Abstract
Primary herpetic gingivo-stomatitis, a well -defined
clinical entity, appears to present a peculiarly difficult
diagnostic challenge to the family doctor. Possible reasons
for this have been examined in a series of studies over a
period of three years by one general practitioner in a large
group practice.
Analysis of the early clinical manifestations of the
disease, studied in a prospective survey, showed upper
respiratory catarrh to be a prominent feature. The difficulty
of spotting this and other early features of the disease
against the background of similar presentations of different -
and more common - illnesses was demonstrated in a one -year
prospective survey of all febrile children seen by this
family doctor.
Laboratory support for the main clinical survey led to
antibody studies of affected children, of a control group,
and of mothers of both groups. The findings supported the
clinical diagnosis, confirmed the high prevalence of
infection in the mothers, and provided information on some
changes in antibody response in relation to the length of the
follow-up period.
Recurrent clinical infections and possible sequelae were
already evident, even within the relatively short duration of
the survey. These phenomena, examined against the control
group employed in the antibody studies, included herpes
facialis, various infections, and recurrent mouth ulceration.
The findings were compared with results of a retrospective
study of cases of probable herpetic stomatitis and of control
children, selected from the group practice records. Similar
results were obtained in this survey.
Comparison of households containing affected children
against others from the practice showed the disease occurred
more frequently in a setting of poor hygiene and larger sized
families, factors which also hinder the family doctor in
diagnosis.
From the pattern of admission diagnoses of cases treated
in the Edinburgh City Hospital during the three years of the
studies, it was clear that other general practitioners in the
area shared difficulties in diagnosis.
The results of all these surveys have been examined in the
light of published reports, with particular reference to
diagnosis in general practice. The differential diagnosis
has been discussed and illustrated by examples drawn from
the day-to-day work of the practice.
It is concluded that greater attention should be paid
to the disease - which is as common as rubella, mumps or the
more severe cases of chickenpox - in undergraduate teaching
and in post-graduate research.
The inadequacy of drug therapy highlights the importance
of prophylaxis, and a greater public awareness of the
potentially infectious nature of the common "cold sore"
needs to be promoted.
