Herpangina

What is herpangina and who gets it?

Herpangina, also called enteroviral vesicular pharyngitis, is a viral infection that causes fever, sore throat and painful mouth sores. Anyone can get it but it is most common in children. It often spreads in the summer and fall.

The viruses that cause herpangina include enterovirus 71, echovirus and coxsackievirus. Despite the name, it is not caused by the herpes virus.

Herpangina and hand, foot and mouth disease are often confused, but they are different conditions caused by similar viruses.

Herpangina is not usually serious but it can be very uncomfortable, especially for young children. Knowing the symptoms of herpangina, how it spreads and when to get medical care can help speed recovery.

Herpangina symptoms in children and adults

The symptoms of herpangina appear suddenly, usually three to five days after your child was exposed to the virus. 

The primary symptom of herpangina is painful blisters or mouth sores that appear on the roof of the mouth, insides of the cheeks and the throat. They could look like white or pink bumps or pimples. These sores usually show up a day or two after the fever, sore throat and headache. They may turn into ulcers (open sores). 

Other symptoms can include:

• High fever, often over 102°F
• Sore throat, difficulty swallowing and can be painful to eat and drink
• Headache
• Dry mouth and loss of appetite, which could lead to dehydration
• Fatigue and irritability, especially in young children
• Swollen glands and neck pain
• Drooling or vomiting

How does herpangina spread?

Herpangina is very contagious. Outbreaks are common in daycare centers, schools and households with young children. It usually infects children from about age 2 to age 9. It’s less common in older children and adults.

Babies, people with compromised immune systems and those who are pregnant could get a severe and dangerous type of herpangina. Contact a health care provider if someone in these groups has been exposed.

The virus spreads through:

• Contact with saliva, mucus or stool from an infected person
• Touching contaminated objects or surfaces
• Coughing and sneezing, which spreads respiratory droplets

Having herpangina makes it less likely you will get infected again, but it’s still possible to get other strains.

How doctors diagnose herpangina

Pediatricians and other health care providers diagnose herpangina in children by evaluating their symptoms and asking about their medical history. 

During a physical exam, they will check for:

• White spots or ulcers in the mouth and throat that have a specific appearance because of the germ that causes them
• Spots on the hands and feet, which are signs of hand, foot and mouth disease, not herpangina
• High fever and sore throat, which are signs of infection
• Signs of dehydration such as dry mouth or less urinating

You don’t usually need other testing to confirm the diagnosis.

How to treat herpangina at home

There is no specific cure for herpangina. You can manage your child’s symptoms at home. It can help to:

• Offer them cold foods and drinks like yogurt, smoothies or ice cream that may soothe mouth pain. Don’t give them salty, acidic or spicy foods, since they can irritate mouth sores.
• Encourage your child to drink plenty of water, milk or electrolyte drinks to help prevent dehydration.
• Use over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to help reduce high fever and sore throat. Don’t use aspirin in children or teenagers.
• Try mouthwashes, gels, sprays or lozenges to help with the pain from mouth and throat sores.
• If your child is able to gargle, gargling with salt water after eating can help the sores heal.
• Make sure your child gets plenty of rest to help them recover.

Children can usually return to school when they no longer have a fever and can go back to normal activities when they don’t have many open blisters or mouth sores.

When to call a doctor for herpangina

Children with herpangina may have trouble drinking enough fluids, so they can be at risk of dehydration. Contact a health care provider if you see signs like:

• Dry mouth and cracked lips
• Few or no wet diapers in babies and less urination in older children
• No tears when they are crying, which can be a sign of severe dehydration
• Extreme fatigue or dizziness

You should also contact a health care provider if your child:

• Has a high fever
• Can’t eat or drink
• Has vomiting or diarrhea for more than 24 hours
• Has mouth sores that don’t go away in a week

How to prevent the spread of herpangina

Herpangina spreads easily. You may be contagious from the time you’re exposed to the virus until three to eight weeks afterward. You’re most contagious in the first two weeks.

These hygiene steps can help protect your family and other people you’re in contact with:

• Wash your own and your child’s hands frequently with soap and water, especially before preparing food and after using the toilet or changing diapers.
• Disinfect surfaces and shared objects like toys, electronics, light switches and doorknobs.
• Keep sick children home from school or daycare to help prevent outbreaks. If possible, have them stay in a well-ventilated room.
• Teach your child proper cough and sneeze hygiene. They should cough into their elbow and cover their mouth and nose.
• Avoid sharing cups, utensils or towels.
• Wash any soiled sheets, towels or clothing in hot water right away.

When to see a health care provider

Most cases of herpangina get better within a week. Your child may need medical care for:

• Severe throat pain or difficulty swallowing
• A high fever that lasts more than three days
• Signs of dehydration
• Symptoms that get worse
• Any concerns you have about your child’s recovery

Get the care you need for herpangina

With herpangina, your child may not feel well but the infection isn’t usually serious as long as you take steps to prevent dehydration. At-home care can help your child feel more comfortable while they recover.

For diagnosis and medical advice, reach out to a Banner Health care provider to make sure your child gets the care they need.