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Oral human papillomavirus infection

Oropharyngeal HPV infection; Oral HPV infection

Human papillomavirus infection is the most common sexually transmitted infection. The infection is caused by the human papilloma virus (HPV).

HPV can cause genital warts and lead to cervical cancer. Certain types of HPV can cause an infection in the mouth and throat. In some people, this can cause oral cancer.

This article is about oral HPV infection.

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Causes

Oral HPV is thought to spread mainly through oral sex and deep tongue kissing. The virus passes from one person to another during sexual activity.

Your risk of getting the infection goes up if you:

• Have more sexual partners
• Use tobacco or alcohol
• Have a weak immune system

Men are more likely to have oral HPV infection than women.

Certain types of HPV are known to cause cancer of the throat or larynx. This is called oropharyngeal cancer. HPV-16 is associated with almost all oral cancers.

Symptoms

Oral HPV infection shows no symptoms. You can have HPV without ever knowing it. You can pass on the virus because you don't know you have it.

Most people who develop oropharyngeal cancer from an HPV infection have had the infection for a long time.

Symptoms of oropharyngeal cancer may include:

• Abnormal (high-pitched) breathing sounds
• Cough
• Coughing up blood
• Trouble swallowing, pain when swallowing
• Sore throat that lasts more than 2 to 3 weeks, even with antibiotics
• Hoarseness that does not get better in 3 to 4 weeks
• Swollen lymph nodes
• White or red area (lesion) on tonsils
• Jaw pain or swelling
• Neck or cheek lump
• Unexplained weight loss

Exams and Tests

An oral HPV infection has no symptoms and cannot be detected by a test.

If you have symptoms that concern you, it does not mean you have cancer, but you should see your health care provider to get it checked.

You may undergo a physical exam. Your provider may examine your mouth area. You may be asked about your medical history and any symptoms you noticed.

Your provider may look in your throat or nose using a flexible tube with a small camera at the end.

If your provider suspects cancer, other tests may be ordered, such as:

• Biopsy of suspected tumor. This tissue will also be tested for HPV.
• Chest x-ray.
• CT scan of chest.
• CT scan of head and neck.
• MRI of the head or neck.
• PET scan.

Treatment

Most oral HPV infections go away on their own without treatment within 2 years and do not cause any health problems.

Possible Complications

Certain types of HPV can cause oropharyngeal cancer.

When to Contact a Medical Professional

Contact your provider right away if you notice any of the symptoms of mouth and throat cancer.

Prevention

Using condoms and dental dams may help prevent the spread of oral HPV. But be aware that condoms or dams cannot fully protect you. This is because the virus can be on the nearby skin.

The HPV vaccine can help prevent cervical cancer. It's not clear if the vaccine can also help prevent oral HPV.

Ask your provider whether vaccination is right for you.

References

Bonnez W. Papillomaviruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 143.

Centers for Disease Control and Prevention website. HPV and oropharyngeal cancer. www.cdc.gov/cancer/hpv/oropharyngeal-cancer.html?CDC_AAref_Val=https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm. Updated November 4, 2023. Accessed June 19, 2024.

Rettig E, Gourin CG, Fakhry C. Human papillomavirus and the epidemiology of head and neck cancer. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 74.

Review Date: 6/4/2023  

Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 10/3/2023.

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