Mouth sores such as canker sores (also called aphthous ulcers) are common and usually form on the soft pinkish-red tissue inside the lips and cheeks and on the bottom or sides of the tongue. Proper treatment of such infections or conditions is key to clearing up these mouth or throat problems. Some of these lesions, especially with primary syphilis, are not painful, making them easy to miss. Some sexually transmitted infections, including chlamydia, gonorrhea and syphilis, can also infect the mouth or throat and produce sore throat, tonsillitis or oral ulcers. Human papilloma virus (HPV, the cause of warts), bacteria - either an overgrowth of bacteria normally found in the mouth or newly introduced bacteria - and lymphoma can also cause mouth and throat conditions. Shingles can cause pain and multiple lesions on one side of the mouth, with the mouth pain lingering long after the initial lesions have healed. These include herpes simplex, which causes painful cold sores on the lip or ulcers on the palate, and herpes zoster, which is the cause of chicken pox and shingles.
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Other mouth and throat infections and conditions can occur in people with HIV regardless of CD4 count. Antiretroviral therapy allows the immune system to rebuild itself, at least partially, resulting in a dramatic decrease in the risk of these infections. People with these infections require immediate attention and need to start antiretroviral therapy. More rarely, mouth lesions can be caused by Mycobacterium avium complex (MAC) and oral fungal lesions can be associated with histoplasmosis, geotrichosis or cryptococcus. Opportunistic infections and conditions that can affect the mouth include Kaposi's sarcoma, oral and esophageal candidiasis (commonly called thrush), hairy leukoplakia and mouth or throat ulcers caused by herpes simplex or cytomegalovirus (CMV). In people with HIV who are not on antiretroviral therapy, mouth problems - and more specifically mouth ulcers - can be a sign of a weakening immune system that has left them vulnerable to an opportunistic infection or other condition. A person experiencing these symptoms should seek medical care right away. The section Rash and Other Problems of the Skin, Hair and Nails has additional information on this reaction. This reaction is very serious and potentially fatal. This reaction results in rash, fever, nausea and other allergy-like symptoms accompanied by tingling, inflammation and blisters in the nose or mouth or on the lips. The reaction, called Stevens-Johnson syndrome, usually develops within two weeks of starting a new drug, including some antiretroviral drugs. Note that changes in the mouth can be a sign of a rare but serious allergic reaction to a drug. Most of the time, once the underlying issue is resolved, the mouth problem clears.
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Below we discuss common issues such as infections, canker sores, dry mouth and dental problems. Developing a treatment plan will depend on the specific problem.
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A trip to a doctor or dentist is needed to determine the cause. There are a number of causes of mouth and throat problems, including infections, antiretroviral drugs and other medications, nutritional issues, oral cancer or other medical conditions and poor dental hygiene.