Oral HPV

Oral HPV is a subtype of human papillomavirus — the most common sexually transmitted infection (STI) in the United States. Over 200 different strains of HPV exist. About 40 of them can affect your mouth, throat and genitals.

Out of those 40 strains, 12 can potentially turn into cancer. The strain that’s most likely to cause throat cancer (oropharyngeal cancer) is HPV-16. This high-risk strain of HPV is uncommon in the general population. Yet most oropharyngeal cancers (8 out of 10) are linked to HPV. (Note: Most people who develop an oral HPV infection won’t get cancer.)

Most of the time, your immune system wipes out HPV before it becomes a full-blown infection. But about 7% of people aged 18 to 60 in the U.S. go on to develop oral HPV.

Symptoms of oral HPV

Most people with oral HPV infections don’t have symptoms. Less often, people develop lesions. Sores or warts may appear on your lips, inside your mouth or in your throat. On average, it takes about three to six months for oral HPV warts to appear after exposure.

As HPV in the mouth doesn’t usually cause symptoms, you may not know you’re infected. This makes it more likely to transmit the virus to a partner.

Are there any signs that are specific to HPV-positive oropharyngeal cancer?

HPV-positive oropharyngeal cancers usually start as a tiny lump in your tonsils or on the base of your tongue. This makes them hard to see in the early stages. As the disease progresses, signs include:

• A lump in your neck or in your cheek
• A white or red patch on your tonsils
• Coughing up blood
• Earaches
• Hoarseness
• Jaw pain or swelling
• Sore throat and trouble swallowing
• Unexplained weight loss

These signs don’t necessarily mean that you have cancer. But if they last longer than two weeks, you should see a healthcare provider.

HPV causes

The human papillomavirus causes oral HPV infections. The virus is contagious. Oral HPV spreads by oral sex or deep kissing. Someone with HPV carries the virus in their saliva and mucus. It can spread if the fluid comes into contact with an open sore or a cut in your partner’s mouth.

Risk factors

The biggest risk factor is engaging in oral sex.

In the past three decades, there’s been a spike in oral HPV cases. It’s four times more common in men.

Other risk factors include:

• A high number of lifetime oral sex partners
• Being HIV-positive
• Having an HPV infection in your genitals
• Heavy alcohol use
• Smoking

Complications of this condition

The biggest concern with oral HPV is that it could progress to throat cancer. The odds of this happening are much greater if the virus causing the infection is HPV-16 or another high-risk strain. Most strains of HPV aren’t linked to cancer.

Still, the number of HPV-related oropharyngeal cancers is on the rise. This is why taking steps to prevent infection is so important.

How doctors diagnose this condition

There isn’t a test that can find the first signs of oral HPV. Your healthcare provider may find oral HPV lesions during routine screenings or exams. But most of the time, testing only confirms the virus is present in people who already have symptoms.

Your healthcare provider may ask to take a biopsy of any suspicious areas. They can test the tissue sample to see if it’s cancerous or pre-cancerous.

How is oral HPV treated?

If you’re living with this condition, your body will likely clear the virus on its own. If you develop sores or warts, your healthcare provider can remove them using one of these treatments:

• Surgery
• Cryotherapy
• An injection of interferon alfa-2B

You can continue engaging in sex after treatment when it feels comfortable for you and your partner. But keep in mind that these treatments don’t clear the virus. They just get rid of the lesions. It’s still possible to transmit HPV if you have an active infection.

When should I see my healthcare provider?

Schedule a visit with a provider if you notice sores or warts on your lips or in your mouth. And reach out if you have questions about reducing your risk of developing or spreading oral HPV.

What can I expect if I have oral HPV?

Most of the time, oral HPV goes away on its own. Most oral HPV infections clear up without treatment in about two years. If you develop warts on your lips or inside your mouth, your healthcare provider can remove them.

For some people, the virus stays in their system for decades. In these cases, oral HPV could go on to cause more serious health issues, including oropharyngeal cancer.

This is why it’s important to see a healthcare provider if you have symptoms. Don’t miss follow-up appointments after treatment to remove lesions.

Does the HPV vaccine prevent oral HPV?

Yes. Research shows that HPV vaccination prevents oral HPV infections. It also protects against strains of HPV that can lead to cervical cancer, vulvar cancer, vaginal cancer, anal cancer and penile cancer.

Based on this evidence, the U.S. Food and Drug Administration (FDA) updated its guidelines in 2021 to recommend the HPV vaccine in the prevention of oropharyngeal cancer.

Why is oral HPV more common in men?

Medical experts don’t know for sure. There are several theories.

It’s possible that men have more oral sex partners than women. Transmission may be more likely when performing oral sex on a vulva. Another theory is that women who are exposed to HPV on their genitals develop a stronger immune response that protects them from future oral HPV infections.

More research is needed to understand why being male increases the risk.