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MOUTH AND THROAT SYMPTOMSRecognise the patient needing urgent attention:• Unable to open mouth• Unable to swallow at allManagement:• Refer same dayExamine the mouth and throat for redness, white patches, blisters or ulcers.Are there pus or white patches on tonsils?NoViral pharyngitis likely• Give paracetamol 1g6 hourly• Salt water mouthwash• Reassure patient thatantibiotics are notnecessary.Red throatYesBacterial tonsillitis likely• Give paracetamol 1g 6hourly• Salt water mouthwash• Give benzathinepenicillin 1.2MUIM single dose orphenoxymethylpenicillin500mg 12 hourly for 10days. If penicillin allergicgive erythromycin500mg 6 hourly for 10days instead.Refer for ENTassessment if > 4episodes per year.White patches on cheeks, gums,tongue, palate, may have angularcheilitis (cracks in corners of mouth).Oral thrush/candida likely• Nystatin suspension 1ml orally aftereating for 7 days. Keep in mouth aslong as possible.If patient uses inhaled corticosteroids,ensure s/he uses spacer and rinsesmouth after use 65.If status unknown, test for HIV 60.• For routine HIV care 61.• Oral thrush is a stage 3 HIV disease.Patient needs co-trimoxazole.• The HIV patient with difficulty orpainful swallowing (oesophagealthrush likely) needs fluconazole200mg daily for 14 days and ART.Painful blisters on lips/mouthHerpes simplex likely• Apply tetracaine 0.5% on blisters6 hourly.• If HIV give aciclovir 400mg 8 hourly for 7days if:--Ulcers are extensive or recurrent--Severe pain--Ulcers present for > 1 monthIf status unknown, test for HIV 60.• For routine HIV care 61.• Herpes > 1 month is a stage 4 HIV disease.Patient needs ART 61.Painful ulcer/s in mouth/throatAphthous ulcer/s likely• Apply tetracaine 0.5%on ulcers 6 hourly.until healed.• Refer if:--Not healed within2 weeks--Larger than 1 cmin diameter• Advise the patient with a sore mouth/throat to avoid spicy, hot, sticky, dry or acidic food and to eat soft, moist food or to soften food with margarine or gravy, or dip in tea/coffee or soup.• Advise to keep mouth and teeth clean by brushing and rinsing regularly.14TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH