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Tonsillitis, sever sore throat ,dysphagia and odynophagia, no symptoms, WBC, Lymphocyte, Ceftriaxon , Cefpodoxime. STD?

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ENT Specialist
Practicing since : 2001
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Tonsillitis :

Dear Doctor

I am 28 years old male ,before two months I got sever sore throat ,dysphagia and odynophagia ,with out any other symptoms like fever and and cough,but I had nausea and I lost weight ,6 days before that I had unprotected sex .so I am afraid of HIV tonsillitis .

Past history.i had history of recurrent tonsillitis in past 3 years but every time was not sever and returned back to normal after taking antibiotic .
On exam.
My tonsils enlarged bilatteraly(follicular) specially in right side with multiple white spot on both of them and ptechiae on soft palate


Wbc was 8700
Lymphocyte percentage was in lower normal range limit XXXXXXX bunnel test was negative
Aso titer normal
Culture was negative
ESR was 3mm /hr

Treatment : I received antibiotic
Ceftriaxon vial for 5 days
Cefpodoxime(orelox) 5 days without significant improvement in my condition
So my ENT prescribed for me
Co-amoxiclav and ciprofloxacin for next 5 days
After all these medication white spot on tonsils went away but tonsil still enlarged till today .
My question is that
1_could this tonsillitis due to acute HIV infection? Usually tonsilar enlargement by HIV will last how many days till return back to normal?
2_what is differential diagnosis of my condition and do you suggest tonsillectomy??
3_drinking alcohol can affect my condition?

I attached the photos of my tonsil before 2 months and now

Best regards
Posted Tue, 22 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Naveen Kumar 29 hours later


Thanks for the query and a detailed history.

Transmission of the virus from an HIV positive active partner to an HIV negative receptive partner is less common. This is because HIV is normally present in low levels in the throat which are not sufficient enough to cause infection. Secondly, the lining of the mouth and throat are very resistant to viral infections such as HIV, so infection is unlikely if they are healthy.

But, if there is bleeding wounds or gums in the HIV positive person’s mouth or on their lips, the virus may transfer through the blood into the mucous membranes of the other person’s genitals or into any cuts or sores they may have.

After examining the photos carefully, I am of the opinion that it is more of a chronic tonsillitis. In the old photo, one can see the multiple pus pointed regions over the tonsil which denotes an active infection. But, in the new image, there is absence of any active infection and it is only the residual congestion of the anterior tonsillar pillar and congestion over the posterior pharyngeal wall.

The difficulty in swallowing could be due to the inflammation over the pharyngeal wall. This can be treated with home remedies such as drinking plenty of warm water; avoiding chilled or hot food and beverages and coffee.

It is not uncommon for HIV infection to present with ENT symptoms. The most common presentations are cervical lymphadenopathy, oro-oesophageal candidiasis, and otitis media. Tonsillitis can be noticed when the immune status in the body gets low and is generally noticed during the later stages.

If the symptoms of the sore throat are more than 3-4 episodes per year, it is better to undergo tonsillectomy. Also get HIV 1 and 2 antibody test done, this confirms your HIV status and you can have a piece of mind.

Drinking alcohol in small amounts is not at all a problem; avoid chilled beverages.

Hope I have answered your query; I will be available for the follow-up queries.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
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