What Causes Herpangina and How is it Treated?

Can Adults Get Herpangina?

Yes. However, herpangina is less common in adults than in younger children. Herpangina typically occurs in children younger than age 10. But cases have still been reported in adolescents and young adults.¹

Newborns, people with compromised immune systems, and pregnant women can develop a more severe form of the disease. Call your healthcare provider or your child’s healthcare provider immediately if you suspect herpangina in one of these high-risk groups.

What is Herpangina?

Herpangina is a viral infection caused by a group of common viruses called enteroviruses. It causes small blister-like bumps or ulcers to form on the throat and roof of the mouth. 

Although it’s a common viral infection in children, herpangina can occur in any age group. The disease is highly contagious and can rapidly spread through areas where children are in close contact with other children, like daycare centers and schools.

Herpangina is related to hand, foot, and mouth disease (HFMD). The same virus causes the two diseases, resulting in similar symptoms and sores. The main difference is that the sores only occur in the mouth with herpangina.

What Causes Herpangina in Adults?

Herpangina is a viral infection that can be caused by 22 different enteroviruses. The most common virus subtypes found in herpangina infections include:¹

• Coxsackie B
• Coxsackie A16
• Enterovirus 71

Less common viruses include echovirus, adenovirus, and herpes simplex virus.

Is Herpangina Contagious?

Yes. The viruses that cause herpangina are highly contagious. They can easily spread through:

• Fecal matter
• Direct contact with saliva or other bodily fluids
• Small particles of moisture in your breath (respiratory droplets)

Humans are the only known carriers of these viruses. But they can survive outside the body for an extended amount of time.

The time between exposure to the virus and symptom development (incubation period) is about 3 to 5 days. People are contagious during incubation and 3 to 8 weeks after.

What are the Symptoms of Herpangina in Adults?

Twenty-two different enteroviruses can cause herpangina. Symptoms vary depending on the subtype of enterovirus causing the infection.

Common Symptoms

Symptoms usually appear within 3 to 5 days after the initial infection. Common herpangina symptoms include:

• Sore throat — The throat becomes swollen and painful, making it difficult to swallow.
• Fever — Most children develop a high-grade fever that can be high enough to cause seizures. 
• Loss of appetite — Children may not want to eat due to painful sores in the mouth and throat.
• Mouth sores — Grayish blister-like sores appear on the mouth and throat 1 to 2 days after the sore throat begins. They develop into shallow mouth ulcers over the next 24 hours and are usually smaller than 5 mm in diameter.

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Young children may be fussy and uninterested in feeding. Older children, adolescents, and adults might experience headaches or back pain. Some people also experience dehydration and abdominal pain. 

Severe Symptoms

Severe symptoms of herpangina may include:

• Neck pain and stiffness 
• Confusion
• Difficulty breathing
• Headache
• Seizures
• Muscle weakness

How Long Do the Symptoms of Herpangina Last?

Herpangina symptoms, including mouth sores, typically disappear in 1 to 7 days. Call your doctor if your or your child’s symptoms last longer than a week.

How is Herpangina Diagnosed?

Your healthcare provider will diagnose herpangina with a physical examination and review of your symptoms and medical history. 

Tests usually aren’t necessary because the sores that develop are unique to herpangina. A physical exam is typically all your doctor needs to confirm the diagnosis.

How is Herpangina Treated?

Herpangina treatment focuses on relieving symptoms with good oral hygiene and home care. 

Antibiotics and antiviral drugs don’t effectively treat herpangina. After your child recovers, they’ll have natural immunity to the virus.

Home Remedies

Depending on your child’s age and general health, your doctor may recommend the following home remedies to ease symptoms:

• Rest — In a well-ventilated and clean room to prevent spreading the infection to family members
• Acetaminophen or ibuprofen — To relieve pain and reduce fever 
• Increased fluid intake — Drink plenty of fluids to avoid dehydration, especially if they have a high fever
• Topical anesthetics — To numb painful sores in the mouth and throat
• Bland diet — Avoid potentially irritating foods and drinks, such as hot beverages and spicy or acidic foods
• Rinsing the mouth with saltwater — To help maintain oral hygiene after meals

Potential Complications

Herpangina is generally a mild condition. Dehydration is a common complication in children who refuse food and fluids due to painful herpangina sores.

