31 August 2026Chapter 3: Gastrointestinal disordersPDF page 127
Oral herpes
Full paraphrased clinical guide to oral herpes, primary gingivostomatitis, recurrent cold sores, contagion, and supportive care.
This guide supports clinical education and care navigation. It does not replace bedside judgement, emergency care, specialist advice, or local treatment protocol.
Seek urgent care
- Inability to drink, dehydration, severe extensive ulcers, eye involvement, altered consciousness, or severe systemic illness.
- Frequent or extensive episodes suggesting HIV or immune suppression.
- Oral herpes in a newborn or very young infant.
Overview
Oral herpes is caused by herpes simplex virus.
Primary infection often occurs in children 6 months to 5 years and can cause acute gingivostomatitis, sometimes severe.
After primary infection, the virus remains in the body and can recur as herpes labialis.
Clinical features
- Primary gingivostomatitis may cause multiple vesicles on the mouth mucosa and lips that rupture into painful yellowish ulcers.
- General malaise, regional lymph node enlargement, and fever may occur.
- Recurrent herpes labialis causes clusters of vesicles at the lip-skin border and is usually benign.
Treatment and prevention of spread
- Assess hydration and feeding in children with primary gingivostomatitis; give fluid support when intake is poor.
- Frequent or extensive disease should prompt HIV or immune-status assessment. Immunocompromised patients need specialised management.
- Both primary and recurrent herpes are contagious. Avoid touching lesions, wash hands after contact, and avoid oral contact while lesions are active.
- Refer urgently for eye involvement, newborn infection, altered consciousness, severe dehydration, extensive disease, or immune suppression.
- Handover should include age, day of illness, lesion extent, oral intake, hydration, pain control, aciclovir eligibility/timing, secondary infection, eye findings, immune risk, and prevention advice.
| Situation | Treatment direction |
|---|---|
| Pain and fever | Use paracetamol or ibuprofen when appropriate. |
| Severe lesions, inability to drink, or significant pain | Admit the child because dehydration risk is high. |
| Presentation within 96 hours of symptom onset | Aciclovir PO for 5 to 7 days. Children under 2 years: 200 mg five times daily. Children 2 years and over and adults: 400 mg five times daily. |
| Secondary bacterial infection | Amoxicillin PO for 7 days according to age/weight guidance. |
| Expected course | Treatment direction |
|---|---|
| Usually benign | Spontaneous resolution within 7 to 10 days. |
| Symptomatic lesions | Apply an antiseptic such as chlorhexidine or povidone iodine when appropriate; use paracetamol if needed. |
Medicines in this guide
Paracetamol = acetaminophen oralPain or fever treatment for gingivostomatitis or recurrent lesions.Ibuprofen oralAlternative pain or fever treatment when appropriate.Aciclovir oralAntiviral for severe primary herpetic gingivostomatitis within 96 hours of symptom onset.Amoxicillin oralUsed when secondary bacterial infection is present.Chlorhexidine 0.2% mouthwashAntiseptic option for recurrent herpes labialis when appropriate.Povidone iodine 10%, aqueous solutionAntiseptic option when suitable for local mucosal/skin application.Oral rehydration salts = ORSSupport if painful lesions reduce drinking and dehydration risk develops.
Source
MSF Clinical guidelines - Diagnosis and treatment manual (December 2024)
This page is a paraphrased clinician-oriented guide derived from the source topic on PDF page 127. Medicine-specific details should be checked against local protocol and the linked drug-information pages.