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Persistent oral thrush
Hello Doctors,
First, let me tell that you’re work here has been inmensely helpful to get through these last dark 12 weeks. Thanks for that.
This is my case. After having unprotected vaginal sex with a CSW and developing a lot of symptoms (more on that later), I’ve got three negative HIV tests, all fourth generation. One at 5 weeks, another at 8 and the last one day and a half short of 12. I understand I should consider myself unequivocally in the clear and should be celebrating. But the problem is that I have persistent oral thrush, diagnosed by two doctors. Since 10 days after my exposure, my tongue has like a white thick carpet from the back to the end and its borders and other spots are completely depapillated; in the back is thicker and somewhat raised. Sometimes my mouth hurts, and sometimes I have a weird taste like sand. First one week of oral nystatin, then four days of daktarin gel and, finally, 7 days of 100 mg pills of fluconazol have done anything. In fact, it has got worse since beginning fluconazol and now my throat hurst a little. This resistance has my doctor very worried, as is very very rare in people with regular immune systems. Besides, I have a weird cough, that sometimes makes me gag and a on and off mild headaches. I know all information referent to probabilities, times of testing…etc My questions are somewhat different:
1) Days before the episode, I had been taking amoxicilin for about two weeks, could that cause such a persistent and resistent thrush in a healthy people?
2) Should I go for a PCR RNA test, or are my tests completely conclusive? I understand that even if I am one of the unlucky ones without much antibody response the antigen part of my test would pick my infection anyway.
3) In my county it’s pretty hard to get a public infectious diseases doctor and a private one is very expensive. In your opinion, should I spend my money visiting one or my regular doctor should do?
Thanks for all.
First, let me tell that you’re work here has been inmensely helpful to get through these last dark 12 weeks. Thanks for that.
This is my case. After having unprotected vaginal sex with a CSW and developing a lot of symptoms (more on that later), I’ve got three negative HIV tests, all fourth generation. One at 5 weeks, another at 8 and the last one day and a half short of 12. I understand I should consider myself unequivocally in the clear and should be celebrating. But the problem is that I have persistent oral thrush, diagnosed by two doctors. Since 10 days after my exposure, my tongue has like a white thick carpet from the back to the end and its borders and other spots are completely depapillated; in the back is thicker and somewhat raised. Sometimes my mouth hurts, and sometimes I have a weird taste like sand. First one week of oral nystatin, then four days of daktarin gel and, finally, 7 days of 100 mg pills of fluconazol have done anything. In fact, it has got worse since beginning fluconazol and now my throat hurst a little. This resistance has my doctor very worried, as is very very rare in people with regular immune systems. Besides, I have a weird cough, that sometimes makes me gag and a on and off mild headaches. I know all information referent to probabilities, times of testing…etc My questions are somewhat different:
1) Days before the episode, I had been taking amoxicilin for about two weeks, could that cause such a persistent and resistent thrush in a healthy people?
2) Should I go for a PCR RNA test, or are my tests completely conclusive? I understand that even if I am one of the unlucky ones without much antibody response the antigen part of my test would pick my infection anyway.
3) In my county it’s pretty hard to get a public infectious diseases doctor and a private one is very expensive. In your opinion, should I spend my money visiting one or my regular doctor should do?
Thanks for all.
MEDICAL PROFESSIONAL
Try to relax. Your current doctor is exactly right and your HIV test is virtually 100% reliable. As I said above, test results always overrule symptoms.
Thaks for the advice, doctor.
Like many people, It was a drunken mistake;i don't even believe it has happened.
I'll visit the ID doctor on thursday. Yesterday I saw the regular doc and she said not to worry and gave me another round of nystatin + diflucan. She says that is not so uncommon that the thrush takes a while to disappear.
Well, I'll let you know how my visit with the ID doctor goes. I hope am not the hiperunfortunate one. But, yes, you're right, with the cough, the mouth and all, i am deeply worried.
Like many people, It was a drunken mistake;i don't even believe it has happened.
