All You Need To Know About Herpetic Gingivostomatitis & Why You Must Avoid Any Adult From Kissing Your Kids

In January, just a few weeks after Beat FM OAP, Tolu Oniru aka Toolz welcomed her first child, she took to her Instagram handle to issue a notice to everyone to not attempt to kiss her newborn after she shared the photo of a baby that had contracted herpes following being kissed by a visitor.

Herpes is an infection caused by exposure to the herpes simplex virus, many adults are carriers without even knowing it, but when they kiss babies and newborns, the virus is transmitted to the child and can have fatal or life-threatening consequences because their immunity has not reached maturity.

Most times, it is safer for parents to insist on no one kissing the baby, since it will not always be obvious, who could potentially infect the baby.

Dr Ganiyu Abib, a general dentist at GeeTee Dental Centre in Southwest Houston, Texas, US., is once again bringing the topic to light. In an interview with PUNCH, the expert talks about herpetic gingivostomatitis, a contagious infection of the mouth common among children and adults.

What is herpetic gingivostomatitis?

Herpetic gingivostomatitis is a contagious infection of the mouth caused by a virus called herpes simplex virus, also known as HSV. Numerous small blisters erupt in the affected area and these blisters rapidly rupture, leaving a painful ulcer which may coalesce and form a bigger ulcer. The term, herpetic, is derived from the first part of the virus’ name, herpes, and the term, gingivostomatitis, is combination of gingivitis and stomatitis.

Gingivitis is a medical term for inflammation of the gum and stomatitis simply refers to inflammation of the lining of the mouth, including the lips. The virus responsible for this infection is of two types: herpes simplex virus type-1 and herpes simplex virus type-2. HSV-1 causes most of the infection in the mouth, nose, face and eyes, whereas, HSV-2 is responsible for the infection in the genital areas and skin in the lower part of the body.

SEE ALSO: It’s RSV Season! Mom Raises Awareness On The Dangers Of Kissing Babies After She Almost Lost Her Infant To The Virus

Are there different types of the infection?

Yes, there are two types: primary (acute) herpetic gingivostomatitis and secondary (recurrent) herpetic gingivostomatitis. The PHGS refers to the infection of HSV when it happens for the first time. Subsequent infection by HSV is known as secondary (recurrent) herpetic gingivostomatitis. Primary infection occurs most often in infancy or childhood. It may or may not be symptomatic. Gingivostomatitis is the most common presentation in young children. It presents with blisters and then ulcers after a rupture on the tongue, lips, gums, buccal mucosa and hard and soft palates.

Pain, inability to swallow, drooling and dehydration are common. There may be associated fever, cervical lymphadenopathy (swelling of glands in the neck), halitosis (mouth odour), lethargy, irritability and loss of appetite. Pharyngitis (inflammation of upper part of the throat) is a more common presentation in adolescents. Herpetic whitlow is the infection of a finger by the HSV, which may occasionally occur via spread to the fingers.

The recurrent infection tends to occur in the same location, usually unilateral (affecting only one side of the body) and recurs two or three times a year on average. Prodromal (early) symptoms may occur six to 24 hours before the appearance of a lesion and include tingling, pain and or itching in the skin around the mouth.

Cold sores are usually seen on the lips and extend to the skin around the mouth. Other areas on the face, chin, or nose are sometimes involved. Lesions begin as reddish areas that swell and then become vesicles (blisters), which then rupture into ulcers. This takes one to three days. The ulcers crust over and the skin returns to normal within about two weeks without scar formation.

How does the infection present itself in severe cases?

In severe cases of PHGS, the infection appears as several clusters of blisters on the gum, lining of lips, cheeks, tongue, palate (roof of the mouth) and throat. Approximately 24 hours later, the blisters rupture resulting in several painful sores with red margin and whitish central portion. There may be presence of swelling and bleeding of the gum. Sometimes, it may be difficult to swallow and drooling may be present. Also, because the sores make it difficult to eat and drink, dehydration can occur.

What is the major cause?

Herpes simplex virus type-1 is the major cause of PHGS. During the initial (primary) infection, the virus ascends through the nerve to an area of the brain called ganglion. The virus remains dormant in the ganglion until favourable time for secondary infection comes.

