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Oral Health and HIVOral Health and HIV
           
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PLEASE ANSWER!!!
Apr 30, 2001

David, Thanks for your comments and insight. I have a worry that is driving me up the wall. 81 days ago or about 11 weeks I had unprotected vaginal sex with a sex worker. It lasted only a few minutes, but this concern stems deeper. At 10 weeks post exposure I had a neg test. Exactly one week later I started to expirience thrush. At least that is what the first doctor said it was. He didn't do a culture and just took a quick look. I got scarred and ran off to another doctor who is specializes in HIV. He couldn't believe that the doctor didn't do a culture. He also said that this could be stress related. This doctor took the time out to look in my mouth with a light and a said it could be thrush. He kept asking me to open my mouth while we talked. At the end of the conversation which lasted about an hour he said he could see it disappearing and thrush usually doesn't do this. Dave, I am not here to ask about timing and relability of test, but the condition of my tongue. I have read about coated tongue and have also read about thrush. The thing is that the thrush is only on my tongue although and I am expirieng heart burn in the morning with this. I scraped it off and it was red and sore underneath, but no blood. My tongue is sore, but it is getting better. My tongue started to hurt on Wednesday by Thursday it was completely covered in white plaque. I started to rub it off. On Friday I went to the Doctor who diagnosed me, buy Friday night most of the paste and irration was gone. Today is Saturday and almost all the paste is gone. My taste buds in the back of my mouth are enlarged and I have a sore throat with a little irration on my tongue. From the way it is progressing I expect it all to clear up by tommorrow. Is this normal for Thrush? Having a four day attack? I had no other idications of thrush on other part of my mouth (cheeks, roof of mouth, or any I could see in my throat). I am scared to death and am going to get another hiv test in a couple of days. I also wear braces and smoke heavily. Could this contribute to my attack? Also 3 weeks after the sexual encounter I started to get the fissures at the side of my mouth. The fissures are even worse now and only seem to be affected the left side of my mouth. A side note: During this time I have been very depressed and scared. My nerves have been on edge and have been on Biaxan 6 days after exposre for 5 days. Also Luvox and Xianax for depression.

Response from Dr. Reznik

First, let talk about coated tongue, which appears as a white or off-white covering of the dorsal (top) surface of the tongue. This condition is normally seen in people with dry mouth, who are under stress, smoke, drink alcoholic beverages, etc. Treatment for coated tongue involves a gentle brushing of the tongue each and every time you brush your teeth. Of course, reducing stress, which is often times easier said than done, staying well-hydrated, avoiding smoking and drinking will prevent recurrence as long as you brush your tongue on a daily basis. Coated tongue is not associated with HIV infection as many, many people, without any underlying medical illness present with this condition.

As far as culturing for thrush, it is important to note that the organisms that lead to thrush normally inhabit the oral cavity. A positive fungal culture on a white tongue is by no means diagnostic of thrush. Whereas it is possible for pseudomembranous candidiasis to present on the tongue, very seldom do we see this is as the only location where thrush presents. For people who do present with candidiasis due to an underlying condition such as HIV disease, uncontrolled diabetes, use of systemic steroid, etc., the condition normally does not go away in four days unless the underlying condition has been successfully addressed. In the case of HIV disease, this would mean being on a stable and successful antiretroviral regimen.

The fissures you mention may possibly be oral aphthous ulcerations. Again, people who are under stress tend to present with these ulcerations more frequently. There is a new over-the-counter medication, Orabase SOOTHE-N-SEAL, which will eliminate the pain associated with these ulcers. This product has just hit the market and is presently available at Wallmart stores.

As with anyone who is concerned about their HIV status, it is important to follow-up with testing three months after the potential exposure.

I hope this information proves helpful!

Sincerely,

DR


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