Human papillomavirus or HPV is a common sexually transmitted infection in the US. According to CDC, in 2018 there were about 43 million HPV infections, and many infected people were in their late teens and early 20s. It is estimated that approximately 7% of Americans ages 14 to 69 have oral HPV. And this infection has increased over the past three decades. There are more than 100 types of human papillomavirus, and at least 14 of those are cancer-causing which is also known as the high-risk type. HPV usually clears up without any intervention within a few months. Nearly 90% clear within 2 years. Certain types of HPV may persist and progress to cervical cancer.
What is HPV?
A viral infection that is passed between people through skin-to-skin contact is HPV. Sexually active people will get some type of this infection at some point (even if they have few sexual partners). Many people get a genital HPV infection via direct sexual contact, including vaginal, anal, and oral sex. Genital HPV infection may not cause any health problems in some cases. But, some types of HPV can lead to the development of genital warts and even cancers of the cervix, anus, and throat. A pregnant woman who is infected with HPV can pass on the virus to her baby during delivery. In this case, the infant may develop a condition called recurrent respiratory papillomatosis. And they develop warts inside their throat or airways.
In the US every day about 12,000 people ages 15 to 24 is infected with HPV. Because of its ubiquitous nature, more than 80% of Americans will have an HPV infection in their lifetimes.
HPV is spread by skin-to-skin contact. Most people get HPV in their genital area through sexual intercourse. But when a person engages in oral sex, they may contract it in the mouth or throat. This is known as oral HPV or oropharyngeal HPV infection. This can also cause oral cancer. Approximately 10% of men and 3.6% of women in the US are living with an oral HPV infection. According to an ongoing NHANES study, nearly 26 million Americans on any given day have an oral HPV infection. Between all age groups, this infection is most common among older adults.
Of all strains of the infection, 40 types of HPV are capable of affecting the throat, mouth, and genital areas. Both men and women can have oral HPV, however, it is more common among men. Over several years, oral HPV may lead to oropharyngeal cancer or cancer that develops in the back of the throat. And it is also estimated that 70% of oropharyngeal cancer cases are caused by oral HPV.
Oral HPV causes
Many people get infected by having oral sex. During mouth-to-genital and mouth-to-mouth contact, HPV particles in the saliva or mucus of infected people enter through an open cut or sore in the mouth or throat to someone who is not infected. Sometimes, it may spread through oral contact with contaminated utensils or medical instruments. Some types of HPV can cause cancer of the throat or larynx, oropharyngeal cancer. HPV-16 is linked with almost all oral cancers.
The risk of HPV infection increases with an increasing number of a lifetime or recent sexual partners for sexual behavior like vaginal sex or oral sex. For people with 20 or more lifetime sexual partners, the prevalence of oral HPV infection is 20%. And people who smoke are at greater risk than nonsmokers.
Researchers are trying to learn the full range of risk factors for oral HPV. Some known factors include:
- Not using barrier methods during oral sex
- Having multiple sexual partners
- Engaging in deep kissing
- People who engage in sexual activities from a young age
- Drinking alcohol
- Smoking cigarettes and using other tobacco products
- Sharing drinks and utensils
Oral HPV symptoms
Oral HPV has no symptoms. In some cases, infected people may develop warts in the mouth or throat. And this type of HPV turns into oropharyngeal cancer (rare). When a person has oropharyngeal cancer, the cancer cells form in the middle of the throat, including the tongue, tonsils, and pharynx walls. And these cells may develop from oral HPV. And the early symptoms of oropharyngeal cancer include:
- Trouble swallowing
- Abnormal breathing sounds
- Coughing up blood
- Unexplained weight loss
- Enlarged lymph nodes
- Hoarseness, which does not get better in 3 to 4 weeks
- White or red area (lesion) on tonsils
- Constant sore throats
- Lumps on the cheeks
- Growths or lumps on the neck
- Discoloration of the tissues (mouth and throat)
- Jaw swelling and pain
- A persistent earache
- Numbness/tingling in the tongue or lips
What does oral HPV look like?
Infected people may experience growths within the oral cavity that are:
- Pink, red, white, or flesh-colored
- Small and dense to the touch
- Singular or multiple that resembles a pebble
- Flat or slightly raised
- Smooth or slightly rough
Testing for oral HPV
Oral HPV lesions can be found by a dentist or a doctor during a special type of exam, however, the presence of the infection is discovered through a biopsy on people who have the symptoms of the disease. Testing is an important diagnostic method, which makes it possible for patients to get early treatment of the disease. Oral HPV testing involves the use of small mirrors that are used to examine areas of the throat. Lesions may develop in the throat, larynx, and at the base of the tongue. And the dentists may also use a pharyngoscope or a flexible laryngoscope to see deeper into the patient’s throat and look directly at lesions in some cases.
