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Oropharyngeal Candidiasis — SCE Infectious Diseases MCQ

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EasyHIV MedicineOropharyngeal CandidiasisSCE Infectious Diseases

A 35-year-old woman with HIV (CD4 80) presents with extensive white plaques on her oropharyngeal mucosa that are easily scraped off revealing an erythematous base. She has odynophagia. What is the most likely diagnosis and first-line treatment?

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Correct answer: D — Oropharyngeal candidiasis; Fluconazole 100 mg daily for 7–14 days

White plaques on oropharyngeal mucosa that can be scraped off to reveal an erythematous base are diagnostic of oropharyngeal candidiasis (thrush). This is extremely common in HIV when CD4 <200. Fluconazole 100 mg daily for 7–14 days is first-line treatment. Nystatin suspension is an alternative for mild disease. Oral hairy leukoplakia (EBV) cannot be scraped off and occurs on lateral tongue borders. ART initiation is the key long-term management to prevent recurrence.

Reference: BHIVA 2022 – OI guidelines; BNF 2024 – Oropharyngeal candidiasis