Treatment of Herpangina
Herpangina is a self-limited viral illness requiring only supportive care, as there is no specific antiviral therapy indicated for this enterovirus infection.
Key Clinical Distinction
Herpangina is not caused by herpes simplex virus (HSV) despite its name. The provided evidence about HSV treatment with acyclovir, valacyclovir, and famciclovir 1, 2 is not applicable to herpangina, which is caused by enteroviruses—primarily Coxsackievirus A, Enterovirus A, and Echovirus 3.
Recommended Treatment Approach
Symptomatic Management
- Supportive care is the mainstay of treatment, as the disease is self-limited with a typical course of 4-6 days and good prognosis 3
- Topical oral spray with antiviral agents may be incorporated for symptom relief 3
- Pain management for oral lesions (oral lesions rarely persist more than 7 days) 4
- Fever control as needed (herpangina patients have significantly higher body temperatures and fever incidence compared to hand-foot-mouth disease) 5
Emerging Evidence for Specific Therapy
- Interferon α-2b spray showed superior efficacy compared to Ribavirin in a large randomized controlled trial of 668 children, with 98.5% achieving fever resolution within 72 hours versus 94.3% with Ribavirin (P=0.004) 6
- The interferon α-2b spray also demonstrated faster improvement in oral herpes lesions (46.7% vs 37.1%, P=0.011) with no adverse reactions 6
- This represents the highest quality evidence for active treatment, though supportive care remains standard in most settings 6
Prevention Strategies
- Hand-washing by children and caregivers has a highly significant protective effect (OR: 0.00069,95% CI: 0.0022-0.022) 7
- Avoid crowded places and contact with infected children during outbreaks (OR for exposure: 7.3-11) 7
- Social distancing measures during epidemic periods 7
Common Pitfalls to Avoid
- Do not prescribe acyclovir or other HSV antivirals—these are ineffective against enteroviruses and represent inappropriate use of resources
- Do not confuse with HSV pharyngitis/stomatitis—herpangina has characteristic posterior pharyngeal vesicles, while HSV typically affects anterior oral structures
- Do not overlook the need for virological confirmation in atypical cases, as diagnosis is based on epidemiology, typical symptoms, characteristic pharyngeal damage, and virological testing 3