Herpes in the mouth: primary gingivostomatitis and cold sores
- Oral pathology
First infection with herpes simplex causes painful mouth ulcers and swollen gums in young children. Later, the virus returns as cold sores on the lip.
What it is
Herpes simplex virus type 1 is caught in childhood by most people. The primary infection is often silent, but in some children (usually between six months and five years) it causes primary herpetic gingivostomatitis: fever, irritability, drooling, refusal to eat or drink, swollen bleeding gums and clusters of vesicles that break into ulcers anywhere in the mouth and on the lips. The virus then stays latent in the trigeminal ganglion and can reactivate (sun, fever, stress, menstruation) as herpes labialis: tingling, then vesicles and crusts on the lip border, healing in about a week. In immunocompromised people recurrences can be large and intraoral.
How to recognise it
- Primary infection: whole-mouth ulcers plus inflamed gingiva, fever, lymph nodes; lasts one to two weeks.
- Recurrence: vesicles on the lip border or on keratinised mucosa (hard palate, attached gingiva).
- Aphthous ulcers, by contrast, occur on non-keratinised mucosa and are not preceded by vesicles.
- Herpangina (coxsackievirus) affects the back of the mouth; hand, foot and mouth disease adds skin lesions.
- Herpes zoster of V2 or V3 gives a unilateral band of vesicles that stops at the midline.
Differential and risks
- The main danger in children is dehydration from refusal to drink.
- Touching lesions and then the eye can cause herpetic keratitis; autoinoculation of fingers gives herpetic whitlow.
- Newborns, people with eczema (eczema herpeticum) and the immunocompromised can develop severe disease.
Next step / Initial management
- Primary gingivostomatitis: fluids, analgesia (paracetamol or ibuprofen), soft cold foods; oral aciclovir if seen early (within about three days) or severe.
- Admit and give intravenous fluids if the child cannot drink or is dehydrated; refer urgently if the eye is involved or the child is immunocompromised or a newborn.
- Cold sores: topical or oral antivirals at the first tingling; sun protection for the lips; frequent or severe recurrences may need suppressive therapy and evaluation for immunosuppression.
Test yourself
Think of the answer, then tap the question to see it.
What distinguishes primary herpetic gingivostomatitis from aphthous ulcers?
Fever, inflamed gums and vesicles turning into ulcers anywhere, including keratinised mucosa; aphthae occur on non-keratinised mucosa without vesicles or fever.
Where does herpes simplex virus stay latent after oral infection?
In the trigeminal ganglion.
What is the most common reason to admit a child with herpetic gingivostomatitis?
Dehydration because of refusal to drink.
Elsewhere in DurgiPedia
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In Pharmacology2
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Herpetic Gingivostomatitis (StatPearls Publishing (NCBI Bookshelf), 2023); Herpes Simplex Type 1 Infection (StatPearls Publishing (NCBI Bookshelf), 2023); Viral Infections of the Oral Mucosa (StatPearls Publishing (NCBI Bookshelf), 2023); Herpes simplex virus (World Health Organization, 2024).
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