Herpangina

Symptoms

Symptoms begin 3 to 6 days after exposure and come on suddenly:

• fever, often 38.9 to 40 °C (102 to 104 °F)
• sore throat and painful swallowing
• small grayish blisters, 1 to 2 mm, on the soft palate (back of the roof of the mouth), uvula, tonsils and back of the throat, which break into shallow, red-rimmed ulcers
• typically 2 to 12 sores
• drooling, refusing food and drinks in young children
• headache, neck pain, tiredness and loss of appetite
• sometimes vomiting or belly pain

The fever usually lasts 2 to 4 days, and the sores heal within 7 to 10 days.

Herpangina vs similar conditions

How herpangina spreads

Enteroviruses spread through:

• saliva, nasal mucus and droplets from coughs and sneezes
• stool, especially during diaper changes and toilet use
• contaminated hands, toys and surfaces

Children are most contagious during the first week, but the virus can remain in stool for several weeks after symptoms clear. Outbreaks are common in childcare and schools in summer and early fall.

Diagnosis

Herpangina is diagnosed by looking at the mouth and throat. The typical location of the sores at the back of the mouth, with fever and no hand or foot rash, is usually enough. Tests are rarely needed but may be used to rule out strep throat or in severe cases.

Treatment and home care

There is no specific antiviral treatment, and antibiotics do not work against viruses. The goal is comfort and hydration.

Keep your child drinking

• offer small, frequent sips of cool water, milk or oral rehydration solution
• cold foods and drinks, such as ice pops, smoothies, yogurt and ice cream, soothe the throat
• avoid acidic, salty or spicy foods and juices like orange juice, which sting
• a straw or spoon may help if drinking from a cup hurts
• soft foods such as mashed potatoes, pasta and soup (lukewarm)

Pain and fever relief

• acetaminophen (paracetamol) or ibuprofen at the dose for your child's weight. Ibuprofen is not for babies under 6 months. Do not give aspirin to children or teenagers.
• giving pain relief 30 minutes before meals can make eating and drinking easier
• for children old enough not to swallow it, rinsing with salt water can soothe
• avoid numbing gels containing benzocaine in children under 2

Preventing spread

• wash hands often with soap and water, especially after diaper changes and toilet use
• avoid sharing cups, utensils and towels
• clean toys and frequently touched surfaces
• keep children home from childcare or school while they have a fever and are unwell, and until they feel well enough to participate

Herpangina in adults

Adults can get herpangina, usually from a child in the household. Symptoms are similar but often milder. Many adults have immunity from childhood infections.

Complications

Most children recover completely. Possible complications include:

• dehydration, the most common reason for a hospital visit
• rarely, enteroviruses cause viral meningitis, encephalitis or inflammation of the heart muscle (myocarditis)
• newborns can develop more severe disease

Frequently asked questions

What does herpangina look like?

Herpangina causes small grayish blisters at the back of the roof of the mouth, the uvula and around the tonsils. They burst into shallow ulcers with red borders. There is usually no rash on the hands or feet, which distinguishes it from hand, foot and mouth disease.

How long is herpangina contagious?

Children are most contagious in the first week of illness. However, the virus can be shed in stool for several weeks after symptoms go away, so good handwashing is important even after recovery.

How long does herpangina last?

The fever usually lasts 2 to 4 days, and the mouth sores heal within 7 to 10 days. Most children feel much better within a few days, though eating may be uncomfortable for about a week.

Can adults get herpangina?

Yes, though it is much less common than in children. Adults usually catch it from a child and often have milder symptoms. Treatment is the same: fluids, pain relief and rest.