Table of ContentsView AllTable of ContentsOral ThrushOral Hairy LeukoplakiaOral HerpesHyperpigmentationOral WartsPreventive Oral Care
Table of ContentsView All
View All
Table of Contents
Oral Thrush
Oral Hairy Leukoplakia
Oral Herpes
Hyperpigmentation
Oral Warts
Preventive Oral Care
The human immunodeficiency virus (HIV) can affect areas of the mouth, including the tongue. Oral symptoms are common for people with HIV, with anywhere from 30% to 80% of individuals experiencing some type of mouth sore or lesion.
When the immune system is suppressed, it leaves the body vulnerable to infections that don’t typically happen in people with healthy immune systems. Disease-causing viruses and bacteria take advantage of the body’s weakened state and produce symptoms that can affect the tongue. In some cases, these can be thefirst signs of an HIV infection.
This article discusses the different conditions common to HIV that can affect the tongue. It covers symptoms for each condition as well as treatment.
Laura Porter / Verywell
When oral thrush strikes the tongue, it’s usually painless. Other symptoms may include:
An Overview of Oral Thrush
Treatment
Oral and topical antifungals help treat oral thrush.Oral medications like fluconazole are generally preferred over topical agents because you take them once a day and they’re easier to tolerate. Additionally, they can treat thrush all over the body (for instance, in the esophagus).
Topical antifungals, including clotrimazole lozenges or a nystatin suspension, require multiple doses, sometimes up to five per day. They can also have an unpleasant taste. Miconazole buccal tablets (a tablet applied between the gum and cheek) are given once a day but need to stay in place for at least six hours to be effective.
Benefits of Topical Agents vs. Oral MedsTopical agents limit your exposure to harsh treatments because they don’t affect your whole body. Localized treatment lowers the risk of side effects and drug interactions. If thrush hasn’t spread to the esophagus, treatment courses can be completed in just one to two weeks.
Benefits of Topical Agents vs. Oral Meds
Topical agents limit your exposure to harsh treatments because they don’t affect your whole body. Localized treatment lowers the risk of side effects and drug interactions. If thrush hasn’t spread to the esophagus, treatment courses can be completed in just one to two weeks.
Oral Thrush: Prescription Treatments and Home Remedies
Oral hairy leukoplakia (OHL)can occur if the Epstein-Barr virus (EBV) gets reactivated in individuals with HIV. EBV infection in childhood is usually mild or asymptomatic. Mononucleosis (“mono”) is how EBV typically shows up in adolescents and adults.
After these early infections, the virus stays quiet in certain cells of the body. Over 90% of adults around the world are thought to have EBV, many without active symptoms.When the immune system is weakened, EBV can reactivate and cause OHL.
Characteristics of OHL include:
What Is Leukoplakia?
OHL lesions are generally asymptomatic and benign. Most people don’t require specific treatment for OHL. Instead,managing the underlying HIV infectionwith antiretroviral therapy (ART) and boosting immune function helps clear up and prevent future flare-ups.
In some cases, your healthcare provider may suggest ways to improve comfort, restore your tongue’s cosmetic appearance, and minimize the folds of the plaques where other bacterial or viral infections may occur.
Topical agents, oral antiviral medications such as Zovirax (acyclovir) or Valtrex (valacyclovir), or even surgical removal may be recommended.Unfortunately, withoutimmune system improvementsthrough ART, there’s a high chance of recurring issues.
Theherpes simplex virus type 1 (HSV-1)is responsible for oral herpes. It’s easily spread from one person to another. People often get infected with HSV-1 in childhood, and it stays with them for the rest of their lives.
In the United States, about 50% of people ages 14 to 49 are positive for HSV-1.
Symptoms typically occur in the following progression:
Oral herpes is treated for five to 10 days withoral antiviral agentssuch as:
Healthcare providers may advise taking medication every day even when not experiencing an outbreak (called chronic suppressive therapy). Chronic suppressive therapy is helpful for people with frequent infections that keep coming back after treatment. It’s paired with the same antiviral oral medicines.
