Primary herpetic gingivostomatitis is an infection of the mouth and gums representing a person’s initial exposure to the herpes simplex virus. It occurs most often in young children between the ages of six months and five years old. This condition is characterized by inflammation and uncomfortable sores throughout the oral cavity. The infection is self-resolving, though it causes discomfort that requires management.
Causes and Transmission
The condition is caused by the herpes simplex virus, most often type 1 (HSV-1). This is the same virus responsible for recurrent cold sores, but the primary infection is more widespread and severe. The virus establishes a lifelong presence in the body after this first encounter and can reactivate later in life during periods of a weakened immune system.
The virus spreads through direct contact with the saliva or oral lesions of an infected individual. Transmission happens when children share items like utensils, cups, or toys. Kissing or other close personal contact with someone who has an active HSV-1 infection, even if they are asymptomatic, can also transmit the virus. Young children are particularly susceptible because their immune systems are still developing, and increased social interaction in settings like daycare contributes to their risk.
Identifying the Symptoms
The onset is marked by a prodromal phase before any oral signs are visible. This initial stage includes a high fever, general malaise, irritability, and sometimes a headache. These systemic symptoms can appear one to two days before the oral manifestations, causing a child to feel unwell and become fussy.
Following the initial fever, the condition’s characteristic oral symptoms develop. The gums become inflamed, appearing swollen, red, and tender to the touch, a condition known as acute gingivitis. They may also bleed easily with minimal provocation, such as during tooth brushing.
Shortly after the gums become inflamed, small fluid-filled blisters, or vesicles, erupt throughout the mouth. These vesicles can appear on the tongue, the roof of the mouth, the inside of the cheeks, and the lips. Within a short period, these blisters rupture, leaving behind multiple shallow, round, yellowish-gray ulcers that are painful. The pain from these sores leads to drooling, bad breath, and a refusal to eat or drink.
Medical Diagnosis and Treatment
A medical diagnosis is made based on a clinical evaluation. A healthcare provider can identify the condition by observing the inflamed gums and characteristic lesions inside the mouth. The patient’s history, including the initial high fever followed by oral sores, further supports the diagnosis. Laboratory tests to confirm the presence of HSV-1 are not always necessary.
The main goals of treatment are to manage pain and ensure the child remains adequately hydrated. Dehydration is a concern because mouth pain can make swallowing difficult, leading to a refusal of liquids. For pain and fever, over-the-counter analgesics such as acetaminophen or ibuprofen are recommended. These medications can improve a child’s willingness to drink fluids.
In some cases, a doctor may prescribe an antiviral medication like acyclovir. For it to be most effective, it needs to be started within the first 72 to 96 hours of symptom onset. Antiviral therapy is considered for children with more severe infections or who are immunocompromised, as it can shorten the duration of symptoms.
Home Care and Recovery Timeline
Supportive care at home is centered on minimizing discomfort and preventing dehydration. Dietary modifications are important to avoid irritating the oral ulcers. Offer soft, bland, and cool foods such as yogurt, applesauce, smoothies, and ice pops. Foods and drinks that are acidic, salty, spicy, or have a rough texture should be avoided as they can cause pain.
The illness resolves on its own within 10 to 14 days. The initial fever and systemic symptoms subside within the first three to four days. The oral sores will then begin to heal over the following one to two weeks, causing less discomfort. Prevent the spread of the virus to other family members by not sharing utensils, cups, or towels during the active infection.
Parents should monitor for signs of dehydration. Indicators of dehydration include:
- A dry mouth
- Decreased frequency of urination (fewer wet diapers in infants)
- The absence of tears when crying
- Unusual lethargy or listlessness
If a child is unable to drink liquids or appears to be getting sicker, medical attention is necessary.