Dear Doc,

24 yr old Gay man, HIV+ for around 3 years, on Atripla for 10 months. Genital herpes (less aggressive strain) and undiagnosed but suspected anal HPV (one outbreak) No other known coinfections. Last Viral load was undetectable and CD4 was up from 261 to 505 and 16% to 39%. I understand this is a very good response?

In the last few days I have developed a sore throat but I realised after a day or two that it was only one one side and that my gland on one side was very swollen and my neck was stiff. I looked at my throat in the mirror and realised one of my tonsils (or around that area) was swollen. It looks like a red lump with white patches and lines on it. It is not hugely painful but it is uncomfortable to swallow. It is about the size of two or three peas.

I did have oral sex 4 days ago and felt no pain then (and the man's penis did go down my throat) I have drunk only a couple of times a year for the past 4 years and smoked for four years between the ages of 17 and 21. I have booked an appointment with my doctor but it is not for a few days so I wanted to ask some questions:

1) I have read that oral cancers are often caught late and that pain is a sign of advanced disease. Considering this, is it possible that it could be cancer even though I have only noticed discomfort for the last three days?

2) Could potential oral sex related trauma have triggered an infection?

3) Could it be another infection which has resulted in pharyngitis?

I suspect the answer maybe be that it could be any of these and I'll just have to wait a week to go to the docs! But any pointers, however broad would be appreciated.

Many Thanks

I am actually concerned you have a simple strep throat infection.

If you are still having the same symptoms, sore throat and difficulty swallowing with swollen lymph nodes, I would get yourself to a clinic for a rapid strep test since you have classic symptoms.