Hi Dr. Resnick,

I was recently diagnosed by a dentist with a moderate case of NUP. I am a male with a partner of the same sex who was recently diagnosed with HIV. I have, of course, been very worried about becoming HIV+ because although we always used a condom, we had one break at the tip about 30 days ago. I have always been the insertive partner in our relationship.

Unfortunately I was not able to determine when the condom broke during sex etc. so I have been told that it is very difficult to ascertain the degree of my risk. I took an HIV antibody test the other day and I should know my results within a few days.

I guess my question to you is this: Would it be expected that I would have NUP approximately 30 days after a possible exposure? Can NUP be mis-diagnosed as something else? Is this NUP something that you would only expect to see in a person who was HIV+?

I appreciate any insight that you could provide me on this. Please keep up this wonderful service you are providing. I feel very fortunate to have gathered a lot of useful information regarding HIV from your site prior to my testing results. You have made it easier for me to accept a + result if it should turn out that way.

_James

Dear James:

Necrotizing Ulcerative Periodontitis (NUP) is a condition associated with severe immune depression and to my knowledge is not something seen in seroconversion illness. NUP is usually seen in people with CD4 counts less than 200, which would mean the patient has progressed to an AIDS diagnosis.

NUP, at first glance, would look very similar to Acute Necrotizing Ulcerative Gingivitis (ANUG). ANUG is usually seen in students, people under stress, and people who are not achieving proper nutrition. The clinical difference between NUP and ANUG, is that ANUG does not lead to destruction of the bone which supports the teeth. ANUG is a soft tissue manifestation that is painful, is associated with a foul odor and bleeding gingiva (gums). The best treatment for NUP would be a thorough cleaning at your dental office and use of systemic antibiotics and mouth rinses such as PerioGard (.12% chlorhexidine gluconate).

I hope this helps!

DR