Case Study #3a Scenario Doug was a young single guy who on occasion had casual sexual encounters with women he met while out in bars. A few months after one such encounter, during a dentist’s appointment, the hygienist noted what looked like a series of small bumps on the back and side of Doug’s tongue, which had not been noted in his chart before. Signs and Symptoms At his next visit, the bumps had expanded into lesions and Doug mentioned them as a concern. The dentist noticed that his tonsil on the side of the tongue lesions was swollen, as were the lymph nodes. He prescribed an antibiotic, which Doug took. The lesions didn’t get better but they also got no worse. A few weeks later Doug developed a stubborn sore throat, so he went to see his family physician. Testing When Doug’s doctor saw the lesion at the back of his tongue, he sent Doug for an oral brush biopsy procedure. When the biopsied tissue was stained with hematoxylin and eosin stain, the pathologist noted a well-differentiated squamous cell carcinoma. A second sample was obtained by scalpel biopsy and tested for human papillomavirus (HPV) DNA, specifically HPV-16 and HPV-18. The results were returned as positive for viral DNA. Question: Why did the antibiotics not improve Doug’s condition?
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