Table of ContentsView AllTable of ContentsAphthous UlcersOral HerpesOral ThrushOral Hairy LeukoplakiaHIV-Associated GingivitisHuman PapillomavirusKaposi Sarcoma
Table of ContentsView All
View All
Table of Contents
Aphthous Ulcers
Oral Herpes
Oral Thrush
Oral Hairy Leukoplakia
HIV-Associated Gingivitis
Human Papillomavirus
Kaposi Sarcoma
Mouth sores are common withHIV (human immunodeficiency virus), affecting 70% to 90% of people at some stage of the disease. They may develop as an early sign of infection or at the most advanced stage of the disease, calledAIDS (acquired immunodeficiency syndrome).
The sores develop as a result of aweakened immune systemthat makes it harder to control infections like oral herpes or thrush. The sores can be directly treated, but managing HIV withantiretroviral drugscan bolster your immune defenses and reduce your risk of these and other opportunistic infections.
This article describes the different types ofHIV-associated mouth sores, offering pictures and a list of symptoms and treatments.
Mohd Akhir / EyeEm / Getty Images
Aphthous Ulcers or Canker Sores
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNetdermnetnz.org2023
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNetdermnetnz.org2023
Symptoms of canker sores include:
Aphthous ulcers can affect anyone but are more common—and tend to be more severe and recurrent—in people with HIV.
How Aphthous Ulcers Are Treated
Aphthous ulcers often resolve on their own. Saltwater mouth rinses can aid with healing, while sipping on ice water or sucking on ice chips can help ease mouth pain.
These include:
Herpes Simplex Virus (HSV)
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet and © Dr. Richard Ashtonwww.dermnetnz.org2023.
Reproduced with permission from © DermNet and © Dr. Richard Ashtonwww.dermnetnz.org2023.
There are two types of HSV:HSV-1commonly associated with oral herpes andHSV-2commonly associated with genital herpes. Some cases of oral herpes occur when HSV-2 is passed to the mouth during oral sex.
Oral herpes can develop spontaneously, often when a person’s immune system is down. The sores tend to develop on the lip or under the nose but also occur inside the lip or inner cheek.
Symptoms include:
How Oral Herpes Is Treated
Cold sores typically last for one to two weeks without treatment. The severity and duration may be reduced if oralantiviral drugsare taken as soon as you recognize the symptoms.
These include antivirals like:
Oral Candidiasis
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from ©DermNet NZwww.dermnetnz.org2022
Reproduced with permission from ©DermNet NZwww.dermnetnz.org2022
Oral candidiasis—also known as oral thrush—is the most common oral opportunistic infection in people with HIV. Oral thrush is the first sign of HIV in around 10% of cases.
Symptoms of oral thrush include:
Oral thrush limited to the mouth can occur at any stage of the infection. When candidiasis develops in the throat or around the tonsils, it generally indicates advanced HIV or AIDS.
How Oral Thrush Is Treated
Oral thrush is treated withtopical antifungalsfor milder cases ororal antifungalsfor more severe or recurrent cases.
These include antifungal drugs like:
Oral Hairy Leukoplakia (OHL)
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNetdermnetnz.org2023.
Reproduced with permission from © DermNetdermnetnz.org2023.
Oral hairy leukoplakia(OHL)affects up to 60% of people with HIV who are not onantiretroviral therapy. OHL is also a common first sign of HIV, typically when the disease is advanced and the immune system has already been compromised.
OHL is due to an infection with theEpstein-Barr virus (EBV)which only causes OHL when there immune system is severely damaged.
Although EBV is contagious, the infection is ubiquitous, affecting over 90% of the world’s population. It is only when immunodeficiency occurs that EBV can express itself as OHL.
Symptoms of OHL include:
The lining of the cheeks and lips can also sometimes be affected.
How Oral Hairy Leukoplakia Is Treated
OHL may not require any other treatment than antiretroviral therapy. Oral antivirals like Zovirax (acyclovir) may speed the clearance of OHL, but in the absence of antiretroviral therapy, OHL is likely to recur and become more serious.
Types of Antiretrovirals Used to Treat HIV
This photo contains content that some people may find graphic or disturbing.See Photodanielzgombic / Getty Images
danielzgombic / Getty Images
HIV-associatedgingivitis—more commonly referred to asperiodontal diseasein people with HIV—is a non-contagious form of gum disease that can take two forms:
HIV-associated gingivitis is commonly seen in people whose immune systems have been compromised. It rarely occurs on its own and is more likely to accompany otherAIDS-defining conditions.
