This article is based on an original article in Swedish which can be found here

BACKGROUND

Cause

In the oral mucosa, viral infections typically present with a relatively rapid onset and often lead to blisters or sores. Herpes simplex is transmitted through direct contact, while varicella zoster and coxsackievirus are primarily spread through inhalation of contaminated droplets. The transmission route for HPV is not entirely clarified, but it is likely that infection occurs through direct contact.

Herpes Simplex Virus (HSV)

Herpes simplex virus type 1 (HSV-1) is a neurotropic virus with double-stranded DNA. It most commonly manifests in the oral mucosa but can also affect the nervous system, skin, and genital mucosa. Herpes simplex virus type 2 (HSV-2) is mostly seen in the genital mucosa but can also present in the oral mucosa. Primary infection with HSV-1 usually occurs in early childhood and is often asymptomatic or, in rare cases, presents as acute herpetic gingivostomatitis. Typically, transmission to children occurs from a parent with an active infection. After experiencing a primary infection, a latent phase is established with infection in the sensory nerve ganglia of cranial nerves, such as the trigeminal nerve ganglia. In some individuals, the infection remains asymptomatic, but reactivation can occur, often resulting in cold sores (oral herpes or herpes labialis). Regarding HSV-1, about 80% of the Swedish population is seropositive, but only 15% have antibodies against HSV-2.

Clinical Findings

Primary Herpetic Gingivostomatitis

In primary infection, extensive inflammation, sores, and/or blister formation in the oral mucosa can occasionally be observed, affecting both non-keratinized and keratinized mucosa. The onset can be rapid and may also be a very painful condition, often in combination with a general decline in health such as fever and fatigue. It is not uncommon for patients to have difficulty nourishing themselves, which can lead to hospitalization.