What Is Herpangina?

Medically Reviewed by Zilpah Sheikh, MD on January 02, 2024
Written by Keri Wiginton
7 min read

Herpangina is a viral infection that usually affects children. It's caused by the coxsackie virus and sometimes by other types of viruses. The symptoms are fever, sore throat, and small painful blisters or ulcers in the back of the mouth, throat, and tonsils. 

Herpangina spreads easily through close contact with others who have the infection. It can be very uncomfortable for your child, but it normally gets better within a week without treatment.

Herpangina is a highly contagious viral infection that usually affects children under the age of 10. Children usually are exposed to the virus at school or day care, and it’s most common in the summer and fall. Newborn babies who are immunocompromised can get herpangina and are at risk for a more serious infection.‌

Herpangina in babies

You can pass the virus that causes herpangina to your baby if you have it while you’re pregnant. They may show symptoms within 2 weeks after birth. But your baby can develop herpangina after they’re born if they’re around someone infected with the virus. 

Because your baby can’t tell you what’s bothering them, it’s important to know what signs to watch for.

To spot herpangina, check for blistery bumps or open sores (ulcers). They’re typically on the sides or roof of the mouth, on the tonsils, or inside the throat. These sores and blisters usually look white or gray and have a red border.

Other signs and symptoms of herpangina in infants are:

  • Fever that comes on fast
  • Very high fever (up to 106°F)
  • Unusual sleepiness
  • Drooling
  • Not eating or drinking as much
  • More fussy than usual

The above symptoms may be signs that your baby has a headache, neck pain, or full-body aches or discomfort. They may not nurse or swallow liquids if their throat hurts.

To treat herpangina in babies, ask your doctor if you can give your infant:

  • Baby acetaminophen or ibuprofen to lower fever and help with pain
  • Little bits of iced fluid
  • Numbing mouth rinses or sprays for mouth pain

Babies don’t have fully formed immune systems, and they’re more likely to get a serious infection from herpangina. While most babies have mild symptoms and get better on their own, some need special tests or treatment in a hospital to get better. Check with your doctor if you’re not sure how sick your baby is.

Get medical help right away if your infant is younger than 6 months and has a fever higher than 100.4 F.

Herpangina in adults

It's not as common, but sometimes teens and adults get herpangina. This can happen if you don’t build immunity as a kid to the virus that causes it. Your odds of getting it when you grow up may be higher if you have a job where you work with or around young children, such as at a day care or school, or if you live in close contact with kids.

The infection is usually mild and goes away on its own in adults (just like with young children). But herpangina can cause more serious problems or even be life-threatening if you are:

  • Immunocompromised. You may not be able to fight germs as well if you take certain medications or have a health condition that affects your ability to make antibodies, which are a part of the immune system and help you clear out infections.

  • Pregnant. It's rare, but your baby could develop heart problems or have a low birth weight if you have herpangina while pregnant. You also may give birth early or have higher odds of miscarriage, especially if you get herpangina early on during pregnancy.

Herpangina is caused by a virus. The most common viruses that cause it are:

  • Coxsackieviruses A and B
  • Echovirus
  • Enterovirus 71

Herpangina is spread through respiratory droplets, saliva, directly touching fluid from a sore, or through fecal matter (pee and poop). You can get the virus if someone with herpangina coughs, sneezes, or shouts near you.

Symptoms of herpangina can vary depending on which virus causes the infection. Some children with herpangina don’t have any symptoms.

Herpangina usually shows up 3-5 days after you’ve been exposed to the virus. Symptoms include:

  • White blister-like bumps in the back of the throat or on the roof of the mouth, tonsils, uvula, or tongue
  • Sudden fever
  • High fever (up to 106 F)
  • Sore throat and mouth
  • Headache
  • Loss of appetite
  • Drooling
  • Fussiness
  • Dehydration from not drinking due to mouth and throat pain

Depending on the type of virus, some children also have symptoms such as throwing up, muscle weakness, and trouble breathing. Older children might also have back pain. Rarely, the virus can cause seizures or neurological problems.

Hand, foot, and mouth disease and herpangina are related. Both infections are caused by the coxsackie virus, but herpangina only causes sores in the mouth. Hand, foot, and mouth disease can cause mouth sores as well as sores on the soles of the feet and on the palms. Babies will also have sores around the diaper area.

