Clinical Aspects and Antiviral Therapy in Primary Herpetic Gingivostomatitis

Abstract

Primary symptomatic herpes simplex virus infection in children usually manifests as gingivostomatitis and is prevalent in the 1- to 3-year age group. The disease involves the buccal and gingival mucosa and the tongue, and lasts approximately 2 weeks. Two recent non-blind studies reported a more rapid regression of symptoms after treatment with aciclovir suspension. Three randomised double-blind, placebo-controlled trials have clearly demonstrated that early aciclovir treatment significantly shortens the duration of all clinical manifestations and infectivity of affected children compared with placebo. We conclude that the treatment of herpetic gingivostomatitis with aciclovir is recommended. Treatment should be started within the first 3 days of disease onset. The proposed therapeutic dose is 15 mg/kg, 5 times daily for 5 to 7 days.

Question 1

“…Primary herpes simplex gingivostomatitis is a self-limiting condition and affected individuals may experience significant mouth pain, fever, and difficulty eating and drinking, as well as being highly infectious 5. Although an approved treatment, retrospective data suggest that aciclovir is used infrequently in the management of this condition 7.…”

An approach to oral infections and their management

“…Herpetic gingivostomatitis has a peak incidence in the 1-to 3-year age group, and only 13% to 30% of children with primary infection present with symptoms [43]. In contrast, adolescents and adults with primary HSV gingivostomatitis present with painful vesicular lesions that subsequently ulcerate on the buccal surfaces, gingiva, and tongue.…”

“…Viral culture from vesicles or rapid enzyme immunoassays for HSV detection helps in making the diagnosis. Antiviral therapy with acyclovir shortens the time to healing in primary herpes labialis in children [43]. Valacyclovir, a prodrug of acyclovir that achieves therapeutic concentrations with longer dosing intervals, may be used as an alternative (Table 1).…”

Summary of ‘Acylovir for treating primary herpetic gingivostomatitis’, including tables of key findings and quality of included trials

“…The differential diagnosis of primary herpetic gingivostomatitis includes acute necrotizing ulcerative gingivitis, herpangina, aphthous stomatitis, candidiasis of the mouth, Steven-Johnson syndrome and hand, foot and mouth disease (1,5).…”

“…herpes encephalitis, neonatal herpes, primary herpes genitals and recurrent herpes labialis) (5). One of the limitations of acyclovir is its poor gastrointestinal absorption and bioavailability and therefore derivatives (e.g.…”