Oral melanin hyperpigmentation describes when mouth tissues look darker. It’s more common in individuals with darker skin tones. Characteristics of oral hyperpigmentation in HIV-positive people include:
HIV-associated oral hyperpigmentation is asymptomatic and does not require any specific treatment.However, be sure to discuss any darkened areas inside the mouth with your healthcare professional. Your healthcare provider can help you determine if these symptoms represent a different condition that can be treated separately.
Treament
Oral warts are benign. They may be removed with:
It’s not always practical to protect yourself against infections. Treating HIV with ART and restoring immune function is essential to your overall health. It’s also crucial to practice oral hygiene using these tips:
Various medications and medical conditions can causedry mouth, increasing the risk of infections and tooth decay. Sipping on water or sugarless drinks, sucking on sugarless hard candy, or chewing sugarless gum may help.
An artificial saliva product can also helpkeep the mouth wet. Speak with your healthcare provider if you have a dry mouth due to medication changes.
Summary
HIV can produce several conditions that affect the tongue, including oral thrush, herpes, warts, and more. Some conditions are asymptomatic and don’t require treatment while others will require medications or procedures to resolve.
Be sure to monitor your tongue and mouth for changes regularly and report any issues to your healthcare provider. Keeping your provider informed and practicing good oral hygiene will help you maintain good health.
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.The American Dental Association.Human immunodeficiency virus (HIV).Panel on Opportunistic Infections in Adults and Adolescents with HIV.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Centers for Disease Control and Prevention.Symptoms of candidiasis.Khammissa RA, Fourie J, Chandran R, Lemmer J, Feller L.Epstein-Barr virus and its association with oral hairy leukoplakia: a short review.Int J Dent. 2016;2016:4941783. doi:10.1155/2016/4941783Johns Hopkins Medicine.Oral hairy leukoplakia.Brasileiro CB, Abreu MH, Mesquita RA.Critical review of topical management of oral hairy leukoplakia.World J Clin Cases. 2014;2(7):253-256. doi:10.12998/wjcc.v2.i7.253Clinical Info HIV.gov.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.John Hopkins Medicine.Oral herpes.Feller L, Khammissa RAG, Lemmer J.Oral mucosal melanosis. In: Blumenberg M, ed.Melanin. InTech; 2017. doi:10.5772/65567R Chandran, RAG Khammissa, J Lemmer, L Feller.Oral medicine case book 63: HIV-associated oral melanin hyperpigmentation.South African Dental Journal.Testi D, Nardone M, Melone P, Cardelli P, Ottria L, Arcuri C.HPV and oral lesions: preventive possibilities, vaccines and early diagnosis of malignant lesions.Oral Implantol (Rome). 2016;8(2-3):45-51. doi:10.11138/orl/2015.8.2.045Syrjänen S.Oral manifestations of human papillomavirus infections.Eur J Oral Sci. 2018;126 Suppl 1(Suppl Suppl 1):49-66. doi:10.1111/eos.12538
12 Sources
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.The American Dental Association.Human immunodeficiency virus (HIV).Panel on Opportunistic Infections in Adults and Adolescents with HIV.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Centers for Disease Control and Prevention.Symptoms of candidiasis.Khammissa RA, Fourie J, Chandran R, Lemmer J, Feller L.Epstein-Barr virus and its association with oral hairy leukoplakia: a short review.Int J Dent. 2016;2016:4941783. doi:10.1155/2016/4941783Johns Hopkins Medicine.Oral hairy leukoplakia.Brasileiro CB, Abreu MH, Mesquita RA.Critical review of topical management of oral hairy leukoplakia.World J Clin Cases. 2014;2(7):253-256. doi:10.12998/wjcc.v2.i7.253Clinical Info HIV.gov.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.John Hopkins Medicine.Oral herpes.Feller L, Khammissa RAG, Lemmer J.Oral mucosal melanosis. In: Blumenberg M, ed.Melanin. InTech; 2017. doi:10.5772/65567R Chandran, RAG Khammissa, J Lemmer, L Feller.Oral medicine case book 63: HIV-associated oral melanin hyperpigmentation.South African Dental Journal.Testi D, Nardone M, Melone P, Cardelli P, Ottria L, Arcuri C.HPV and oral lesions: preventive possibilities, vaccines and early diagnosis of malignant lesions.Oral Implantol (Rome). 2016;8(2-3):45-51. doi:10.11138/orl/2015.8.2.045Syrjänen S.Oral manifestations of human papillomavirus infections.Eur J Oral Sci. 2018;126 Suppl 1(Suppl Suppl 1):49-66. doi:10.1111/eos.12538
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.