Herpangina vs. strep throat

Both herpangina and strep throat are contagious infections that commonly affect children. But there are some key differences between the two. A big one is that herpangina is a viral infection, while strep throat is a bacterial infection. Herpangina is caused by coxsackie virus or enterovirus, and strep throat is caused by group A streptococcus bacteria.

Other differences between herpangina and strep throat are:

  • Herpangina spreads in summer and fall, while strep throat peaks during winter and spring.
  • Herpangina causes whitish sores in and around the mouth or throat. With strep, you’re more likely to see tiny red spots, swelling, and inflammation in the back of the throat, along with some white patches or streaks of pus.
  • Antibiotics can get rid of strep, but they don’t work on the viruses that cause herpangina. 

Similarities between herpangina and strep throat are that they both cause flu-like symptoms including fever, headache, loss of appetite, and sore throat.

Your doctor will take your child's personal history and do a physical examination. Herpangina sores look different from other infections or sores, so they can be easily identified. If it’s a mild infection, you might not need any tests or scans.

There isn't any type of herpangina medicine. Herpangina is treated by managing symptoms. The illness will be different depending on your child’s age and general health and the severity of the infection. As herpangina is a viral infection, antibiotics will not help.‌

Your child should be isolated as much as possible. Have them rest in a well-ventilated room to prevent the virus from sticking to surfaces, objects, and other members of the family.Your child will need to stay home from school or day care while they are sick. Children can go back to school once their fever is gone and if they don't have a lot of open sores.

It's important for your child to drink lots of water and other fluids. The mouth sores can be painful, and your child might not want to eat or drink. This can quickly lead to dehydration. If your child has a high fever, this can worsen dehydration. You can give your child an electrolyte drink to help.

Your child may not have an appetite, but it's important to encourage them to eat. Focus on a light, healthy diet with cool, soft, bland foods. Avoid anything acidic, hot, or spicy. Some ideas include:‌

  • Unsweetened applesauce
  • Yogurt
  • Milk
  • Ice cream

Popsicles and ice chips can also soothe the mouth and throat and help them get fluids.

Over-the-counter pain relievers such as acetaminophen or ibuprofen can help relieve pain and headaches.

You can find mouth sprays, mouthwash, or gels that can help relieve pain from the sores. Throat lozenges can also help. Make sure your child is old enough (usually age 6 or older) to take a lozenge without choking.

Herpangina rarely causes complications. Most cases are mild, and your child will usually get better within 10 days.

Because it hurts to eat and drink, some children may become dehydrated. This can be dangerous if not treated quickly. Make sure your child drinks small sips of liquid frequently, and watch for these signs of dehydration:

  • Dry mouth
  • Few or no tears while crying
  • Sunken eyes
  • Peeing less
  • Sleepiness and dizziness
  • Being more cranky than usual
  • In babies, a sunken soft spot on the top of the head

Rarely, some children who have the enterovirus 71 strain can also get other health problems. These include:‌

If you or your child are very unwell with herpangina, see your doctor right away.

Herpangina is a common infection that mostly affects children younger than 10, but you can get it at any age. Most cases are mild and go away on their own within a week or so. Supportive care can help ease symptoms such as fever, sore throat, or trouble eating or drinking.

Rarely, you can get very sick and need treatment at a hospital. Talk to your doctor about the risk for herpangina complications if you’re pregnant, you or your child have a compromised immune system, or you have a newborn baby.

How long does herpangina last?

The infection typically lasts around 7-10 days. See your doctor if your child doesn't get better after that.

How can I prevent the spread of herpangina?

The best way is to wash your hands with soap and water for at least 20 seconds. Do this often, but especially after you go to the bathroom or change a diaper, and before you cook or handle food. Remember to clean or disinfect shared toys at home or in childcare centers. Cover your mouth and nose when you cough or sneeze. Stay home if you or your child feel sick.

Is there a vaccine for herpangina?

There isn’t currently a vaccine for herpangina. Some vaccines developed in China have shown promise for protecting against the enterovirus 71, but they aren't available to the public yet.