HIV can increase the likelihood of a person developing oral health problems. This can include effects on the tongue including, herpes, warts, and candidiasis.

HIV is a viral infection that attacks the immune system, leading to a wide range of symptoms. The virus can affect every part of the body, including the skin and the nervous, respiratory, and digestive systems.

The National Institute of Dental and Craniofacial Research states that people living with HIV are “at special risk for oral health problems.” Evidence suggests that about 30–80% of people living with HIV experience associated oral complications.

The symptoms of HIV vary depending on the stage of the condition. There are three stages of HIV:

  • Stage 1: Acute HIV infection
  • Stage 2: Chronic HIV infection
  • Stage 3: AIDS

Oral symptoms, such as mouth ulcers, often occur during the acute stage. As a result, they can be an early sign of HIV. Oral symptoms can also be important for monitoring the progression of HIV to AIDS.

The oral symptoms of HIV can affect the tongue in various ways, each of which may require different treatments.

In this article, we look at the main symptoms of HIV that can affect the tongue and the possible treatment options. We also discuss how to reduce the risk of oral complications and explain why the virus does not spread through kissing.

A person with HIV preparing to start their oral hygiene routine.Share on Pinterest
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HIV can indirectly affect the tongue because it causes various oral health problems. These include:

  • candidiasis
  • hairy leukoplakia
  • herpes
  • hyperpigmentation
  • warts

Oral candidiasis

Oral candidiasis, or thrush, is a fungal infection that can develop anywhere in the mouth. It presents as bumpy patches that can be yellow, white, or red and may cause a burning sensation. People with oral thrush may experience changes in taste, and their sensitivity to spice may increase.

If the infection is mild, a doctor may prescribe antifungal lozenges or mouthwash. They may suggest taking antifungal pills if the infection is severe.

Hairy leukoplakia

Hairy leukoplakia causes a thick, white, hair-like patch to grow on the tongue. Although it is not usually painful, the growth can cause discomfort. Hairy leukoplakia patches can resemble those of oral thrush. However, it is not possible to move hairy leukoplakia patches, whereas a person can wipe away patches that develop from oral thrush.

Treatment is not always necessary if symptoms of hairy leukoplakia are mild. A doctor may prescribe a pill to reduce symptoms if they are more severe.

Oral herpes

People with HIV are more likely than other people to develop oral herpes, as the virus weakens the immune system. Oral herpes infections cause red sores and blisters to develop in and around the mouth. These are not always painful, but they often cause a tingling or burning feeling.

Unlike thrush and hairy leukoplakia, oral herpes is contagious and can transfer through mouth-to-mouth contact — for instance, through kissing.

There is currently no cure for herpes, but a doctor can prescribe antiviral medication to reduce the frequency and severity of oral symptoms.

Oral hyperpigmentation

Oral hyperpigmentation causes dark lesions to develop in the mouth, as changes in hormone levels cause additional pigmentation to collect in the tissues. These lesions can be blue, purple, brown, gray, or black.

The effects of oral hyperpigmentation are aesthetic, and treatment is unlikely to be unnecessary.

Oral warts

Oral warts develop as small bumps in the mouth. They can be pink, white, or gray and can sometimes spread through kissing.

The treatment will depend on where they grow. Doctors can prescribe a cream to treat warts on the lips, but those that grow inside the mouth require surgery or cryosurgery, a freezing treatment, to remove them.

People can take several steps to minimize their chance of contracting HIV. The Centers for Disease Control and Prevention (CDC) note that these include:

  • abstaining from sex
  • using a barrier method, such as a condom, during all sexual activity
  • avoiding sharing needles
  • using HIV prevention medication, such as pre-exposure prophylaxis (PrEP), for those at increased risk

According to the American Dental Association, a person with HIV can help prevent oral complications by adopting the following practices:

  • attending regular dental appointments
  • brushing the teeth twice a day for at least 2 minutes each time
  • flossing between the teeth
  • taking HIV medication regularly

In addition to experiencing the oral complications above, a person with HIV may have chronic dry mouth. This can lead to further issues, including infection and tooth decay. A person can reduce dryness of the mouth by:

  • drinking water regularly
  • avoiding salt
  • avoiding alcohol
  • refraining from smoking
  • chewing or sucking on sugarless gum or sugarless hard candy
  • using artificial saliva

HIV is extremely unlikely to transmit through kissing, as the virus is not transmissible through saliva. However, it is possible if both partners have open wounds in their mouths, as this may enable the blood from a person with the infection to enter the bloodstream of the other person.

Learn more about why a person is very unlikely to get HIV from kissing.

The risk of transmitting HIV through oral sex is minimal.

However, it could happen if the bodily fluids of a person with HIV entered the bloodstream of the other person through an open wound in their mouth. Transmission could also be possible if someone with a detectable viral load ejaculated into the mouth of a sexual partner.

Therefore, it is advisable that people use barrier protection, such as condoms and dental dams, during sexual activity.

Learn more about why a person is unlikely to get HIV from oral sex.

People with HIV may develop other conditions that lead to mouth complications, including:

  • human papillomavirus
  • canker sores
  • gum disease
  • Kaposi’s sarcoma

The reason for this is that HIV weakens the immune system, making it harder for the body to fight against infection.

HIV can cause a wide range of symptoms that affect all parts of the body. Oral symptoms, which often occur during the first stage of the virus, can affect the tongue. HIV lowers the immune response, so a person with the virus is more susceptible to new infections. As a result, people with HIV often develop other complications, including conditions such as oral herpes.

There is little chance of HIV spreading through kissing. The virus transmits when the blood, breast milk, vaginal fluid, or semen of the person with the infection enters the bloodstream of another person. Therefore, both partners would have to have open mouth sores for the virus to spread through kissing.