What are the signs and symptoms of primary orolabial herpes simplex virus (HSV) infection?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Clinical features include the following [1] :

  • Abrupt onset of illness

  • Fever

  • Listlessness or irritability

  • Inability to eat and/or drink

  • Gingivitis (with markedly swollen, erythematous, and occasionally bleeding gums)

  • Increased drooling in infants due to pain on swallowing

  • Vesicular lesions on the tongue, buccal mucosa, and palate with extension, at times, to the lips and face (These may rupture and coalesce to form large, ulcerated areas.)

  • Tender submandibular or cervical adenopathy

The lesions can be quite painful and symptoms may persist for 10-14 days. Primary herpes simplex virus infection of the oropharynx may be associated with viral shedding for as long as 23 days.

Primary HSV-1 infection of the oropharynx in adolescents and adults usually manifests as pharyngotonsillitis rather than gingivostomatitis. Patients usually present with fever, malaise, odynophagia, and headache with vesiculoulcerative lesions on the tonsils.

Primary HSV-2 infection can have a presentation similar to this after orogenital contact and it may occur concurrently with genital herpes simplex virus infection.

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