HIV-Related Mouth Sores: Symptoms and Treatments

Medically Reviewed by Carmelita Swiner, MD on August 03, 2022
3 min read

Mouth sores are common in people with human immunodeficiency virus (HIV). They usually happen because the virus weakens your immune system, so your body has a hard time fighting infections that cause them.

While they aren’t life-threatening, they can impact your quality of life. They can be painful or make it hard for you to eat. But whatever the cause, there’s likely an effective treatment.

When you have HIV, there are several reasons the inside of your mouth might hurt.

Aphthous ulcers. Also called canker sores, aphthous ulcers can appear many places inside your mouth: the inner surface of your cheeks and lips, your tongue or soft palate, or the base of your gums. People with HIV are more likely to get them than people who don’t have the virus. The sores aren’t contagious, but they are often very painful.

For mild cases, your doctor might recommend an antiseptic mouthwash.

Oral hairy leukoplakia. These are white patches with ridges in them. Hair-like growths come out between the ridges. They’re typically on the tongue, but they can also show up elsewhere in your mouth. The Epstein-Barr virus is what triggers them. Because they happen in people with weak immune systems, they could be a sign that your HIV is getting worse.

You may not need treatment if you have a mild case. If you have severe symptoms, a doctor might prescribe a prescription pill to suppress the Epstein-Barr virus that causes it.

Thrush. Also known as candidiasis, this fungal infection causes cream-colored patches in the mouth, soreness, and bleeding. It’s a common symptom of advanced HIV. It’s an opportunistic infection, which means it easily takes hold when HIV has caused major damage to your immune system.

A prescription antifungal lozenge or mouthwash can knock out mild cases. You may need prescription antifungal pills if your thrush is severe.

Other STIs. Mouth sores can be a symptom of several types of sexually transmitted infections, including:

  • HPV (human papillomavirus), which may cause painless mouth lesions or warts. Your doctor will usually use surgery to remove them.
  • Syphilis, which can cause sores on your lips, tongue, gums, or at the back of your mouth. Your doctor will typically treat it with antibiotics by injection and pills.
  • Gonorrhea, which could cause a sore throat and sometimes white spots in your mouth. Antibiotics are the usual treatment.

Oral herpes. Many conditions can cause sores on or near your mouth, whether or not you have HIV. But if you have HIV and sores on your lips or inside your mouth, there’s a good chance the herpes simplex virus (HSV) is causing them.

HSV infections are common in people who have HIV. That’s because the herpes virus -- which was likely in the body long before HIV -- “wakes up” as HIV attacks the immune system.

Two types of herpes simplex virus (HSV) cause sores. HSV-1 typically causes sores on or near the mouth. HSV-2 usually causes sores on or near the genitals.

Here’s what you should know about oral herpes:

  • Sores may be clear, pink, red, yellow, or gray.
  • It’s very contagious right before and during an outbreak.
  • Some infections are resistant to treatment.
  • Treatment-resistant viruses can cause worse symptoms.
  • Longstanding, severe HSV sores may be an early symptom of AIDS.

Prescription antiviral drugs can help sores heal faster and make outbreaks less frequent.