GPAtlas🧭 When to suspect
Oral herpes is infection with the herpes simplex virus (HSV), usually HSV type 1 (HSV-1). It presents in two main ways: a severe first (primary) infection in young children – primary herpetic gingivostomatitis (PHG) – and recurrent cold sores (herpes labialis) thereafter. After the primary infection the virus stays latent in the trigeminal sensory ganglion and reactivates with triggers.
Suspect PHG in a child under 5 with fever, malaise, severe oral pain and poor oral intake, and widespread vesicles or ulcers on the gums and oral mucosa. Suspect recurrent herpes labialis when grouped vesicles appear at the vermilion border, often preceded by a tingling or burning prodrome, with known triggers such as ultraviolet (UV) exposure, stress, fatigue, fever or menstruation. Diagnosis is almost always clinical.
| Presentation | Key features |
|---|---|
| Primary herpetic gingivostomatitis (PHG) | Children < 5; fever, malaise, widespread gingival inflammation with vesicles/ulcers on gums, tongue, buccal mucosa and palate; severe pain, drooling, reduced intake; tender cervical lymphadenopathy; lasts 7–14 days. |
| Recurrent herpes labialis (cold sores) | Tingling/burning prodrome; grouped vesicles at the vermilion border or perioral skin that crust over; self-limiting in 7–10 days; recognised triggers. |
| Herpetic whitlow | Painful grouped vesicles on a finger or thumb from autoinoculation (e.g. thumb-sucking, nail-biting) – often mistaken for bacterial infection. |
| Eczema herpeticum | A patient with atopic eczema developing rapidly spreading, monomorphic, punched-out vesicles/erosions ± fever – a dermatological emergency. |
Adults can also develop primary gingivostomatitis, though it is usually milder and more often associated with a posterior pharyngitis. Raise suspicion of complications in the immunocompromised (chemotherapy, HIV), in anyone with atopic eczema, and in neonates.
Source: DermNet
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.