AtlasVesiculobullousPrimary Herpetic Gingivostomatitis

Vesiculobullous Diseases

Primary Herpetic Gingivostomatitis

aka PHGS · Primary Herpes · Acute Herpetic Gingivostomatitis

Acute, self-limiting primary infection with HSV-1 causing widespread oral vesicles, ulcers, and gingivitis in children.

Agent
HSV-1
Age
6mo - 5yr
Rx
Aciclovir (within 72h) + supportive

§ figuresFigures (2)

Fig. 1Herpetic gingivostomatitis. Note ulcers just below the front bottom teeth within the circle.

“Herpesgingiva” · James Heilman, MD · CC BY-SA 3.0 · Wikimedia Commons

Fig. 2Herpetic whitlow in a young child who in the previous few days had developed gingivostomatitis

“Herpetic whitlow in young child” · James Heilman, MD · CC BY-SA 3.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Primary Herpetic Gingivostomatitis figures pending faculty review.

§ overviewOverview

Primary infection with herpes simplex virus type 1 presenting as acute vesicular and ulcerative stomatitis with systemic symptoms.

§ icdICD Classification

B00.2

§ etiologyEtiology

  • 01HSV-1 (>90%); HSV-2 in genital-oral transmission

§ epidemiologyEpidemiology

Most common viral oral infection. Peak 6 months – 5 years. Also young adults.

§ pathogenesisPathogenesis

HSV infects epithelial cells → replication → cell lysis → vesicle formation → ulceration. Virus establishes latency in trigeminal ganglion.

§ clinicalClinical Features

  • 01Prodrome: fever, malaise, irritability
  • 02Oral: vesicles on keratinised and non-keratinised mucosa → shallow painful ulcers
  • 03Fiery red, swollen, bleeding gingiva
  • 04Cervical lymphadenopathy
  • 05Resolves 10–14 days

§ differentialDifferential Diagnosis

  • 01Herpangina (posterior)
  • 02Hand-foot-mouth disease
  • 03Aphthous stomatitis
  • 04Erythema multiforme

§ histopathHistopathology

  • 01Ballooning degeneration
  • 02Acantholysis
  • 03Cowdry type A intranuclear inclusions
  • 04Multinucleated epithelial cells

§ investigationsInvestigations

  • 01Clinical diagnosis
  • 02Tzanck smear (multinucleated giant cells)
  • 03Viral culture/PCR if atypical

§ treatmentTreatment

  • 01Supportive: hydration, soft diet, antipyretics
  • 02Aciclovir (if within 72h onset): 15 mg/kg 5×/day × 7 days (children)
  • 03Topical benzocaine, lidocaine gel for pain

§ complicationsComplications

  • 01Dehydration (pain → poor intake)
  • 02Herpetic whitlow
  • 03Herpes keratitis
  • 04Encephalitis (rare)

§ prognosisPrognosis

Excellent; self-limiting but virus persists latent.

§ examKey Examination Points

  • 01Vesicles on ALL mucosa (keratinised + non-keratinised)
  • 02Fiery red gingivitis
  • 03Tzanck smear

§ revisionQuick Revision Summary

  • 01HSV-1 primary infection
  • 02Children 6mo-5yr
  • 03Aciclovir within 72h

§ vivaBDS Viva Questions

  • 01How do you differentiate PHGS from herpangina?
  • 02What is Tzanck smear?
  • 03Describe the histology.

§ mcqsMCQs — Assessment (3)

Question 1

PHGS affects:

Question 2

Histological feature:

Question 3

Aciclovir is most effective if started within:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Histopathology References

Reference #4L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #2L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #3L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. Neville BW. Oral & Maxillofacial Pathology, 4e
  2. Arduino PG. J Oral Pathol Med 2008

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.