Human Papillomavirus, or HPV, is a group of over 100 related viruses and is the most common sexually transmitted infection in the United States. While often associated with the genital area, certain HPV strains can also infect the oral cavity, which includes the mouth and throat. An oral infection occurs when the virus enters the body through a small cut or tear inside the mouth. For most people, the immune system clears the virus without intervention, often without them ever knowing they were infected.
Transmission and Prevalence
The primary way oral HPV spreads is through sexual contact, specifically oral sex. The virus passes from one person to another when infected saliva or mucus contacts a small opening in a partner’s mouth. While oral-genital contact is the most documented route, deep kissing is also a possible method of transmission. Having multiple sexual partners increases the likelihood of acquiring an oral HPV infection.
Oral HPV is widespread, affecting approximately 7 percent of people in the United States between the ages of 14 and 69. Infections are more common in men than in women, with statistics showing about 10% of men and 3.6% of women have an oral HPV infection. The majority of these infections are temporary and resolve on their own, often within two years.
Signs and Symptoms
A characteristic of oral HPV is that most infections do not produce any noticeable signs or symptoms. Because of this asymptomatic nature, individuals often do not realize they have the virus and can unknowingly transmit it to others.
In the minority of cases where symptoms manifest, they can appear as painless sores or small, hard bumps inside the mouth. These growths might be found on the lips, the tongue, or in the throat area, including the soft palate. The lesions can be flat or slightly raised and may appear white, pink, red, or the same color as the surrounding skin.
Associated Health Risks
While most oral HPV infections are harmless, certain strains are associated with health risks. HPV types are categorized as either low-risk or high-risk. Low-risk types may cause warts in the mouth or throat, but high-risk strains are linked to cancer. Specifically, high-risk HPV, most notably HPV-16, is a cause of oropharyngeal cancers, which affect the middle part of the throat, including the base of the tongue, the tonsils, and the pharynx walls.
The connection between HPV and oropharyngeal cancer is well-established, with approximately two-thirds of these cancers containing HPV DNA. Although about 7% of the population has oral HPV, only about 1% of people have the high-risk HPV-16 type. This means that while oral HPV is common, the development of cancer as a result is rare. Factors that can elevate the risk include smoking and having a weakened immune system.
Having a high-risk HPV infection does not guarantee that cancer will develop. In a small number of individuals, the infection can persist for years, leading to cellular changes that may eventually become cancerous. Symptoms that could indicate oropharyngeal cancer include:
- A persistent sore throat
- Trouble swallowing
- Constant earaches
- A lump in the neck or cheek
Diagnosis and Medical Management
Currently, there is no routine, FDA-approved test to screen for oral HPV in individuals without symptoms, unlike the Pap test for cervical HPV. A diagnosis of an oral HPV-related issue begins with a physical examination by a doctor or dentist, who will visually inspect the mouth, tongue, and throat for abnormalities.
If a doctor or dentist identifies a suspicious sore, lump, or lesion, the next step is a biopsy. This procedure involves taking a small tissue sample from the affected area. The sample is then sent to a laboratory to be examined for abnormal or cancerous cells and can also be tested for HPV DNA.
The management of oral HPV depends on the findings. For non-cancerous warts or lesions that cause discomfort, a doctor may recommend removal through surgical procedures or cryotherapy. If a biopsy confirms oropharyngeal cancer, a team of specialists will determine the treatment, which may include surgery, radiation therapy, or chemotherapy, based on the cancer’s stage and location.
Prevention Through Vaccination and Safe Practices
The most effective method of preventing oral HPV infections is vaccination. The HPV vaccine, such as Gardasil 9, is highly effective at protecting against the HPV types that cause the majority of related cancers, including HPV-16. The vaccine is recommended for both males and females, ideally before they become sexually active.
In addition to vaccination, certain lifestyle choices can reduce the risk of transmission. Using barrier methods like condoms and dental dams during any sexual activity, including oral sex, can lower the chances of spreading the virus. Limiting the number of sexual partners also reduces potential exposure. Open communication with partners about sexual health is another preventative measure.
These practices can lower the risk but do not offer complete protection because the virus can be present on skin not covered by a barrier. Regular dental and medical check-ups that include an examination of the mouth and throat are also important for catching any potential problems early.