Herpangina is a common childhood viral illness characterized by sudden fever, sore throat, and painful ulcers at the back of the mouth. It most often affects children between 3 and 10 years old, though adults can occasionally be infected. The condition is usually caused by enteroviruses, especially Coxsackievirus A, and is not related to herpes despite its name. Herpangina spreads easily in group settings like schools and summer camps, particularly in warmer months. While typically self-limiting and mild, it can cause significant discomfort and may occasionally lead to complications, especially in children with weakened immune systems.

Herpangina, sometimes called “mouth blisters,” presents with small, painful ulcers in the throat, tonsils, or soft palate surrounded by a red halo. These lesions, combined with fever and sore throat, create a distinct clinical picture that allows for easy diagnosis. The illness is most prevalent during summer and fall in temperate climates and year-round in tropical regions. Although the symptoms usually resolve within a week, they can be distressing for children, leading to decreased food and fluid intake. The condition is highly contagious, spreading rapidly in close-contact environments.

Herpangina is caused by a group of viruses known as enteroviruses. These viruses primarily inhabit the gastrointestinal tract but can spread to other tissues. They are resilient, surviving for extended periods on surfaces and in stool. Understanding the viral causes and risk factors helps guide prevention and control.

• Coxsackievirus A (A6, A10, A16): The most common cause of herpangina in children.
• Coxsackievirus B: A less frequent cause.
• Enterovirus 71: Sometimes linked to more severe outbreaks.
• Echoviruses: Rarely implicated but possible causes.

Risk factors include attending daycare or school, warm and humid climates, poor sanitation, and being between ages 3 and 10. Because viruses can persist in stool for weeks after recovery, children can unknowingly continue spreading the infection.

After entering the body, enteroviruses infect the lining of the throat and intestines. They replicate in the lymphoid tissue and spread through the bloodstream. The body’s immune response causes inflammation in the throat and the development of ulcers. The incubation period is typically 3–6 days, after which symptoms appear suddenly. Viral shedding occurs in respiratory secretions and stool, contributing to the high contagiousness of the illness. Although the immune system usually clears the infection within a week, some individuals may shed the virus longer.

Herpangina is common worldwide, especially in children under 10 years. Outbreaks often occur in community settings where children gather, such as preschools, summer camps, and daycare centers. The illness peaks in summer and fall in temperate climates but occurs year-round in tropical areas. While most cases are mild, severe infections can occasionally occur in infants, immunocompromised children, or during outbreaks of more virulent strains such as Enterovirus 71. Because of its ease of transmission, herpangina remains a frequent cause of pediatric viral illness.

Symptoms of herpangina typically appear 3–6 days after exposure. The illness begins suddenly with fever and sore throat, followed by characteristic ulcers. While self-limiting, the pain and discomfort can significantly affect a child’s eating and drinking habits.

• Fever: Sudden onset, often high (102–104°F or 39–40°C), lasting 2–4 days.
• Sore throat: Painful swallowing that may cause refusal to eat or drink.
• Headache: Mild to moderate in intensity.
• Fatigue and irritability: Common in young children.
• Loss of appetite: Related to throat pain and feeling unwell.
• Neck pain or stiffness: Occasionally present.
• Mouth ulcers: Grayish-white with a red border, usually 2–10 lesions on the tonsils, uvula, or soft palate.
• Drooling: Seen in younger children unable to swallow comfortably.
• Swollen lymph nodes: Especially in the neck.

While most children recover within a week, dehydration is the primary concern due to reduced fluid intake. Parents should watch closely for signs of decreased urination, dry mouth, or lethargy.

Herpangina is usually diagnosed clinically without laboratory tests. The combination of fever, sore throat, and characteristic mouth ulcers during summer or fall strongly suggests the condition. However, doctors may take additional steps if the presentation is severe, prolonged, or atypical.

• History: Recent illness exposure, travel to warm climates, onset and duration of symptoms.
• Examination: Inspection of mouth and throat for ulcers, assessment of fever, hydration, and lymph nodes.
• Laboratory tests (rare):
  • Throat swab or stool culture: Identifies the virus but takes several days.
  • PCR testing: Rapidly detects viral genetic material and is highly sensitive.
  • Complete blood count (CBC): Helps rule out bacterial infections.

In most cases, the distinct clinical appearance is sufficient to confirm diagnosis.

Differential diagnosis for Herpangina

Because other conditions can cause mouth sores and sore throat, doctors consider alternatives before confirming herpangina. These include:

• Hand, Foot, and Mouth Disease (HFMD)
• Herpes simplex virus (HSV) stomatitis
• Streptococcal pharyngitis (strep throat)
• Infectious mononucleosis
• Aphthous ulcers (canker sores)

Herpangina is distinguished from HFMD by the absence of a rash on the hands, feet, and buttocks. Herpes stomatitis tends to affect the gums and lips rather than the back of the throat.

There is no specific antiviral therapy for herpangina, and antibiotics are ineffective since it is a viral illness. Treatment focuses on symptom relief, hydration, and rest. Most children recover fully within 7 days.

• Pain and fever control: Acetaminophen or ibuprofen helps lower fever and relieve throat pain. Aspirin should be avoided in children due to the risk of Reye’s syndrome.
• Hydration: Encourage fluids like water, diluted juice, or oral rehydration solutions. Avoid acidic or carbonated drinks that irritate ulcers.
• Dietary changes: Soft, bland foods are easier to swallow. Avoid spicy, salty, or citrus-based foods that worsen pain.
• Topical oral treatments: Mouthwashes or sprays with lidocaine or benzocaine may provide relief but are not recommended for very young children due to choking risks.
• Rest and isolation: Adequate rest supports recovery. Keeping children home from daycare or school helps prevent spread.

Parents should monitor closely for dehydration and seek medical care if symptoms worsen or persist.

Most children recover without complications, but rare issues can occur. The most common is dehydration due to poor oral intake. In rare cases, the infection may spread and cause viral meningitis, encephalitis, or myocarditis. Children with weakened immune systems are at greater risk of severe illness. Prompt recognition and supportive care reduce the likelihood of complications.

The prognosis is excellent in otherwise healthy children. Symptoms usually resolve within a week without lasting effects. Recurrence is possible since immunity is strain-specific, but most children experience only one or two episodes in their lifetime. Severe complications are very rare, and with good supportive care, outcomes are overwhelmingly positive.

Preventing herpangina focuses on limiting transmission of enteroviruses. Good hygiene and sanitation are key strategies.

• Wash hands regularly with soap and water, especially after bathroom use or diaper changes.
• Disinfect commonly touched surfaces like toys, doorknobs, and countertops.
• Avoid sharing utensils, drinks, or towels with infected individuals.
• Keep children home from school or daycare until fever subsides.
• Teach children proper cough and sneeze etiquette.

These simple measures greatly reduce the spread of herpangina in households and communities.

Herpangina is a common viral illness in children, most often caused by Coxsackievirus A. It spreads quickly in group settings, particularly in summer and fall, and causes sudden fever, sore throat, and painful mouth ulcers. While the condition is uncomfortable, it is self-limiting and usually resolves in less than a week with supportive care. Preventive strategies like handwashing and avoiding close contact remain the best defense against transmission. With early recognition and proper care, most children recover fully without complications.

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