Symptoms of Herpetic Gingivostomatitis
Herpetic gingivostomatitis presents with fever, irritability, tender submandibular lymphadenopathy, and painful ulcers in the gingival and oral mucosa, typically lasting about 12 days in children. 1, 2
Clinical Manifestations
Prodromal Phase
- Initial symptoms include fever, anorexia, irritability, malaise, and headache that may occur before visible oral lesions appear 3
- Fever typically lasts for approximately 4-5 days 2
Oral Manifestations
- Numerous pin-head vesicles form in the mouth, which rupture rapidly to form painful irregular ulcerations covered by yellow-grey membranes 3
- Lesions affect the buccal and gingival mucosa and tongue 4
- Oral lesions persist for an average of 12 days in untreated children 2
Associated Symptoms
- Submandibular lymphadenitis (swollen lymph nodes under the jaw) 1
- Halitosis (bad breath) 3
- Refusal to drink due to pain 3
- Eating difficulties lasting approximately 9 days 2
- Drinking difficulties lasting approximately 7 days 2
Extraoral Manifestations
- Lesions around the mouth but outside the oral cavity (extraoral lesions) occur in many patients 2
- These extraoral lesions typically last about 12 days 2
Disease Progression
- The disease follows a characteristic progression from prodromal symptoms to vesicle formation, pustulation, ulceration, and finally scabbing 1
- Peak viral titers occur in the first 24 hours after lesion onset 5
- Viral shedding persists for an average of 7 days (range 2-12 days) 2
Complications
- Dehydration is the most common complication, sometimes requiring hospitalization for intravenous rehydration 2
- Secondary bacterial infections can occur, including bacteremia in rare cases 2
- In immunocompromised patients, episodes are usually longer and more severe, potentially involving the entire oral cavity or extending across the face 5
- HIV-infected children with severe immunocompromise may experience more frequent and severe recurrences with potential for disseminated disease involving multiple organs 5
Special Considerations
- In immunocompetent hosts, primary infection is typically self-limiting 3
- After resolution, the virus establishes latency in sensory ganglia and may reactivate later as herpes labialis (cold sores) 5
- Reactivation triggers include exposure to ultraviolet light, fever, psychological stress, and menstruation 5, 1
Recognizing these symptoms promptly is important as early treatment with antiviral therapy (within 72 hours of symptom onset) can significantly reduce the duration of symptoms and viral shedding 6, 4.