QuestionSBA
QuestionChoice
Chlorhexidine mouthwash is useful in a variety of conditions such as ulcers, mucositis and following oral surgery. This option however does not appreciate the urgency of the situation and the need for an HIV specialist.
10035565
d
Commence chlorhexidine mouthwash with topical analgesia
QuestionChoice
This is very inappropriate given the patient's symptoms, concerns and history.
10035566
e
Discharge and advise improvement in dental hygiene
QuestionChoice
Nystatin may be used in oral candidiasis (thrush) where we would expect white patches on gums, tongue and inside the mouth that can be peeled off leaving a raw area. Oesophageal candidiasis can occur in HIV as well but we would expect odynophagia and sometimes dysphagia.
10035563
b
Commence Nystatin suspension
QuestionChoice
This is correct. The patient is presenting with oral hairy leukoplakia, an EBV infection of the tongue, suggestive of advanced immunocompromise likely on the background of HIV and ulcerative colitis here. This can be an AIDS-defining illness and he needs to be rapidly assessed by an HIV specialist.
10035562
a
Refer to secondary care
QuestionChoice
Antiretrovirals must never be stopped, started or withheld by anyone other than an HIV specialist. In addition, we do not know if the patient is established on them in this case.
10035564
c
Stop the patient’s antiretrovirals
Concept
Chapter
2693
6143
Oral lesions
Topic
136
Gastroenterology
19516
Oral hairy leukoplakia, often associated with HIV, requires urgent referral to secondary care for assessment and management.
A 48-year-old man comes to the GP concerned about a white patch on the side of his tongue that he is not able to rub off. His past medical history consists of ulcerative colitis, hypertension and HIV.

What is the most appropriate management?
a