HSV Gingivostomatitis

  • See also: Specimen collectionsite
    IV fluid guideline
    Pharmacopoeia online

    Background

    Primary Herpes simplex virus (HSV) infection in children is usually asymptomatic or non- specific. Herpetic gingivostomatitis is the most common specific clinical manifestation, occurring in 25% to 30% of cases

    • Condition is usually self limiting
    • General course is 10 -14 days
    • Virus readily transmitted through direct contact 
    • Ensuring adequate hydration and analgesia are the mainstays of treatment
    • There is little role for the use of antiviral medications except in certain circumstances

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    Assessment

    See flow chart

    Diagnosis

    • The diagnosis is clinical in the majority of cases
    • Typical herpetic gingivostomatitis usually does not require lab confirmation
    • Where confirmation is required (immunocompromised host or contact), direct immunofluorescence (DIF) and cell culture of scrapings from the base of the lesion should be performed (See how to take swab for HSV)
    • Serology is rarely helpful

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    Management

    See flow chart

    Analgesia

    Pain relief is of paramount importance in HSV gingivostomatitis

    • Topical analgesics are effective but may be expensive eg Xylocaine Viscous®, Lignocaine gel 2%® 
    • Regular analgesics such as paracetamol seem to have little effect, although Codeine containing medications may be beneficial eg Painstop®

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    Specific treatment

    • Aciclovir is not recommended in immunocompetent hosts with typical herpetic gingivostomatitis
    • Topical aciclovir is generally not effective
    • Specialist advice should be sought regarding immunocompromised patients

    Notes

    • Central nervous system involvement, although rare, can occur with HSV and should be considered in patients who are unusually lethargic or who have abnormal neurological findings see flow chart

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    Appendix

    HSV Stomatitis flowchart

    Appendix-HSV-Stomatitis-flowchart

    Download PDF (71 KB)

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    Specimen collection guide for Herpes Simplez & Varicella Zoster virus detection

    Material required:
    (Available from the RCH Virology Lab 8th floor)

    1. Two sterile swabs
    2. One vial of Viral Transport Medium, (pink medium)
    3. One painted 3-well glass microscope slide.

    Method of collection:

    1. Puncture the vesicle with a sterile swab / needle.
    2. Collect as much of the vesicle fluid as possible by absorbing onto a sterile  dry swab. (Shown in Diagram 1)
    3. Immediately immerse and break the swab into Viral Transport Media for viral isolation studies.
      HSV swab diagram 1
    4. After the vesicular fluid is removed for isolation, lift the loose flap of skin and roll the second sterile swab back and forth across the base and under the flap. Holding a clean 3 well slide by the frosted end, painted side up, smear the sample onto the wells. Use a circular motion and a new surface of the swab for each well. (Shown in Diagram 2).
    5. Immerse and break the second swab into Viral Transport Medium for viral isolation studies.
      HSV swab diagram 2