Sir, I write further to the letter from J. Winterburn in relation to syphilis.1 It is important that history taking should include the possibility of sexually transmitted infections (STIs), especially in relation to oral manifestations. As a recently graduated dentist it is surprising to find that HIV testing is not routinely requested when investigating lesions such as recurrent aphthous stomatitis (RAS).
Whilst investigations are routinely carried out to assess full blood count and the serum B12 levels, a request to identify the antigen p24, which is indicative for exposure to HIV, is not routinely made. However, multiple studies have demonstrated the benefits of providing routine HIV screening in the A&E environment to be both feasible and effective. We are aware of the oral manifestations which are common in HIV-positive patients, such as candidiasis, RAS, hairy tongue and periodontal disease.
In providing routine HIV screens as a form of investigation, we can collectively increase the number of undiagnosed positive patients which would in-turn not only aid in the appropriate management of these patients, but also reduce the risk of HIV transmission to other members of the population. I feel that all clinicians should consider the deduction of STIs, particularly HIV, when investigating and thus diagnosing oral diseases.
Winterburn J. Syphilis up. Br Dent J 2021; 230: 5.