# Herpangina - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Herpangina - StatPearls (NCBI Bookshelf NBK507792) - https://www.ncbi.nlm.nih.gov/books/NBK507792/ · Herpangina - disease-level clinical article (herpangina-full.txt) · Herpangina - disease-level clinical article (herpangina-clinical.txt) · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - Herpangina - StatPearls (NCBI Bookshelf NBK507792) - https://www.ncbi.nlm.nih.gov/books/NBK507792/ - Herpangina - disease-level clinical article (herpangina-full.txt) - Herpangina - disease-level clinical article (herpangina-clinical.txt) - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - Keep the child drinking, treat the fever, watch for the rare bad ones ## Complete treatment card ```text HERPANGINA Sources: Herpangina - StatPearls (NCBI Bookshelf NBK507792) - https://www.ncbi.nlm.nih.gov/books/NBK507792/ · Herpangina - disease-level clinical article (herpangina-full.txt) · Herpangina - disease-level clinical article (herpangina- clinical.txt) · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Herpangina begins abruptly with fever, sore throat, irritability, and poor appetite [fever · irritability · poor appetite · sore throat] - Some children also report headache, malaise, or mild belly discomfort [abdominal pain · headache · malaise] - The illness develops quickly, over one to two days, with outbreaks peaking in summer and early autumn - A recent exposure to other children with similar symptoms at daycare or school is common - In older children, poor appetite, dehydration, or belly pain can develop alongside back pain and headache [abdominal pain · back pain · dehydration · headache · poor appetite] - Complicated cases can bring neck stiffness, confusion, seizures, muscle weakness, or trouble breathing [confusion · muscle weakness · neck stiffness · seizures] SIGNS - what you find (4) - Small blisters or shallow ulcers appear at the back of the throat, sparing the front of the mouth [blisters · vesicles] - Neck lymph nodes may be mildly enlarged, and the child can seem irritable or lethargic from the fever [fever · irritability · lethargy] - Dry mouth and reduced skin turgor point to dehydration, a common complication [dehydration · dry mouth] - Neck stiffness or paralysis suggests a complicating meningitis, flaccid paralysis, or encephalitis [neck stiffness · paralysis] TESTS (4) - Diagnosis is mainly clinical, and routine labs are usually unnecessary in straightforward cases - A CBC and metabolic panel can assess dehydration or rule out other diagnoses, though results are usually normal - PCR for nonpolio enteroviruses on throat, stool, spinal fluid, or vesicle fluid is preferred for confirming complicated or outbreak cases - Lumbar puncture or brain imaging is used when meningitis, encephalitis, or flaccid paralysis is a concern IF NOT THIS - what else fits (9) - Herpangina must be differentiated from eczema herpeticum - Herpangina must be differentiated from toxic shock syndrome - Herpangina must be differentiated from measles - Herpangina must be differentiated from varicella - Herpangina must be differentiated from Kawasaki disease - Herpangina must be differentiated from insect bites or a hypersensitivity reaction - Herpangina must be differentiated from Rocky Mountain spotted fever - Herpangina must be differentiated from a drug eruption - Herpangina must be differentiated from erythema multiforme major Source Herpangina - disease-level clinical article (herpangina-full.txt) Status traced to the source above 1. KEEP THE CHILD DRINKING, TREAT THE FEVER, WATCH FOR THE RARE BAD ONES[1st line] Adult Source Herpangina - StatPearls (NCBI Bookshelf NBK507792) - https://www.ncbi.nlm.nih.gov/books/NBK507792/ Why A self-limiting enterovirus illness with an unmistakable picture. There is nothing to prescribe for the virus and the article gives no paediatric analgesic amount, so no dose is printed here - the fever and pain doses live on the fever entry. What it carries instead is how to be sure of the diagnosis, how to get fluid into a child with a raw throat, and the small list of complications that turn it serious. Caution WHERE THE ULCERS ARE IS THE DIAGNOSIS - on examination there are small vesicles or shallow ulcers at the back of the oropharynx: the soft palate, the tonsillar pillars, the uvula. The front of the mouth is usually left alone, and where it is involved instead, that points elsewhere. The diagnosis is made clinically, on the history and on those posterior lesions; in an uncomplicated case routine laboratory tests are often unnecessary. THE STORY THAT GOES WITH IT - fever comes on suddenly, with a sore throat, irritability and a poor appetite. It builds fast, over 1 to 2 days. Outbreaks cluster in the summer and the early autumn, and there is usually a recent contact - another child with the same thing at nursery or at school. FLUID FIRST, AND MAKE IT EASY TO SWALLOW - push light, soft or semi-liquid food so the calories still go in, and keep away from anything hot, spicy or irritant that will make the ulcers worse. Where feeding is genuinely difficult, or dehydration is a risk, oral rehydration solution with electrolytes is what is advised. SALT WATER IS THE MOUTH CARE - an older child can rinse the mouth with normal saline after meals. A younger one who cannot rinse has the mouth wiped gently instead, with gauze soaked in saline. Where normal saline is not to hand, water with a little salt in it will do. DO NOT PAINT THE ULCERS WITH ANAESTHETIC GEL - a topical anaesthetic containing lidocaine or diphenhydramine is generally NOT recommended for oral lesions in herpangina: the evidence of benefit is limited, and there is a risk of systemic toxicity in a young child. This is worth saying out loud in a pharmacy-first setting where a lidocaine oral gel is easy to buy. FEVER TREATMENT, WITHOUT A NUMBER FROM THIS ARTICLE - where the temperature is 38.5 C or higher - that is 101.3 F - an antipyretic, paracetamol or ibuprofen, may be given at the dose appropriate to the child's age. The article states no milligrams, so none are invented here; use the weight-based paracetamol and ibuprofen doses on the fever entry. NO ANTIVIRAL, AND NO ANTIBIOTIC EITHER - there is no specific antiviral recommended for routine treatment of herpangina; supportive care is the mainstay. The interferon-alfa spray that sometimes gets mentioned is explicitly unsettled - its routine use stays limited, and there is not yet evidence enough to recommend it widely. THE COMPLICATIONS THAT MAKE IT NOT MILD - herpangina is usually mild, but some of the viruses behind it, enterovirus 71 above all, can cause serious trouble: brainstem encephalitis, myocarditis, aseptic meningitis, acute flaccid paralysis. A limb that goes weak in a child with mouth ulcers is a notifiable acute flaccid paralysis - see that entry the same day. SAFETY-NET ON FITS AND ON DRINKING - watch a young child with a high fever closely for a febrile seizure. And dehydration is a common complication - a dry mouth, and skin turgor that has gone. Give the parents both triggers before they leave. WHAT ELSE LOOKS LIKE THIS - the history and the examination should also be working to exclude the other serious febrile exanthems that can look similar: toxic shock syndrome, eczema herpeticum, Rocky Mountain spotted fever, and Kawasaki disease. EXPECTED COURSE AND THE HYGIENE ADVICE - with care, isolation, decent nutrition and enough fluid, most children are better in about 10 days. Encourage frequent handwashing, particularly after a nappy change, after feeding the child, and after handling anything the child has used. A follow-up visit is usually unnecessary, because it settles quickly by itself. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)