The symptoms of HIV-associated gingivitis include:
How HIV-Associated Gingivitis Is Treated
Underpinning the immediate need for antiretroviral therapy is good dental hygiene. Dental pain can be eased with anesthetic mouthwash and ice chips.
Corrective dental procedures can prevent the worsening of gum disease and tooth loss, including:
Oralantibioticsmay be added to preventsecondary bacterial infections.
Human Papillomavirus (HPV)
Human papillomavirus(HPV)is a highly contagious virus most commonly associated with genital warts but one that can also occur in the mouth due to oral sex.
HPV is the most common sexually transmitted infection in the United States. There are more than 100 different types, including at least 12 high-risk strains associated with cancer.
Approximately 10% of males and 3.6% of females have oral HPV. It is also thought to cause 70% oforopharyngeal (mouth and throat) cancersin the United States.
With that said, high-risk HPV doesn’t tend to cause symptoms unless oropharyngeal cancer develops (typically five to 15 years after the initial infection).
If oral symptoms do develop, they are most often related to low-risk HPV types that do not cause cancer.
Symptoms of oral HPV include:
How Oral HPV Is Treated
In most cases, oral HPV infections go away on their own within two years and don’t cause any health problems. If warts develop, surgery orcryotherapywith liquid nitrogen is the only way to remove them.
Vaccination to Avoid HPVHPV can be prevented with avaccine. The vaccine is recommended for children ages 11 or 12 but can be started as early as 9. People who were not adequately vaccinated can receive the vaccine up to the age of 26.People older than 26 are more likely than not to already have HPV but can request vaccination after consultation with their healthcare provider.
Vaccination to Avoid HPV
HPV can be prevented with avaccine. The vaccine is recommended for children ages 11 or 12 but can be started as early as 9. People who were not adequately vaccinated can receive the vaccine up to the age of 26.People older than 26 are more likely than not to already have HPV but can request vaccination after consultation with their healthcare provider.
HPV can be prevented with avaccine. The vaccine is recommended for children ages 11 or 12 but can be started as early as 9. People who were not adequately vaccinated can receive the vaccine up to the age of 26.
People older than 26 are more likely than not to already have HPV but can request vaccination after consultation with their healthcare provider.
Kaposi Sarcoma (KS)
KS can cause lesions on any part of the body, including the lips and gums.
Symptoms of Kaposi sarcoma include:
How Kaposi Sarcoma Is Treated
Thetreatment of KSis focused on restoring your immune function with antiretroviral therapy. Doing so can clear the cancer and may require no other form of treatment. Even so, the lesions can cause extreme distress, and some people may opt to have them removed with cryotherapy.
KS may require more aggressive treatment if it disseminates (spreads) from the skin to internal organs. In such cases,chemotherapyorradiation therapymay be recommended.
Summary
Mouth sores are common in people with HIV. Some can occur during any stage of the infection, such as aphthous stomatitis (canker sores), oral herpes (cold sores), oral candidiasis (thrush), and oral HPV (oral warts). Others are seen with advanced HIV or AIDS, including oral hairy leukoplakia, AIDS-associated gingivitis, and Kaposi sarcoma.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pakfetrat A, Falaki F, Delavarian Z, Dalirsani Z, Sanatkhani M, Zabihi Marani M.Oral manifestations of human immunodeficiency virus-infected patients.Iran J Otorhinolaryngol. 2015;27(78):43-54.Southeast AIDS Education & Training Center.HIV and oral health 101: aphthous ulcers (canker sores).MedlinePlus.Canker sores.MedlinePlus.Herpes - oral.Looker KJ, Elmes JAR, Gottlieb SL, et al.Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.The Lancet Infectious Diseases. 2017;17(12):1303-1316. doi:10.1016%2FS1473-3099(17)30405-XCenters for Disease Control and Prevention.Candidiasis.Martins LL, Rosseto JHF, Andrade NS, Franco JB, Braz-Silv PH, Ortega KL.Diagnosis of oral hairy leukoplakia: the importance of EBV in situ hybridization.Int J Dent.2017;2017:3457479. doi:10.1155/2017/3457479University of California, San Francisco.Oral manifestations of HIV infection.University of California, San Francisco.Oral human papillomavirus (HPV) infection.Centers for Disease Control and Prevention.HPV and oropharyngeal cancer.Centers for Disease Control and Prevention.HPV vaccine recommendations.MedlinePlus.Kaposi sarcoma.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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