Some viruses that cause herpangina, such as enterovirus 71, can lead to serious complications. These complications include: 

• Brain stem encephalitis 
• Aseptic meningitis 
• Myocarditis

Enterovirus 71 can also cause severe symptoms in adults with hand, foot, and mouth disease. 

Pregnancy Complications

Pregnant women who suspect a herpangina infection should contact their healthcare provider.

Research shows that herpangina increases the risk of pregnancy complications, including:⁶

• Low birth weight
• Preterm delivery
• Babies that are small for their gestational age

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Outlook for Herpangina

Herpangina is usually a mild disease that resolves in less than 10 days with proper home care. 

Children who are sick with herpangina will likely experience mouth pain, a high fever, and a sore throat. Even if they don’t feel like eating or drinking, make sure your child drinks plenty of fluids to avoid dehydration.

Herpangina can cause severe symptoms in newborns, pregnant women, and people with compromised immune systems. Seek immediate medical care in these cases.

Herpangina vs. Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease and herpangina are two different conditions, but they share similarities. 

How They’re Similar

Similarities between herpangina and hand, foot, and mouth disease include: 

• Both primarily affect younger children and rarely occur in older children and adults 
• Enterovirus infections cause both diseases 
• Both cause mouth sores as a symptom 

How They’re Different

The most obvious difference between herpangina and hand, foot, and mouth disease is where the sores appear:

• Sores caused by a herpangina infection — Only affect the throat, tonsils, uvula, tongue, roof of the mouth, and soft palate.
• Sores caused by hand, foot, and mouth disease — Can affect all the same areas as herpangina, in addition to the hands, feet, knees, elbows, genitals, and buttocks.

What to Eat and Avoid if You Have Herpangina

Herpangina sores on the mouth and throat can make eating and drinking difficult. Many children experience a loss of appetite due to pain when swallowing. 

However, it’s essential to maintain a healthy diet and get plenty of fluids to avoid dehydration. Popsicles, ice cream, and soft, bland foods can help soothe discomfort. 

Drink plenty of water. Cold milk and electrolyte drinks are also good.

Avoid hot drinks and acidic beverages like orange juice, as these irritate sores. Also, avoid eating spicy, salty, or fried foods.

How to Prevent the Spread of Herpangina

Things you can do to prevent the spread of viruses that cause herpangina include:

Practicing Good Hygiene

Regularly wash your hands with soap and warm water, especially after coughing, sneezing, or changing a diaper.

Research shows that proper handwashing by children and their adult caregivers significantly protects against enterovirus 71.⁷ This virus is most likely to cause severe symptoms in herpangina and hand, foot, and mouth disease. 

Sanitizing Surfaces 

Sanitize and disinfect high-touch surfaces and objects. Viruses that cause herpangina can stay alive for a long time on surfaces.

Staying Home 

Keep your child home from school if they have herpangina. This disease tends to spread quickly through schools and daycare centers.

You should also stay home if you or someone in your household has herpangina. You can spread the virus even if you don’t have symptoms (viral shedding).

Summary

Herpangina is a viral illness that primarily affects children younger than 10 years old. However, older children, adolescents, and young adults can also get this disease. 

Early clinical features of herpangina include fever, sore throat, and difficulty swallowing. Blister-like bumps appear on the mouth and throat a day or two later. These mouth sores can be painful, causing difficulty swallowing and reduced appetite.

Herpangina is highly contagious and spreads through fecal matter, saliva, and other bodily fluids. Proper handwashing has been shown to reduce the spread of the virus.

A healthcare provider can diagnose herpangina with a physical examination. Medications cannot kill the viruses that cause herpangina, but home remedies can relieve pain. Drinking plenty of water is essential as dehydration is a common complication of herpangina.