Intended for healthcare professionals

Practice 10-Minute Consultation

Primary herpetic gingivostomatitis in children

BMJ 2021; 375 doi: (Published 31 December 2021) Cite this as: BMJ 2021;375:e065540
  1. Isabelle Heliotis, specialty trainee in paediatric dentistry1,
  2. Rosemary Whatling, consultant in paediatric dentistry1,
  3. Shinal Desai, specialty trainee in orthodontics2,
  4. Medona Visavadia, general medical practitioner3
  1. 1The Royal London Dental Hospital, London, UK
  2. 2Birmingham Dental Hospital, Birmingham, UK
  3. 3Watford Health Centre, Watford, UK
  1. Correspondence to I Heliotis Isabelle.heliotis{at}

What you need to know

  • Primary herpetic gingivostomatitis (PHGS) typically has a prodrome of 2-4 days, and consists of fever, malaise, headaches, and cervical lymphadenopathy before generalised gingival inflammation and ulceration occur

  • PHGS is often a self-limiting infection that resolves in 10-14 days. Be aware of more serious complications of a herpes simplex infection, including erythema multiforme, aseptic meningitis, and encephalitis

  • Treatment with oral aciclovir is recommended within five days of prodromal signs and symptoms

A mother and father bring their 2 year old child to their GP, concerned that she has had a fever for two days and has been unsettled. Today they also noticed that their child has a loss of appetite, and several small ulcers have formed in her mouth. Her gums appear very inflamed.

Non-specific prodromal symptoms followed by oral inflammation and ulceration in a child of this age are characteristic of primary herpetic gingivostomatitis (PHGS). Although PHGS is self-limiting and is rarely associated with severe complications, the child’s lack of appetite and malaise, and the painful appearance of the oral tissues can distress the parents and child. This article offers an overview of the typical presentation of PHGS, the differentials to consider, and management advice for parents.

PHGS is an acute infectious disease affecting the oral cavity and is classically caused by herpes simplex virus type 1 (HSV-1).1 The virus is transmitted through direct contact with a lesion or infected body fluids (eg, saliva) and frequently affects children aged 2-5 in the form of PHGS.123 Infection before the age of 6 months is rare, owing to circulating maternal antibodies which are present in 70-80% of the adult population.1234 The absence of passive immunity can result in early contraction of HSV-1, which can be a potentially serious complication in a young infant.

Primary …

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