herpangina is sudden, beginning with a high fever (103°F to 106°F) and a severe sore throat. Within one to two days, small, painful lesions appear in the posterior region of the mouth. These lesions start as grayish papules, turn into fluid-filled vesicles, and then break down into shallow, yellowish-gray ulcers with a red border.
The sores are most frequently located on the soft palate, tonsillar pillars, and the uvula. The pain often leads to difficulty swallowing and a reduced appetite, especially in young children. Preventing dehydration is the main concern, as discomfort can cause patients to refuse liquids.
Supportive Care
Since herpangina is a viral infection, treatment focuses entirely on supportive care to manage symptoms until the illness resolves, usually within 7 to 10 days. Acetaminophen or ibuprofen can be used to control the fever and alleviate the significant throat pain. Maintaining fluid intake is paramount, and cold liquids, such as milk, water, or electrolyte solutions, are recommended because they are soothing.
Acidic, spicy, or hot foods and beverages should be avoided as they irritate the oral lesions. For severe pain, topical anesthetics (gels or sprays) may be used. Gargling with cool salt water can also offer relief.
Practical Steps for Prevention
Prevention centers on interrupting the transmission cycle of the highly contagious enteroviruses. Since the virus is shed in respiratory secretions and can be present in stool for several weeks after symptoms resolve, meticulous personal hygiene is the most effective defense.
Frequent and thorough handwashing is important, especially after using the restroom, changing diapers, and before eating. Shared surfaces and objects, such as toys and countertops, should be cleaned regularly with an appropriate disinfectant. Children diagnosed with herpangina should be kept home from school or daycare to prevent outbreaks.