[Question #1638] Oral thrush and fear of exposure many years ago

44 months ago
Dear doctor,

I am a heterosexual male in the UK aged 40. I recently was diagnosed with oral thrush and it did not resolve after a round of fluconazole, so I am now taking a second round. I did not know anything oral thrush beforehand so I researched it online, and I've now got myself very concerned about HIV, especially as I have not been on antibiotics recently, and the thrush didn't totally go away first time.

I had a one night stand around 20 years ago (sex twice in one night with a 20-year-old girl, no protection), but that is the only risky exposure that I can think of. The only other women I've slept with were during relationships, and they have gone on to have families so will have been tested when pregnant.  Could my oral thrush be the first sign of advanced HIV disease after 20 years?  I am otherwise in good health and have not had any illnesses other than the usual colds. I've looked up the other symptoms associated with HIV such as dermatitis, rashes, diarrea etc, and I haven't had any of those, although I did have some verrucas at some point in the past (I would guess about 14 years ago). My doctor did give me a full blood count, liver function test etc to rule out diabetes (all apparently normal). I will get a HIV test next week at a local drop-in center, but in the meantime I am very anxious and would like your opinion. 

Thanks.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

I'm going to assume your diagnosis of oral yeast infection (thrush) is correct. I mention it because it is a much over-diagnosed condition, especially if not confirmed by an experienced health professional. White coated tongue, which accompanies many minor health issues like common colds, is much more common than yeast and often mistaken for it.

But even assuming the correct diagnosis, a localized yeast infection would rarely if ever be the first and only abnormality to show up in someone with immune deficiency due to HIV, especially with HIV 20 years in duration. In other words, you really couldn't have an HIV infection advanced enough to predispose to thrush without having other symptoms and signs or at least feeling quite sick pretty much all the time. Stated another way, if you are otherwise outwardly healthy, there is little possibility of HIV. Having had warts (verrucas), genital or otherwise, is not an indication of immune deficiency or HIV. Second, most people with untreated HIV die well before 20 years. Finally, you describe a virtually zero risk lifestyle for HIV. In the UK (and all North America and western Europe), HIV is less frequently heterosexually transmitted than you might assume from media reports. The large majority of heterosexually acquired infections are in people who are the regular, ongoing partners of infected persons, who in turn usually are injection drug users, closeted gay men, etc. I've never seen an HIV infected person with so few heterosexual partners.

The important thing is to be tested, as you intend to do. Why are you planning to wait a week? Get tested today if you can (although I guess it's now after close of business in the UK, and I don't know if the "drop in" clinics you refer to are available on Saturdays). Whenever you do it, you can expect a negative result. in the meantime, you can kick back and relax.

I hope this has been helpful. Let me know if anything isn't clear, and please also plan on posting the results when you have been tested.

Best wishes--  HHH, MD

---
44 months ago
Thanks Dr for the quick and thorough reply. You have certainly helped alleviate my fears. I believe my doctor's thrush diagnosis was correct because the treatment did improve it a lot, it just didn't quite seem to clear it altogether. It was at that point that my fears went into overdrive! I'm also unsure how I could have got oral thrush in the first place, other than being generally run down at the time.  I guess sometimes there isn't an obvious reason for it? 

I'm going to the drop-in on Monday, it was the soonest I could do it due to work commitments this week. 




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
The host-pathogen interactions in yeast and other fungal infections are complex and poorly understood. The details of how the immune system responds to specific pathogens, especially fungi, may have significant differences among entirely healthy persons with immune systems that are normal by all available measures. On this basis, some experts suspect that some people may be less capable than others of controlling a particular strain of yeast. This is mostly speculative, but it might also help explain why some women have much greater problems with recurrent vaginal yeast infections than others.

Whatever the explanation, it's not all that rare to see patients with localized yeast infections in the absence of obvious immune deficiency, and the vast majority of people with problems like yours do not have HIV or any other apparent immune deficiency.

I look forward to hearing about your (almost certainly negative) HIV test result. Let's hold off on further discussion until then.




---
43 months ago
Hi Doc!

Sorry for the slow update, but the clinic I went to takes up to two weeks to give results, and after waiting all that time I didn't receive a text or get a call, so I rang up today and. after a pause at the other end of the phone that felt like a lifetime, I heard the magic word: negative! Wow, such a huge weight has been lifted from my shoulders in the space of a few seconds! I know I shouldn't have doubted you, Doc, but I guess it's human nature to fear the worst, and over the last couple of weeks I had convinced myself I was positive. After all, why else would I have such persistent oral thrush? (The dangers of Dr Google!) It didn't help that I started getting other problems as well, like chronic fatigue, nausea and shooting pains in my groin, armpits and neck. I'm not sure if it's stress-related or something else, and I still don't know why I have this oral thrush, but at least (and at last) I can rule out HIV.

To anyone else reading this who has gone many years without having a HIV test, do yourself a favour and go to a clinic today. Don't wait until you wake up one day with a weird symptom like oral thrush and then go into a spiral of HIV panic and paranoia. Seriously, the past few weeks have been hell for me, but I know it's my own fault. If I'd bothered getting tested years earlier, I would never have jumped to such an unreasonable conclusion. 

Anyway, thanks again, Doc. You and your colleagues do great work on this site, and your advice was worth every penny I paid.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Congratulations on the negative result, but of course I am less surprised than you were. 

You make a good point in your advice to others about HIV testing if concerned and to not delay testing because of fear of the result. When fearful of testing for potentially life threatening conditions -- e.g. women afraid of mammograms, as well as HIV testing and lots of other situations -- almost always stress declines after testing. Not only are most results negative, but stress also delines even if positive. Just clearing the air and knowing the result is almost always beneficial psychologically. 

Best wishes and stay safe. Thanks for your kind words about the forum.

---