Oropharyngeal Human Papillomavirus (HPV) Infection

Overview

What is oral HPV?

Oral HPV is a subtype of human papillomavirus — the most common sexually transmitted disease (STD) in the United States. Over 100 different strains of HPV exist, and about 40 of them can affect your mouth, throat and genitals.

Most of the time, your immune system wipes out HPV before it causes symptoms. But, approximately 10% of men and 3.6% of women in the U.S. go on to develop symptomatic oral HPV.

Is oral HPV the same as HPV?

Yes. It’s the same virus, but it can manifest in different ways.

HPV is an umbrella term for human papillomavirus. But, there are many types and subtypes of the virus. Oral HPV is one of them.

What are the types of HPV?

There are almost 200 different strains of HPV. Approximately 40 of those can infect genital and oral mucosa (mucus membranes). Out of those 40 strains, nine can potentially turn into cancer. The strain that’s most likely to cause oropharyngeal cancer is HPV-16.

How common is HPV in the mouth?

A recent study found that 7% of Americans aged 14 to 69 are infected with oral HPV. The same study found that significantly more people have developed HPV over the past three decades, and that more men than women have oral HPV infection.

What does HPV in the mouth look like?

Oftentimes, there aren’t any symptoms associated with oral HPV. But, some people may develop sores or warts on their lips, in their mouth or in their throat.

Is oral HPV cancer?

No. Oral HPV isn’t cancer. But, studies have found that certain types of HPV can turn into oropharyngeal cancer, especially HPV-16.

To put it in perspective, HPV-16 only occurs in about 1% of the population. Yet, about two-thirds of oropharyngeal cancers are linked to HPV. (Note: Most people who develop an oral HPV infection won’t get cancer.)

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

The first sign is often having difficulty swallowing. Other signs are:

These signs don’t necessarily mean that you have cancer, but if any signs are present for longer than two weeks, you should see your healthcare provider.

Symptoms and Causes

Are there oral HPV symptoms?

Most people with oral HPV infections don’t have symptoms. Because they don’t realize they’re infected, they’re more likely to transmit the virus to a partner.

Some people develop oral HPV lesions — such as sores or warts on their lips, inside their mouth or in their throat — though this is less common.

How does oral HPV spread?

Oral HPV is mostly transmitted by oral sex and mouth-to-mouth contact. Someone with HPV carries the virus in their saliva and mucus. It can spread if that saliva or mucus comes into contact with an open sore or cut in their partner’s mouth.

What’s the oral HPV incubation period?

On average, it takes about three to six months for oral HPV warts to appear after exposure. Keep in mind, though, that many people don’t develop symptoms at all.

Does oral HPV go away?

It’s likely. In fact, most oral HPV infections clear up on their own without treatment in about two years.

But, 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.

What are the biggest risk factors for oral HPV?

As mentioned above, the most significant risk factor for oral HPV is having oral sex or mouth-to-mouth contact.

Other known risk factors include:

  • Smoking.
  • Sharing eating utensils and cups.
  • Having multiple sexual partners.
  • Deep kissing.
  • Not using proper protection during oral sex.
  • Alcohol use disorder.

Diagnosis and Tests

How is oral HPV diagnosed?

There is no 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 your tissue sample to see if it’s cancerous or pre-cancerous. If you do have oropharyngeal cancer, treatment may be more effective if it’s HPV-positive.

Management and Treatment

How is oral HPV treated?

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

Prevention

Does the HPV vaccine prevent oral HPV?

Yes. Research shows that HPV vaccination can significantly reduce oral HPV infections. Vaccination also helps protect you against strains of HPV that can lead to oropharyngeal cancer, cervical cancer, vulvar cancer, vaginal cancer, anal cancer and penile cancer.

What else should I know about the HPV vaccine?

The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination at age 11 or 12. The Advisory Committee on Immunization Practices (ACIP) recommends HPV vaccination for everyone through age 26. This means that people who didn’t receive the vaccine at a younger age should ask their healthcare provider about appropriate next steps.

Most people over the age of 26 won’t need HPV vaccination since they’ve likely been exposed to the virus already. However, if you’re between the ages of 27 and 45, vaccination may still be beneficial. Talk to your healthcare provider to find out more.

Outlook / Prognosis

What can I expect if I have oral HPV?

Most of the time, oral HPV goes away on its own. But, if you develop warts on your lips or inside your mouth, your healthcare provider can remove them.

It’s important to see your healthcare provider for routine follow-ups, as oral HPV can potentially turn into oropharyngeal cancer. HPV-positive cancers have better outcomes with treatment compared to HPV-negative cancers. Early detection and treatment are key.

Living With

When should I see my healthcare provider?

If you’d like to learn more about the HPV vaccine, call your healthcare provider to discuss your options.

Additionally, you should schedule a visit with your provider if you notice sores, warts or any other abnormalities.

A note from Cleveland Clinic

Oral HPV is one of the most common subtypes of human papillomavirus. You can significantly reduce your risk for HPV infection by getting vaccinated. But, if you contract HPV, your immune system will likely clear it from your body within a couple of years. If the infection stays in your body, though, it could lead to cancer. Ask your healthcare provider how you can protect yourself against HPV.

Last reviewed by a Cleveland Clinic medical professional on 07/11/2022.

References

  • American Cancer Society. What's new in oral cavity and oropharyngeal cancer research and treatment? (https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/new-research.html) Accessed 7/11/2022.
  • Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:24-35. Accessed 7/11/2022.
  • Centers for Disease Control and Prevention. HPV and Oropharyngeal Cancer. (https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm) Accessed 7/11/2022.
  • Gillison ML, Broutian T, Pickard RKL, et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA 2012;307:693-703. Accessed 7/11/2022.
  • National Cancer Institute. HPV Vaccination Linked to Decreased Oral HPV Infections. (https://www.cancer.gov/news-events/cancer-currents-blog/2017/hpv-vaccine-oral-infection) Accessed 7/11/2022.
  • The Oral Cancer Foundation. HPV / Oral Cancer Facts. (https://oralcancerfoundation.org/understanding/hpv/hpv-oral-cancer-facts/) Accessed 7/11/2022.
  • Young D, Xiao CC, et al. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). (https://www.ncbi.nlm.nih.gov/pubmed/26066977) Oral Oncol. 2015 Aug; 51 (8): 727-30. Accessed 7/11/2022.

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