When the lesions look suspicious, they may need to be biopsied. A small number of cells is withdrawn from a lesion or tumor with a thin needle or forceps during a biopsy. These cells will be viewed under a microscope in a lab setting and cells are examined to see if they are cancerous. The samples from the test may be tested for cancer as well as the presence of HPV DNA. Once a person receives a diagnosis, they may need to undergo testing for HPV every 8 to 12 months until the infection has cleared, or it’s no longer possible to detect it in DNA samples.
Oral HPV treatment
Most oral HPV go away before they cause any health issues. When an infected person develops oral warts due to HPV, the doctor may remove warts. Although researchers have tried a range of topical medications on HPV growths to no effects. Presently, surgical removal is the way to treat HPV growths. To treat warts the doctor may use any of the following methods:
- Surgical removal
- Interferon alfa-2B (Intron A, Roferon-A) – injection
Other health conditions related to oral HPV
- Oropharyngeal cancer – This may affect the tissues of the oropharynx, which include the back of the tongue, tonsils, and the walls of the throat. It is estimated that 7% of people are living with oral HPV, and only about 1% of those individuals test positive for the specific strain associated with oropharyngeal cancer.
- Cervical cancer – This cancer is the most common of all other HPV-related cancers, and nearly 10,900 new cases are diagnosed each year. The two high-risk strains of the virus HPV-16 and HPV-18 are responsible for over 70% of cervical cancers and precancerous lesions.
- Vaginal & vulvar cancer – Vaginal cancer is linked with vaginal intraepithelial neoplasia, abnormal cells within the vagina’s inner lining, which is caused by HPV infection. And the vulvar cancer is also associated with HPV infection, begins in the skin cells on the outer portion of the genitals.
- Anal cancer – Anal cancer that is HPV-related is rare. Which affects both men and women with 2,000 and 4,200 new diagnoses each year. The same two strains – HPV 16 and HPV 18 are responsible for approximately 92% of cases.
The best way to lower their risk of developing HPV is by getting vaccinated. In the US, the vaccine called Gardasil 9 offers almost 100% protection against the strains of HPV associated with types of cancer. The doctors recommend that people up to 45 years of age have the HPV vaccination. Changes in the lifestyle are the easiest ways to help prevent HPV which include:
- Practice safe sex
- Limit the number of sexual partners
- Get tested regularly for STIs (sexually active people)
- Avoid oral sex with an unfamiliar partner
- Using dental dams or condoms to prevent any oral STDs
- Talking to partners about their STI
- Have regular dental check-ups
- Checking the tongue & mouth every month for changes and abnormal growths
- It is good to seek medical attention from a doctor/dentist for sores or growths in the mouth or on the tongue that last for more than 2–3 weeks
Apart from these preventive measures, it is vitally important to eat a healthy diet rich in fruits, vegetables, and whole grains, exercise regularly, get plenty of sleep and avoid smoking.
Previously the HPV vaccine was shown to be highly effective in preventing cervical, anal and genital HPV infections, warts, and cancers. The Roswell Park research shows the vaccine can protect against oral HPV infection as well. In the US, HPV has been linked to most throat and mouth cancers and the frequency of cancers has increased more than 200% over the last few decades. According to some studies, it was identified that vaccines significantly reduce the prevalence of HPV detected in the oral cavity of adolescent women who had been vaccinated.
The CDC recommends HPV vaccine for 11- to 12-year-olds and also recommends HPV vaccination for everyone through age 26 years, if not vaccinated already. However, the vaccine is not recommended for everyone older than age 26 years. But adults aged 27 to 45 years who are not already vaccinated may decide to get the HPV vaccine after consulting with their doctor about their risk for new infections and the possible benefits of vaccination. As many people have already been exposed to HPV infection, vaccine in this age range provides less benefit.
It is important to note that the HPV vaccine can prevent new infections, but doesn’t treat existing infections or diseases. The vaccine works better when given before any exposure to the infection.
Facts about oral HPV
- There are more than 100 types of the virus, and 40 of them can infect the mouth, throat, and genitals.
- It was identified that two-thirds of oropharyngeal cancers have HPV DNA in them.
- Only 1% of people have HPV-16 and less than 15,000 people get HPV-positive oropharyngeal cancers each year.
- According to a study in 2017, oral HPV was 88% lower among young adults who received at least one dose of the HPV vaccine.
- According to CDC, HPV is the cause of 70% of oropharyngeal cancers in the US.
- Every year 11,600 Americans are identified with HPV-related head and neck cancers.
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