The American Dental Association.Human immunodeficiency virus (HIV).Panel on Opportunistic Infections in Adults and Adolescents with HIV.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Centers for Disease Control and Prevention.Symptoms of candidiasis.Khammissa RA, Fourie J, Chandran R, Lemmer J, Feller L.Epstein-Barr virus and its association with oral hairy leukoplakia: a short review.Int J Dent. 2016;2016:4941783. doi:10.1155/2016/4941783Johns Hopkins Medicine.Oral hairy leukoplakia.Brasileiro CB, Abreu MH, Mesquita RA.Critical review of topical management of oral hairy leukoplakia.World J Clin Cases. 2014;2(7):253-256. doi:10.12998/wjcc.v2.i7.253Clinical Info HIV.gov.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.John Hopkins Medicine.Oral herpes.Feller L, Khammissa RAG, Lemmer J.Oral mucosal melanosis. In: Blumenberg M, ed.Melanin. InTech; 2017. doi:10.5772/65567R Chandran, RAG Khammissa, J Lemmer, L Feller.Oral medicine case book 63: HIV-associated oral melanin hyperpigmentation.South African Dental Journal.Testi D, Nardone M, Melone P, Cardelli P, Ottria L, Arcuri C.HPV and oral lesions: preventive possibilities, vaccines and early diagnosis of malignant lesions.Oral Implantol (Rome). 2016;8(2-3):45-51. doi:10.11138/orl/2015.8.2.045Syrjänen S.Oral manifestations of human papillomavirus infections.Eur J Oral Sci. 2018;126 Suppl 1(Suppl Suppl 1):49-66. doi:10.1111/eos.12538
The American Dental Association.Human immunodeficiency virus (HIV).
Panel on Opportunistic Infections in Adults and Adolescents with HIV.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
Centers for Disease Control and Prevention.Symptoms of candidiasis.
Khammissa RA, Fourie J, Chandran R, Lemmer J, Feller L.Epstein-Barr virus and its association with oral hairy leukoplakia: a short review.Int J Dent. 2016;2016:4941783. doi:10.1155/2016/4941783
Johns Hopkins Medicine.Oral hairy leukoplakia.
Brasileiro CB, Abreu MH, Mesquita RA.Critical review of topical management of oral hairy leukoplakia.World J Clin Cases. 2014;2(7):253-256. doi:10.12998/wjcc.v2.i7.253
Clinical Info HIV.gov.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.
John Hopkins Medicine.Oral herpes.
Feller L, Khammissa RAG, Lemmer J.Oral mucosal melanosis. In: Blumenberg M, ed.Melanin. InTech; 2017. doi:10.5772/65567
R Chandran, RAG Khammissa, J Lemmer, L Feller.Oral medicine case book 63: HIV-associated oral melanin hyperpigmentation.South African Dental Journal.
Testi D, Nardone M, Melone P, Cardelli P, Ottria L, Arcuri C.HPV and oral lesions: preventive possibilities, vaccines and early diagnosis of malignant lesions.Oral Implantol (Rome). 2016;8(2-3):45-51. doi:10.11138/orl/2015.8.2.045
Syrjänen S.Oral manifestations of human papillomavirus infections.Eur J Oral Sci. 2018;126 Suppl 1(Suppl Suppl 1):49-66. doi:10.1111/eos.12538
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