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Lesion on Tonsil won't heal
Aug 31, 2008

Dear Dr. McGowan,

I've been poz about 4 years, currently on meds, VL<48, cd4 602/32%. I feel great but, for over year, I have had a sore spot on my right tonsil that won't heal. At it's worse it looked like a giant canker sore however hardly visible now. At times it make it hard to swallow, causes minor pressure on my inner ear and some nights I wake up suddenly with a choking sensation and cough spasm. My doc has put me on Valtrex, courses of antibotics and anti-inflamatory steriods. The steriod will give a breif period of relief but as soon as I come off this sore spot comes right back in the exact same place. My doc doesn't seem overly concerned but it is very uncomfortable. Any thoughts? I hate to keep nagging him but I'd be sleeping now if not in pain.

Response from Dr. McGowan

Dear Sleepless,

This sounds like a very disturbing problem. Certainly herpes simplex (HSV) would be a possibility, but this should be helped by valtrex. Drug resistant HSV may be a possibility and a viral culture of the lesion may help to demontrate that. Certain other sexually transmitted diseases such a syphilis (usually not tender) or gonorrhea can cause lesions or sore throats, but unless you are being repeatedly infected these would usually not last a year. If you have chronic post-nasal drip from allergic rhinitis (runny nose and congestion in the nose) that may cause this. This may also be caused by a cancer or benign polyp on the vocal cords, especially if you are a smoker. The best thing to do next would be an evaluation by an ear-nose-and-throat (ENT) specialist who may want to take a biopsy of the sore.

Joe


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