Herpetic stomatitis

Alternative names
Stomatitis - herpetic

Herpetic stomatitis is a viral infection of the mouth characterized by ulcers and inflammation. Canker sores are different, since they are not caused by the same virus.

Causes, incidence, and risk factors

Herpetic stomatitis is a contagious viral illness caused by Herpes virus hominis (also herpes simplex virus, HSV) and is seen mainly in young children. This condition probably represents their first exposure to herpes virus and can result in a systemic illness characterized by high fever (often as high as 104 degrees Fahrenheit), blisters, ulcers in the mouth, and inflammation of the gums.

The inside of the cheeks and tongue frequently develop ulcers 1-5 mm in diameter with a grayish-white base and a reddish perimeter. These ulcers are very painful and cause drooling, difficulty swallowing, and decrease in food intake (although the patient may be hungry).

An adult member of the family may have a cold sore at the time the child develops the herpetic stomatitis or, more likely, no source for the infection will be discovered. The illness clears up and ulcers are generally healed within 10 days.


  • Fever, may precede appearance of blisters and ulcers by 1 or 2 days  
  • Irritability  
  • Blisters in the mouth, often on the tongue or cheeks  
  • Ulcers in the mouth, often on the tongue or cheeks - these form after the blister pops  
  • Swollen gums  
  • Pain in mouth  
  • Drooling  
  • Difficulty swallowing (dysphagia)

Signs and tests
Herpetic stomatitis is normally diagnosed based on its very typical appearance. Laboratory studies are seldom done. Sometimes viral culture and special stains can help with the diagnosis.


Herpetic stomatitis can be treated with the acyclovir family of antiviral medications.

A mostly liquid diet consisting of cool to cold, nonacidic drinks should be provided while the child’s mouth is very sore.

An oral topical anesthetic (viscous lidocaine) is available for severe pain, but it must be used with care as it masks all sensation and may interfere with swallowing and allow the child to burn himself on hot liquids without knowing it. In addition, a few rare deaths have been reported from overdosage and misuse of lidocaine.

Expectations (prognosis)
Complete recovery is expected within 10 days without medical intervention. Oral acyclovir may speed up recovery.

Herpetic keratoconjunctivitis, a secondary herpes infection in the eye, may develop. This is an ophthalmologic emergency and can lead to blindness. Dehydration may develop if the child refuses to eat and drink adequately because of a sore mouth.

Calling your health care provider
Call your health care provider if your child develops a fever followed by a sore mouth, especially if they begin eating poorly (dehydration can develop rapidly in children).


It is estimated that approximately 90% of the population carries herpes simplex virus. It is difficult to prevent children from picking up the virus at some time during their childhood.

Children should strictly avoid close contact with people with cold sores (such as kissing parents with active cold sores) and avoid other children with herpetic stomatitis. They should not share utensils, glasses, or food with actively infected people.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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