Extremely scared

[worriedtoolong]

I had a significant exposure some years but tested negative on 4 or 5 separate hiv duo tests in uk out to around 7 months (bear with me as I know it sounds like I have nothing to worry about). The cause of the initial hiv test was a severe case of recurrent oral thrush confirmed by gp and oral specialist which responded to prescribed anti fungals but then came back immediately on cessation. This persisted for approx a month after my final negative 4th gen test. 2years ago I had another mild case of thrush but on the side of my tongue this time which cleared up easily with nystatin which I let my self stop worrying about over time. I now as of a week ago have another small patch of thrush on opposite side of tongue which I treated with daktarin gel. So now I am terrified again and back to square one. Could the oral thrush I originally had when I first tested have been a sign of my cd4s plummeting and that it was recurrent because of this and the tests were negative because it didnt finally clear up until after my final test? I had no predisposing factors for thrush

[Edward W Hook, MD]

Neither of these issues has any impact on my assessment.  You should believe your test results.  EWH

[worriedtoolong]

Thanks for the reply Dr, could I just ask a couple of things I forgot that may be important: 1. I had a hep b vaccination ten years ago which I did not respond to (87 miu/ml insufficient for immunity) could this in any way indicate that my hiv antibody response would also be poor? 2. I also noticed that some of my gums had become red (underneith 2 lower front teeth, 2 on back of upper jaw  and 1 either side of upper jaw).  I tried brushing more often and using chlorhexidine mouthwash but no different, BUT after reading about linear gingival erythema (hiv gingivitis) and its treatment with flagyl (metronidazole) I started taking this antibiotic a couple of days and the redness on the back 2 teeth and one in the middle has rapidly turned back to healthy pink (no effect on front gums). Could flagyl have this effect on normal gingivitis after just 2 days or does this signify hiv? Do you believe I am conclusively negative and can continue to have unprotected sex in my monogamous relationship?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  The majority of people who have thrush, even thrush refractory to treatment, do not have HIV.  Some have predisposing issues such as antibiotic use, diabetes, other medications which immunosuppress them or ingestion of lots of sugary substances, many others simply have the recurrent thrush for reason that are hard to understand.  Your repeated negative tests as far out as 7 months after your exposure of concern provide "gold standard" proof that you do not have HIV and should be believed.  I suspect that whatever predisposed you to thrush in the past is affecting you again, not that you have an HIV infection that was missed by your testing.

My advice would be to work through the issues of your recurrent thrush with your doctor.  Unless there is something else related to HIV risk that you have not mentioned however, I would not be worried that your thrush is a manifestation of HIV that was missed by testing.  EWH