Question

Doctor, how common are canker sores as an early symptom of HIV infection? I had one encounter of unprotected sex with a female partner. I tested negative for HIV 7 weeks (50 days) after exposure. However, the past two weeks a single canker sore has appeared on my inner lip. Is this a common symptom of HIV infection or could it be more related to stress? Thanks for your attention to this question.

Answer

Whereas canker sores (aphthous ulcerations) are commonly seen in people living with HIV/AIDS, by no means are they diagnostic of HIV disease. There have been several studies which have looked at seroconversion illness. The results of these studies have concluded that there are no oral signs that are predictive of HIV seroconversion. In other words an association with oral ulcerations and recent HIV infection has not been scientifically proven.

We do not know the cause of aphthous ulcerations, but have established that they are seen with increased frequency in people living with HIV/AIDS. Treatment for these ulcers has improved in recent months due to the release of a new over-the-counter product, Orabase Soothe-N-Seal, which actually seals of the exposed nerve markedly reducing the pain associated with said lesions. For HIV positive people reading this response, be advised that use of a topical corticosteroid such as dexamethasone elixir (0.5mg/5ml) may be needed to address the inflammation seen in associated with these lesions.

Finally, canker sores or aphthous ulcerations are quite common in the general population. Whereas the NHANES study mentioned that only about 17% of the general population presents with aphthous ulcers (canker sores), I am of the opinion that this number is exceptionally low.

I hope this information proves helpful!

DR