Etiology • Herpes simplex virus (HSV) • Over 95% of oral primary herpes due to HSV-1 • Physical contact is mode of transmission
Clinical Presentation • 88% of population experience subclinical infection or mild
transient symptoms • Most cases occur in those between 0.5 and 5 years of age. • Incubation period of up to 2 weeks • Abrupt onset in those with low or absent antibody to HSV-1 • Fever, anorexia, lymphadenopathy, headache, in addition to
Clinical Presentation • 88% of population experience subclinical infection or mild
transient symptoms • Most cases occur in those between 0.5 and 5 years of age. • Incubation period of up to 2 weeks • Abrupt onset in those with low or absent antibody to HSV-1 • Fever, anorexia, lymphadenopathy, headache, in addition to
oral ulcers • Coalescing, grouped, pinhead-sized vesicles that ulcerate • Ulcers show a yellow, fibrinous base with an erythematous halo • Both keratinized and nonkeratinized mucosa affected • Gingival tissue with edema, intense erythema, pain, and
tenderness • Lips, perioral skin may be involved • 7- to 14-day course
Diagnosis • Usually by clinical presentation and pattern of involvement • Cytology preparation to demonstrate multinucleate virus-
infected giant epithelial cells • Biopsy results of intact macular area show intraepithelial
vesicles or early virus-induced epithelial (cytopathic) changes • Viral culture or polymerase chain reaction (PCR) examination
of blister fluid or scraping from base of erosion
Differential Diagnosis • Herpangina • Hand-foot-and-mouth disease • Varicella • Herpes zoster (shingles) • Erythema multiforme (typically no gingival lesions)
Treatment • Soft diet and hydration • Antipyretics (avoid aspirin) • Chlorhexidine rinses • Systemic antiviral agents (acyclovir, valacyclovir) if early in
course or in immunocompromised patients • Compounded mouth rinse
Prognosis • Excellent in immunocompetent host • Remission/latent phase in nearly all those affected who have
adequate antibody titers