Human herpes virus (HHV-1) infections of the oral cavity
are very common. These are DNA viruses that spread
through direct contact. Primary infection most often occurs
in infancy or childhood. It typically follows viral entry into
the oral mucosa, and may be symptomatic, unnoticed,
unrecognized, or asymptomatic. Primary herpetic
gingivostomatitis occurs in individuals who lack primary
immunity 5–7 days following contact with a source. A
vesicular eruption can be preceded by a prodrome of local
tenderness. The vesicles are thin walled and short-lived,
leaving behind shallow, painful ulcers. A characteristic and
diagnostic feature of this infection is the involvement of
keratinized mucosa, especially the marginal gingiva.
The lesions last 1–2 weeks and settle spontaneously
but, despite clinical resolution, viral shedding takes place
and these individuals can be a source of infection.
Differential diagnosis mainly consists of noninfective
conditions such as herpetiform apthous stomatitis,
erythema multiforme, and Stevens-Johnson syndrome.
Infective conditions include acute necrotizing
gingivostomatitis, herpes zoster, measles, and other rarer
Treatment is usually symptomatic to relieve the pain and
maintain oral hygiene. Paracetamol and ibuprofen are
effective in relieving pain and pyrexia. Local analgesics such
as benzydamine hydrochloride mouthwash or lidocaine
(lignocaine) ointment can be used, but their duration of
action is short-lived. Chlorhexidine mouthwash or gel helps
prevent bacterial superinfection of the ulcerated areas and is
therefore indicated. There is no evidence to support the use
of topical antiviral agents for the first attack of oral herpes
simplex. In severe cases, especially in adults or immuno –
compromised patients, systemic antivirals (acyclovir and
famciclovir) may reduce the duration of symptoms if taken
early in an attack and can be used in severe infections.
Owing to the high risk of infecting others, appropriate
advice on hand washing and limiting contact must be given.