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Oral sores and herpes
Jan 21, 2002

I am hiv+ and was recently also diagnosed with genital herpes. At the same time as that outbreak, I had some very painful sores and swelling at the back of my mouth. At first I thought it was thrush but then realized it wasn't. Could have been canker sores, but the amount of swelling seemed unusual. Any connection to the herpes, do you think? Both problems have now cleared up after a course of acyclovir.

Response from Dr. Reznik

Without having the opportunity to exam your mouth, it is very difficult for me to determine what type of oral sores you presented with at the time of the herpetic outbreak. There are a few rules of thumb, which may help you differentiate oral ulcers in the future:

1. Herpetic ulcerations tend to appear on keratinized or fixed tissues such as the roof of the mouth and gingival (gum) tissues. These ulcers tend to be shallow and not as painful as the other prevalent type of oral ulcer (aphthous).

2. Aphthous ulcerations tend to appear on non-keratinized tissues such as the buccal mucosa (cheeks, muccobuccal fold) posterior oropharynx (back of the throat), floor of the mouth and lingual or under surface of the tongue. A grey or yellow pseudomembrane and a hallo of inflammation characterize these ulcers. Aphthous ulcerations tends to be painful and last longer in people living with HIV disease.

I'm happy to hear these ulcers have cleared up.

DR


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