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Primary Herpetic Gingivostomatitis
Primary Herpetic Gingivostomatitis is caused primarily by herpes simplex virus type 1. The primary infection is most severe and usually seen in children younger than 6.  The clinical syndrome of HSV gingivostomatitis lasts 10-14 days. Diagnosis is usually based on clinical history and exam findings.

Clinical presentation includes:

  • Fever and malaise (precede the anorexia, oral findings, and
    cervical lymphadenopathy)
  • Significant lip and gum swelling, erythema, and bleeding
  • Vesicles on the lips, tongue, and cheeks, which then ulcerate

Treatment for Primary Herpetic Gingivostomatitis
Treatment is mainly supportive with hydration maintenance and pain control. The acyclovir family of antiviral medications may be used for immunosuppressed patients. The infection is life-long, and recurrences occur as “cold soresâ€� (herpes labialis), usually at times of stress or infection. 

Coxsackie Viral Infections
Coxsackie viral infections include Herpangina and Hand-Foot-Mouth Disease. Fever, malaise, sore throat, and anorexia precede appearance of the vesicles. Cervical lymphadenopathy is also present. Symptoms last 7-10 days. Treatment is supportive care.

Fast Facts
The major morbidity of primary HSV infection is dehydration.
Treatment for viral infections with oral manifestations is generally only supportive care.
Consider immunodeficiency in a child who has frequent or persistent candidal infections after 1 year of age.
A strawberry tongue is commonly seen with GABHS infections and Kawasaki Syndrome.
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