[Question #10628] Tongue lesions/sores and fungal infection

21 months ago

I(male) had an encounter with a random trans(with penis) who likely also engages in random encounters with other men. I never usually engange in random encounters. I performed oral sex on him, with a condom, and I also received brief anal sex(one single full insertion with condom). I do think the condom stayed intact, although I did not inspect it closely after. I also gave him a short handjob and he touched my penis with his hands, with no condoms. There was no kissing. About 7 weeks after the encounter, I started getting some small sores/lesions and burning sensation on my tongue. Anxiety went through the roof, and I did several HIV blood tests(p24 combination) at 8,5 weeks, 10,5 weeks and 87 days, all negative. I also did syphilis blood tests(Igg/Igm) at 9,5 weeks and 87 days, also negative. I did rectal and urine tests for gonorrhea, chlamydia and mycoplasma at 88 days, also negative. The sores/lesions on my tongue have since progressed, and they mostly appear around the edge and tip of the tongue where it meets my teeth, sometimes with a raised white edge around them and a more white tongue in general, and I still have some burning sensations. I have visited two GP’s, one dentist and one oral surgeon. I was put on nystatin for two weeks, and flucanzole for 1 week, with little to no effect. I also got some burning/soreness in my left armpit and one GP found a small peasized swollen lymph node, and thought that I may have a fungal infection in the armpit. I got an antifungal cream, and it helped somewhat, but now the lymph node and burning is back, and I am also somewhat sore/red skin in my groin between testicles and thigh. Oral surgeon suspects geopraphic tongue, due to unsuccessful fungal treatments. I did not get oral swab for gonorreah/chlamydia due to antifungals, and due to my oral sex being with a condom. Do you think I can rule out any STI/STD completely, or should I test more?

H. Hunter Handsfield, MD

21 months ago

Welcome to the forum. Thanks for your confidence in our services.

The most important aspect of this experience and your question is your negative HIV and STI tests. Those tests are 100% conclusive at the time you had them, proving you do not have HIV or any of the STIs for which you were tested. The results also mean your mouth/tongue problems are not caused by HIV or STI. The symptoms of an HIV infection are caused by the immune response to the virus, not to HIV itself. The immune response is measured by anti-HIV antibody. The positive HIV antibody test results therefore prove that something other than HIV is the cause of these symptoms-- as well as any other symptoms you may develop any time in the future -- no matter how typical for HIV the symptoms seem to be.

In addition, no other STI is a like cause of such symptoms. Gonorrhea, chlamydia, and genital mycoplasmas never cause anything like you describe. The only positivity for the inflammation of your mouth is herpes, but your description doesn't sound at all like herpes. It sounds reasonable for your oral surgeon to have tried anti-yeast treatment. Failure to improve with both nystatin and fluconazole makes yeast less likely, but does not rule it out entirely; there are yeasts (like Candida glabrata and others) that are resistant to these drugs and need alternate treatment.

Another aspect that argues against HIV and other STIs is the 7 week delay from the sexual event to your first symptoms. That's too long for symptoms caused by any of these infections. This fact is strong evidence that your symptoms have nothing at all to do with the sexual exposure you have described. I am confident you have no infection from that event.

In summary, no other STI testing of any kind is likely to be helpful. My only advice is to keep working with your doctor(s) if your symptoms continue.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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21 months ago

Thank you for your thorough reply. A follow up question: the lesions on my tongue do resemble some photographs of secondary syphilis symptoms(but so do many other conditions) I have seen, but nothing like primary. But as I understand, an Igg/Igm test for syphilis would have 100% sensitivity in the secondary stage, i.e since I did testing at 9,5 and 12 weeks, after the lesions appeared, there is no chance it could be caused by syphilis? I understand that a test at 12 weeks would be conclusive no matter the stage of syphilis, but I just want to confirm. One does worry when some conservative goverment agencies cites a 24 week incubation time for syphilis(which I do not believe by the way, but the mind is easily tricked in weak moments of anxiety).

H. Hunter Handsfield, MD

21 months ago

Your understanding on both points is correct: many skin and mucous membrane (e.g. oral) problems can mimic syphilis; and that the IgG/IgM tests never miss syphilis more than 4-6 weeks in duration, including all secondary syphilis. Those results indeed make syphilis impossible as the cause of the problem.

I doubt any "government agency", consertative or not, states a 24 week incubtion period for syphilis. You must have misunderstood something you found online or elsewhere.

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