The dormant HSV in the brain is responsible for the secondary infection (SHGS). Reactivation of the dormant virus can be spontaneous or can be due to factors like stress, trauma, sunlight, feverish condition, low immunity and so on. After reactivation, the virus travels down through the nerve to infect different parts of the mouth and perioral areas.

Is it transmittable and can it be transmitted through kissing?

HGS is a highly contagious disease. It can be transmitted through contact with the saliva of infected persons, direct contact with the ruptured blister and kissing.

What are the risk factors?

The risk factors include but are not limited to reduced immunity, age, socio-economic status and clustering of individuals. When the host’s immunity is low, the tendency of contacting the infection as well as its severity and prevalence is high. PHGS is very common among children between the ages of six months and six years, with peak period being ages two to four years.

Individuals with low socio-economic status have a higher odd of developing HSV-1. Also, places like daycare, orphanages, small and enclosed environments will promote spread of the infection.

How is it diagnosed?

Most of the time, diagnosis of HGS is done clinically. This means that the clinician asks questions to confirm the presence or absence of related symptoms and examines the patient’s mouth for signs of HGS. In rare cases, the doctor may take further steps, which involves taking a swab of the affected area and sending to the laboratory for analysis.

How common is the infection in Nigeria?

The infection is very common in Nigeria. The primary infection is very common among children between the ages of six months and six years with peak period being between ages two to four years. The second peak period is seen between ages 21 and 23 years.

SEE ALSO: How Usher Raymond Allegedly Infected Women With Genital Herpes | Women + Babies Mostly at Risk

Is it curable?

Unfortunately, it is not curable. Once an individual contracts herpes simplex virus, recurrent infection, cold sore outbreaks are likely to occur when the carrier is exposed to risk factors like stress, when the immune system is weakened, or when there is an exposure to ultraviolet rays.

What are the different treatment options?

The focus of treatment is mainly to reduce discomfort, which include pain control, reducing duration of symptoms, getting rid of the viral infection and preventing dehydration.

Some of the treatment options include taking over-the-counter medicine, like acetaminophen for fever and pain relief; maintaining good oral hygiene, through gentle cleaning with gauze and toothpaste, which will reduce secondary bacterial infection and facilitate healing of ulcers in the mouth; and rinsing the mouth with a saltwater solution. One teaspoon of salt in one cup of warm water helps with healing of the ulcers by preventing secondary bacterial infection.

Other treatment options are oral topical analgesics, like lidocaine gel and diphenhydramine, which are helpful in reducing discomfort in severe cases of HGS; and soft diet like oatmeal, mashed banana, and drinking plenty of water and or juice, which help to rehydrate affected individuals.

An antiviral drug called acyclovir may be prescribed by a doctor to reduce the viral load of HSV, especially if the outbreak of the infection is severe. The use of acyclovir has been proven to reduce the severity of the infection and lead to more rapid healing of sores. It does not cure the disease; hence, recurrent infection is still possible.

How available and affordable are the treatment options?

Most of the treatment options listed above are available and affordable.

Is the infection easily mistaken for a symptom of other diseases or infection like HIV/AIDS?

Symptoms of HGS can be mistaken for symptoms of other diseases like aphthous ulcer, teething, herpangina, infectious mononucleosis and so on. Hence, it is important to visit a healthcare professional for accurate diagnosis and treatment. HSV absolutely has no cure, just like HIV.

Once an individual contracts the virus, a recurrent episode is bound to occur. Whenever, the host’s immunity goes down or when exposed to one of the risk factors, like stress as mentioned earlier, the dominant virus becomes active again. However, if the immunity is adequate and there is no exposure to risk factors, the individual may not have any symptom for years. This doesn’t mean the virus has left the body.

Are there simple habits that can help prevent the infection?

Because herpetic gingivostomatitis is highly contagious, the best prevention is avoiding close contact with saliva of infected people. The habit of adults kissing children should be discouraged. Kids should not share food, drinks, or utensils with an infected person. If accidental contact occurs, the area should be thoroughly washed with water and soap. Sharing of toys among non-infected and infected kids should be discouraged.

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