Herpes Simplex Stomatitis (Herpetic Gingivostomatitis)

What causes herpes simplex stomatitis

It is caused by herpes simplex virus type 1 (HSV-1), the same virus that causes cold sores. Most people catch HSV-1 in childhood, often from a parent, relative or another child with a cold sore or who is shedding the virus without symptoms. It spreads through saliva and direct contact, such as kissing and sharing cups, utensils or toys.

Many first infections cause no symptoms. In some children, the first infection causes this widespread mouth illness. After it heals, the virus stays dormant in nerves and can reactivate later as cold sores.

Symptoms

Early (first 1 to 2 days)

• fever, often high
• irritability, poor appetite and tiredness
• drooling
• swollen neck glands

Mouth and lips

• red, swollen gums that bleed easily
• clusters of small blisters that burst into shallow, painful, yellow-gray ulcers with a red rim
• sores on the gums, tongue, roof of the mouth, inside the cheeks and lips
• blisters and crusts on the skin around the mouth
• bad breath
• refusal to eat or drink because of pain

Course

Fever usually settles in 3 to 5 days. Sores heal over 10 to 14 days without scarring.

How it differs from other mouth sores

Diagnosis

Doctors usually recognize it from the appearance and the child's age. A swab of a blister for PCR testing can confirm the virus when the diagnosis is uncertain, the child is very young or immunocompromised, or eye or skin complications are suspected.

Treatment

Keeping hydrated

This is the most important part of care:

• Offer small amounts of fluid often: water, milk, oral rehydration solution or diluted juice.
• Cold drinks, ice pops, yogurt, smoothies and soft, cool foods are easiest.
• Avoid salty, spicy, acidic (orange juice, tomatoes) and crunchy foods.
• A straw or cup may be easier than a bottle.

Pain relief

• Acetaminophen (paracetamol) or ibuprofen at the correct dose for the child's age and weight, following the label. Do not give aspirin to children or teenagers.
• Giving pain relief 30 minutes before meals helps eating.
• Ask a pharmacist about protective mouth gels suitable for the child's age. Avoid benzocaine in children under 2.
• Do not use "magic mouthwash" with numbing agents in young children without medical advice, because of choking and toxicity risks.

Antiviral medicine

Acyclovir, started within the first 3 to 4 days of symptoms, can shorten the illness, fever and pain, and is recommended for children who are severely affected, very young or have weakened immune systems. Ask a doctor early.

Hospital care

Some children need hospital admission for IV fluids if they cannot drink enough.

Complications

• Dehydration: the most common reason for hospital care
• Herpetic whitlow: painful blisters on a finger from thumb-sucking
• Eye infection (herpes keratitis), which can damage vision
• Eczema herpeticum in children with eczema
• Rarely, encephalitis
• Severe infection in newborns and immunocompromised people

Preventing spread

• Wash hands often and keep the child's hands away from the eyes.
• Do not share cups, utensils, towels or toothbrushes.
• Avoid kissing, especially near babies and people with eczema or weakened immunity.
• Keep children out of child care until they are fever-free and drooling has stopped and sores are healing, depending on local policy.
• Adults with cold sores should avoid kissing babies.

Frequently asked questions

How long does herpetic gingivostomatitis last?

It usually lasts about 10 to 14 days. Fever tends to settle within 3 to 5 days, and mouth sores gradually heal over the next week or so without scarring. Antiviral medicine started early can shorten the illness.

Is herpes simplex stomatitis contagious?

Yes. The virus spreads through saliva and contact with sores, especially while blisters are present. Washing hands, not sharing cups or utensils, and avoiding kissing reduce spread. Most people carry HSV-1 by adulthood.

Will my child get cold sores later?

Possibly. After the first infection, the virus stays dormant in nerves. Some children later get cold sores on the lips, triggered by colds, sun or stress. Many never have another noticeable outbreak, and repeated widespread mouth infection is uncommon.

How do I get my child to drink with mouth sores?

Give pain relief 30 minutes before drinks, offer cold fluids, ice pops and smoothies frequently in small amounts, and try a straw or spoon. Avoid acidic and salty foods. If your child is not passing urine at least every 6 to 8 hours, seek medical care.