I'll visit the ID doctor on thursday. Yesterday I saw the regular doc and she said not to worry and gave me another round of nystatin + diflucan. She says that is not so uncommon that the thrush takes a while to disappear.
Well, I'll let you know how my visit with the ID doctor goes. I hope am not the hiperunfortunate one. But, yes, you're right, with the cough, the mouth and all, i am deeply worried.
MEDICAL PROFESSIONAL
Welcome to the forum. Thank you for doing some research and looking at other threads before asking your own question. However, I fear you have missed one of our most consistent messages: as long as HIV testing is done sufficiently long after the last exposure (4 to 12 weeks, depending on the test[s]), the results always overrule symptoms and exposure history.
Therefore, your test results show that for sure you do not have HIV. Indeed, if by "4th generation: you mean a combination test for both HIV antibody and p24 antigen, your 5 week test was 100% reliable. Also, it is very, very rare to catch HIV heterosexually from a single episode of vaginal sex; the anyway, the odds are strong your CSW partner did not have HIV.
Coated tongue and other oral surfances are not necessarily thrush (yeast infection), and even highly skilled physicians can easily mistake the diagnosis. If diagnostic tests for yeast have not been done, you may not have thrush at all. Antibiotics often can trigger either coated tongue or true thrush, so my guess is that whatever is going on is likely related to your recent amoxicillin treatment. In addition, I disagree with your doctor about oral thrush as a sign of severe immune deficiency; it occurs in entirely healthy people (in fact I once had it myself). Finally, early HIV doesn't generally cause cough, headache, and the other symptoms you describe.
So the first step is to confirm you in fact have an oral yeast infection. To your specific questions:
1) Yes, amoxicillin could trigger either coated tongue or yeast; see above.
2) Additional HIV testing is not likely to be helpful, but if you see an infectious diseases specialist, s/he might have different advice. However, your negative combo tests at 5, 8 and 12 weeks are sufficient to be sure you don't have it.
3) My advice would be to see either an infectious diseases or oral medicine specialist, if you can find one. Oral medicine is a dental specialty. Such specialists often can be found at univeristy schools of dentistry.
Final advice: I hope this experience reinforces the importance of condoms for casual or commercial sexual exposures. Although I am confident you did not catch HIV, probably you would be a lot less worried if your recent CSW exposure had been condom-protected.
I hope this has helped. Best wishes-- HHH, MD
Therefore, your test results show that for sure you do not have HIV. Indeed, if by "4th generation: you mean a combination test for both HIV antibody and p24 antigen, your 5 week test was 100% reliable. Also, it is very, very rare to catch HIV heterosexually from a single episode of vaginal sex; the anyway, the odds are strong your CSW partner did not have HIV.
Coated tongue and other oral surfances are not necessarily thrush (yeast infection), and even highly skilled physicians can easily mistake the diagnosis. If diagnostic tests for yeast have not been done, you may not have thrush at all. Antibiotics often can trigger either coated tongue or true thrush, so my guess is that whatever is going on is likely related to your recent amoxicillin treatment. In addition, I disagree with your doctor about oral thrush as a sign of severe immune deficiency; it occurs in entirely healthy people (in fact I once had it myself). Finally, early HIV doesn't generally cause cough, headache, and the other symptoms you describe.
So the first step is to confirm you in fact have an oral yeast infection. To your specific questions:
1) Yes, amoxicillin could trigger either coated tongue or yeast; see above.
2) Additional HIV testing is not likely to be helpful, but if you see an infectious diseases specialist, s/he might have different advice. However, your negative combo tests at 5, 8 and 12 weeks are sufficient to be sure you don't have it.
3) My advice would be to see either an infectious diseases or oral medicine specialist, if you can find one. Oral medicine is a dental specialty. Such specialists often can be found at univeristy schools of dentistry.
Final advice: I hope this experience reinforces the importance of condoms for casual or commercial sexual exposures. Although I am confident you did not catch HIV, probably you would be a lot less worried if your recent CSW exposure had been condom-protected.
I hope this has helped. Best wishes-- HHH, MD
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