An examination of the mouth for abnormalities may help diagnose HIV in those with other risk factors, according to a report in the journal Sexually Transmitted Infections.

In a study of 572 homosexual men, mouth lesions were found in 60% of those with HIV and 7% of those without HIV.

The three most common oral lesions were erythematous candidiasis, in which reddish flat lesions form in the mouth; pseudomembranous candidiasis, which is characterized by yellow-white plaque that can be wiped away; and oral hairy leukoplakia, a slightly elevated white surface that cannot be wiped off the tongue or other mucous membranes.

"Examination of the mouth is a simple non-invasive procedure which few people find unduly unpleasant," reported Dr. Peter Robinson, of the King's College School of Medicine and Dentistry in London, UK, and colleagues. "Oral lesions are common in HIV disease and have long been recognized as the first manifestation of the infection."

However, not all people with such oral lesions have HIV, the authors caution. Other factors that can cause the conditions include denture wearing, topically applied medicine, pregnancy, iron and vitamin deficiency, and use of antibiotics or tobacco.

But patients with oral lesions and other risk factors for HIV are more likely to have the virus, they note.

"Only 2.6% of people in England and Wales with mucosal lesions resembling oral hairy leukoplakia will have HIV, but if the person is a homosexual male the positive predictive value rises to 57.4%," the authors conclude.

SOURCE: Sexually Transmitted Infections 1998;74:345-348.

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