angular cheilitis/thrush

[panickingallday]

Hi Doctor

I originally submitted a question regarding a bump I had on my cheek, which turned out to be innocuous. I’m here now with another query, and I’m very anxious and quite overwhelmed with all the information I’ve been finding.

The other week, I had an extremely sore throat for a few days. I went to the doctor and he said it was probably some viral bug in conjunction with seasonal allergies that caused the illness. I did not take any medication for the sore throat, aside from numerous cough drops, because the soreness subsided in a few days.

However, around the time the soreness was subsiding, my tongue became very white and the corners of my lips began to crack. I do recall in the middle of the night on one of the nights where my throat was very sore, that I was drooling in my sleep because my tonsils were so swollen. This only happened on one side of my mouth, though, so I don’t know why both sides of my mouth are cracked. I believe what I have is angular cheilitis, and it is worrying me. I’m also concerned that the whiteness on my tongue was thrush. My tongue is no longer white today, but for the past few days it has been very sore and it is almost as if I have no sense of taste. My tongue is also a little redder than usual, and there are some bumps throughout my tongue that seem larger than usual. Is this common with thrush/angular cheilitis? I read something about atrophic candida that looks similar to my issue (presenting with angular cheilitis simultaneously).

I’m worried that this thrush/angular cheilitis is caused by HIV infection. Around two and a half years ago, I had a brief unprotected one night stand with a stranger. I’m scared that I might have caught it then and now I’m exhibiting symptoms. I’ve read that oral manifestations are often the first to present themselves when it comes to infection, so now I am sick with worry. Is it likely that this is all just an extension of my viral illness?

[Edward W Hook, MD]

fFinal answer- your fungal nail infection is unrelated to your possibe angular cheletis.  EWH

[panickingallday]

Hi Doctor,

Thanks for the input, again. I'll try not to worry about it so much, but it just alarms me that it seems I've been having issues with yeast infections over the past year and a half, seemingly randomly. I've been dealing with a bit of fungus on one of my nails for the better part of a year now, just a few weeks ago I had a yeast infection, and now this. Should I be concerned that these are all related, or is possible they were caused by separate things?

I'm putting some tea tree oil and aquaphor on the angular cheilitis until I can get to a doctor.

[Edward W Hook, MD]

This is part of the way angular chelitis progresses. You may need some topical anti-fungal therapy. I would talk th your doctor and not worry further about the possiblity of HIV.  EWH

[panickingallday]

Hi Dr. Hook,

Thanks for writing back--I really appreciate your thorough answer, and it has helped to relieve my anxiety a bit.

My viral symptoms are all gone by now, but the angular cheilitis persists. Is it common for this to follow some sort of illness? I'm just mostly concerned as to why I have this, since I've never had this happen before...also, is this something that will go away by itself? When the angular cheilitis first appeared last week, it was slight--now it appears to be getting worse and dryer.

[Edward W Hook, MD]

Welcome back to our Forum. I'll be pleased to comment.  FYI, Dr. Handsfield and I share the Forum and today I happened to pick up your question.  We are comfortable sharing the Forum as we because we have worked together for more than 30 years and have found our assessments and advice (although not necessarily our verbal styles) to uniformly agree with each other.  

We receive many questions from clients who wonder about coatings on their tongues, white patches and recently I had a prolonged exchange with another person about angular chelitis.  In each instance, we have found that what happened is that our clients have been misled through internet searches which raise the specter of HIV infection inappropriately.  I'll reply by first commenting on your risk for HIV from your exposure 2 and 1/2 years ago, then on the findings in your oral cavity and at the angles of your lips.

The risk for HIV form any single encounter, no matter who your partner was, is quite small.  HIV is a rare infection and most people do not have it, even most men who have sex with other men or most persons who have many other past sexual partners.  In addition, even if your partner had HIV (unlikely as I said above), there is no situation in which more than 1% of exposed persons acquire HIV from a single exposure and in most cases the risk for infection is far, far lower, depending on the type of exposure involved.  While to do not know the details of your exposure, I find it most unlikely that you have HIV.

Even if you did have HIV, increased risk for fungal infections (such as thrush or angular chelitis) does not occur until after years (i.e. 8-10 typically) of infection when the diseases is far advanced, not just 3-3 years after infection. Further, most people who get angular chelitis or thrush do not have HIV- these are VERY common conditions which are somewhat more common in persons with HIV but again most people with thrush, angular chelitis or other tongue pathology do not have HIV.

Having read both this post and your prior interactions with Dr. Handsfield, my sense is that it might be a good idea for you to test for HIV to be able to set aside any lingering concerns that you might have that you are still infected.  Infection is most unlikely and a negative test will permit you to move forward without further concern.  EWH