Herpangina is characterized by small blisters or ulcers on the back of the throat and roof of the mouth. It is a viral throat infection that typically affects children during the summer and fall months.

An infection of the mouth and throat, herpangina is caused by a group of viruses called the enteroviruses. It is similar to another condition that affects children, known as hand-foot-mouth disease (HFM), which is also caused by enteroviruses. While both conditions cause oral blisters and ulcers, the location of these sores is different.

Infections caused by enteroviruses are highly contagious and easily spread from one child to another. While adults can experience herpangina, they are less likely to, because they have built up the antibodies to fight the virus.

In most cases, herpangina is easily treatable, and symptoms resolve quickly.

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Herpangina is characterized by small blisters forming in the mouth and at the back of the throat. This infection is contagious, and most commonly affects children.
Image credit: James Heilman, MD, 2016, January 8

According to Stanford Children’s Hospital, the most common types of enteroviruses that cause herpangina are:

  • Coxsackie virus A
  • Coxsackie virus B
  • enterovirus 71
  • echovirus (less commonly)

Children aged 3 to 10 are at highest risk of contracting the condition, because they have usually not yet been exposed to the virus and have not developed the antibodies needed to fight the viral infection.

Herpangina is most commonly spread through contact with respiratory droplets, from sneezing or coughing, or from contact with fecal matter.

The virus can survive for several days outside the body, on objects such as door handles, toys, and faucets.

The risk of getting herpangina increases in:

  • children aged 3 to 10
  • summer and fall in the United States, or year-round in tropical climates
  • schools, summer camps, and childcare centers
  • those who do not wash their hands regularly and thoroughly

Once children have been affected by a specific strain of enterovirus, they tend to become immune to that strain. They may still be at risk of infection by other viral strains, however.

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The risk of being infected is greatest in children aged 3 to 10. Infections are also more common in warmer climates or seasons.

Symptoms of herpangina vary between individuals. However, the most common symptoms include:

  • high fever
  • sore throat
  • blisters or ulcers in the throat and mouth that are gray with a red outline
  • refusal to eat
  • difficulty swallowing
  • loss of appetite
  • headache
  • neck pain
  • swollen lymph glands
  • tiredness
  • drooling
  • vomiting

Because some children may refuse to eat or drink due to pain, they may be at increased risk of becoming dehydrated.

Those infected with herpangina are most contagious during the first 7 days after infection, even though they may show no visual symptoms. This is known as the incubation period.

How does herpangina differ from HFM?

Herpangina and HFM are caused by the same group of viruses and display similar symptoms. They also both commonly affect children. In addition, both herpangina and HFM may begin with a fever and sore throat several days before ulcers appear in the mouth.

As with herpangina, HFM is transmitted through unwashed hands, fecal matter, and respiratory secretions. Treatment for both conditions is the same, and both infections tend to clear within 7 to 10 days.

However, some differences exist between the two conditions. The locations of the ulcers differ. In cases of herpangina, sores are experienced at the back of the mouth, while HFM ulcers occur at the front.

As the name suggests, children with HFM will also experience lesions on the soles of their feet and the palms of their hands in the vast majority of cases. Herpangina lesions are typically only found in the throat and mouth.

The diagnosis of herpangina is usually made based on a medical history and a physical examination.

As the ulcers are so distinct, it is easy to differentiate between herpangina and other conditions of the mouth and throat.

In addition, factors that indicate herpangina above other conditions include:

  • the time of year
  • age of affected child
  • exposure to others with the condition
  • incubation period

While laboratory tests are available to test for enteroviruses, they are generally unnecessary.

When to see a doctor

People should contact a doctor if they experience any symptoms of herpangina so that they can make a formal diagnosis and rule out other conditions.

It is especially important to seek urgent medical treatment if someone experiences any of the following:

  • fever over 106°F, or fever that persists
  • mouth or throat sores for 5 or more days
  • vomiting or diarrhea for more than 1 day

People should also contact a healthcare professional if they develop any symptoms of dehydration. These include:

  • dry mouth
  • lack of tears
  • thirst
  • tiredness
  • feeling lightheaded, dizzy, or weak
  • reduced urine output
  • dark urine
  • sunken cheeks or eyes
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Treatment can involve rinsing the mouth with warm water and salt, drinking water frequently, and eating bland foods.

Viruses cannot be treated with antibiotics, and no antiviral medications are available for the viruses that cause herpangina.

As a result, the aim of treatment is to reduce discomfort and manage the symptoms of the illness until they resolve, which usually happens within 7 to 10 days.

People with herpangina may take pain-relief medication, such as ibuprofen or acetaminophen, to help relieve fever, headache, and pain in the mouth and throat.

It is important to use medications that are suitable for children, as some may not be. For example, aspirin should never be given to children as it has been linked to Reye’s syndrome, a rare but life-threatening condition that causes swelling in the brain and damage to the liver.

Other available treatment options include:

  • Topical anesthetics: Lidocaine and other topically applied creams and gels may provide relief from mouth and throat pain. People should always use an age-appropriate product.
  • Mouth rinse: Rinsing the mouth out with a solution of warm water and salt may help relieve mouth and throat pain. This can be repeated as often as needed.
  • Hydration: As dehydration is a potential complication of herpangina, it is important to have sufficient water intake. Hot drinks and fruit juices are not recommended as they can make mouth and throat pain worse. However, non-citrus frozen popsicles may provide pain relief and provide fluids.
  • Non-irritating foods: Some foods can irritate the ulcers in the mouth and throat, such as hot, fried, spicy, salty, or citrus foods. Non-citrus fruits (such as bananas), vegetables, dairy, and other soothing foods are better options during a herpangina infection.

If symptoms do not improve within 1 week, if they get worse, or if new symptoms appear, it is important to seek urgent medical advice.

The most important step that can be taken to prevent herpangina is to practice proper hand-washing. Children should be taught to wash their hands thoroughly after using the restroom and before eating.

When coughing or sneezing, cover the nose and mouth to prevent spreading viruses and wash hands immediately.

Parents of children with herpangina will need to wash their hands frequently, especially after changing diapers or coming into contact with mucus. Clean and disinfect kitchen countertops, bathrooms, toys, and clothing thoroughly to destroy the virus.

It may be advisable for a child with herpangina to avoid school or camp to reduce the risk of spreading the illness to others.

Although herpangina is highly contagious, it is normally a mild condition that clears up within 7 to 10 days.

The most common complication is dehydration, but this can be avoided with proper home care. Other complications are very rare.

While fatalities have been reported in cases of herpangina, these are rare and occur mainly in infants under 1 year.

Although herpangina is not common in adults, some research suggests that pregnant women who get the illness may be at a higher risk for adverse pregnancy outcomes, such as low birth weight, small-for-gestational-age infants, and preterm delivery.