[Question #6362] Oral Thrush and HIV

16 months ago

Hi Doctor,


25 y/o Male  here. I’ve had two recent risk exposures. First - Unprotected drunk sex with a woman (I met just that night). Second - 20 days after the first, I had ‘protected’ sex with a woman I met just that night. I also kissed the second woman a lot as we’d just met at a party whilst dancing. Since the first event, I was a panicky about HIV given it was my first proper sex. I had a bit of cold, severe running nose, cough, headache, tiny blood shot on eye (weird) etc around 4 to 5 days after the event, although the symptoms cleared individually within 2 to 3 days of each of them showing. Given this, I wasn’t too worried about it being HIV seroconversion as it was the beginning of winter season and catching a cold was quite easy. The second encounter was fully protected. However, what I noticed shortly after the lady left was some dried blood stains on the sheets In about 3 places. It appears she may have been on her period but I don’t know for sure. I panicked again and checked the used condom and put some water in it to see if it broke and I confirm it was still intact. Based on this I concluded that the second event was not very risky. The problem, however, now is that about 4 days after the second encounter (23 days after the first), I started developing a white tongue.  I had a  layer of white on my tongue and inner cheeks that wouldn't come off with brushing. I thought it was oral hairy leukoplakia from EBV associated with HIV. After several weeks of Anxiety, I went to see 2 two different doctors at 40 and 42 days after the first event (which is c.22 days after the second event). Both performed 4th Gen HIV tests and both came back negative. I also used a home self test kit which came back negative. 


Although the white tongue isn’t as bad as when it started, I went for a mouth swab 45 days after the first risk event and it was confirmed as Oral Thrush. Doc prescribed Anti-fungal gel to apply daily. 


It’s now been 1 month in total with the white tongue. Although not as bad as when it started, it is still present and has me worrying. 


Questions:


  • Is oral thrush strongly linked to HIV? 
  • Do any of the timelines below make sense to indicate Thrush as a symptom of HIV?  i.e.


Scenario 1 -, if I theoretically contracted HIV from the first person, I have tested negative at the 6 week Mark.


Scenario 2 - the second intercourse was fully protected, but I got the white tongue after 4 days. isn’t this too early to have a white tongue if it were HIV from the second event?


Today is the 8 week mark since the first event and 5 week mark of the second. The HIV tests were two weeks. I’m super anxious. 

16 months ago

Hi,

 

25 M with two risk exposures. 8 and 5 weeks since first and second. First was unprotected drunk sex with a woman. Second (20 days after the first), ‘protected’ sex with another woman. I also kissed the second woman a lot(Likely Cause of Thrush?)

 

4 days after first, came up with cold, running nose, cough, headache, tiny blood shot on eye. The symptoms cleared within 2-3 days of each showing. Given this, I wasn’t too worried about HIV ARS as it was the beginning of UK cold season.

 

The secondsex was protected. However, I noticed some blood stains on the sheets after the lady left. She may have been on her period, but can’t say. I panicked again and checked the used condom and confirmed it was still intact. Based on this, I concluded that the 2nd event was not very risky. The problem now, is that 4days after the 2nd encounter (23days after the 1st), I developed a white-tongue and some white lesion on inner cheeks that wouldn't come off w/brushing. Thought it was OHL associated with HIV. I eventually saw 2 doctors at 40&42 days after the 1st event (c.22 days after the 2nd event). Both performed 4thGen tests and both came back negative.

 

Despite improvements, I went for a mouth swab 45days after the 1stRisk event and tongue was confirmed as Oral Thrush and given Anti-fungal gel. 

 

It’s been a month with the white tongue and I’m dying-inside. 

 

Questions:

 

·         Is oral thrush strongly linked to HIV? 

·         Do the timelines below make sense to indicate Thrush as a symptom of HIV? 

 

1. If I contracted HIV from the first person, but have tested negative at the 6 week Mark.

 

2. The second event, fully protected, but with white tongue after 4 days. Isn’t this too early?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome to the forum. Thanks for your confidence in our services. I will delete the first (difficult to read) entry; thanks for re-entering it in a second window. (Note to other users:  please enter questions directly in the field provided. Writing elsewhere (e.g. Word® or other word processing programs) and pasting often results in problems such as nearly illegible text.)

First, you have some apparent misunderstandings about HIV and its symptoms and about oral yeast infection (thrush). White coated tongue is not thrush and not caused by yeast. (This is misunderstood by some physicians as well.) Coated tongue occurs in association with innumerable mild health conditions, like colds, dietary changes, perhaps stress or sleep deprivation, and others. It is not an HIV or ARS symptom. probably can occur with acute HIV infection, but 99.9% of cases have other causes. 

Second, oral yeast infections -- for which your symptoms are not typical -- sometimes occurs in entirely healthy people with normal immune systems. And it is not a common occurrence in acute HIV or ARS, although it's quite common in people with advanced HIV for several years, i.e. those with overt AIDS. Most such persons are seriously ill with multiple other symptoms. 

Those comments partly address your specific questions, but to be explicit:

The exposures described were low risk for HIV, which is rare even among the most sexually active women in most of the US and other industrialized countries. And even with entirely unprotected vaginal intercourse, the average HIV transmission risk, female to male, is around once for ever 2,500 exposures. The symptoms you describe do not suggest acute HIV infection (ARS), which doesn't cause cold symptoms at all (nasal congestion, etc); and ARS symptoms cannot start sooner than 7-10 days after exposure. It sounds like you caught a cold -- perhaps from your sex partner -- but not HIV. As for the second exposure, I agree it was essentially zero risk, given successful condom use. (Exposure to menstrual blood is no more risky than vaginal sex with no blood, by the way.)

Finally, you are correct that your blood test result is conclusive in regard to the first exposure. I cannot judge whether or not your coated tongue has anything to do with the second exposure, but if it does it isn't thrush and isn't due to HIV.

So no worries andI would not recommend any further HIV testing. I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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16 months ago
Thank you for the response Dr H, Much appreciated!

Re Oral thrush, my concerns were that Oral thrush is commonly seen as a sign that the Immune system may be compromised, and that my Doctor confirmed couple days ago that I had thrush after lab testing from a mouth swab. The results just didn’t make sense in the first instance because oral thrush is usually wipeable, and my tongue couldn’t be wiped in the first few weeks, and only just a bit now. it was more the tongue itself being white as opposed to a coating, if that makes sense? (Not sure if you’ve ever come across this? My first doctor thought it was a dehydration). I will however finish the course the doctor prescribed and see if it finally clears off. 

Anyway, like you indicate, the 4th Gen at 6 weeks is relatively conclusive and oral thrush (if at all that’s what I have, and relates to HIV) would’ve meant a progression  to more serious stages of HIV, But the extremely early timing of it and negative 4th Gen results might indicate something else. 

Thanks again. Let me know if you have any other thoughts 






H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
The important thing here is your negative HIV test. The AgAb (4th generation) blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. Therefore, when done long enough after exposure, it overrules all other considerations:  no matter how high the risk of HIV at the time of exposure and no matter how typical someone's symptoms might be, a negative result is condlusive. That result is not "relatively" conclusive:  it proves you do not have HIV.

And I remain unconvinced you have oral yeast infection (thrush). We try not to challenge users' doctors or diagnoses made by them. However, it remains true that oral thrush doesn't usually cause white coated tongue, which  is why the whiteness on your tongue could not be wiped away. Yeasts are commonly present in the mouth, not causing disease; do a yeast culture on a hundred healthy people and probably 10-20 of them would be positive. In other words, if cultured for yeast and positive, it doesn't necessarily mean the coated tongue was caused by the yeast. 

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