In most cases, the immune system clears human papillomavirus, or HPV, from the body before it can cause a full infection and symptoms.
What causes it and how does it spread?
HPV is the most common sexually transmitted infection in the U.S.
Oral HPV spreads mostly through oral sex and mouth-to-mouth contact between people.
During mouth-to-genital or mouth-to-mouth contact, HPV particles travel via infected saliva or mucus through an open cut or sore in an uninfected person's mouth or throat.
Mothers can also pass HPV to their children. Most research indicates HPV may also sometimes spread via oral contact with contaminated utensils or medical instruments.
The immune system usually destroys invading HPV particles before they cause an infection. Healthy immune systems usually resolve HPV infections within 1 to 2 years. However, some HPV infections can persist.
How common is HPV?
HPV and oral HPV are very common. According to the Centers for Disease Control and Prevention (CDC), around 10 percent of men and 3.6 percent of woman in the U.S. have oral HPV.
The greatest risk factor for developing oral HPV is oral sex or having mouth-to-mouth contact with someone infected with HPV.
Researchers are still trying to determine the full range of risk factors for oral HPV, but some known factors include:
- not using proper protection during oral sex
- deep kissing
- having multiple sexual partners
- smoking and tobacco products
- engaging in sexual activities from a young age
- drinking alcohol
- sharing drinks and utensils
Symptoms and what it looks like
Using protection during oral sex will reduce the chance of contracting HPV.
Many people with minor cases of HPV do not have any apparent symptoms. There are also many strains of HPV that can each cause slightly different symptoms.
When it does cause a productive infection, HPV can cause growths that are:
- small and hard
- white, pink, flesh-colored, or red
- slightly raised or flat
- usually slow growing
- smooth or slightly calloused
- single or multiple in a cauliflower- or cobblestone-like mass
- anywhere in the mouth, but frequently on the tongue, soft palate at the back or roof of the mouth, and lips
HPV is the leading cause of oropharyngeal, or oral cavity, cancers, although this complication is rare. This is especially true for those infections that involve the tongue and base of the tongue into the throat.
The type of HPV called HPV 16 causes most oral cancers related to HPV.
Oral cancers tend to cause obvious symptoms, especially as they progress. Signs and symptoms of oral cancer include:
- a sore or painful bump that does not go away within 3 weeks
- difficulty swallowing or the feeling of things sticking together when trying to swallow
- discoloration (red, white, black) of the soft tissues in the mouth
- swollen but painless tonsils
- a lump in the mouth that lasts for at least 3 weeks
- a lump that a person feels on the outside of the neck
- pain when chewing
- chronic sore throat or hoarseness
- chronic cough
- numbness or tingling in the lips or tongue
- a unilateral, or one-sided, earache that lasts for more than 3 weeks
There is currently no easy way for a doctor to diagnose HPV. The most useful test for HPV is a polymerase chain reaction (PCR) test.
A PCR test takes a tiny fragment of DNA extracted from cells in a sample of mucus and amplifies it, making countless identical copies. Having so many copies of the DNA fragment allows scientists to look inside cells and detect minute quantities of abnormal or viral DNA.
In rare cases, when lesions are present in the mouth, a doctor may be able to diagnose HPV by examination alone.
What are the treatment options?
There is currently no treatment that can cure HPV or even reduce its growth.
A range of topical medications has been tried and tested on HPV growths to no effect. Currently, the only way to treat HPV growths is surgical removal. Some doctors will also use cryotherapy with liquid nitrogen to freeze and remove the growths.
Once diagnosed, people will need to be tested for HPV every 8 to 12 months until the infection has cleared or detecting it in DNA samples is no longer possible.
The Gardasil 9 vaccine provides protection against HPV.
One of the best ways for people to lower their risk of developing HPV is by getting vaccinated.
In the United States, a vaccine called Gardasil 9 offers almost 100 percent protection against the strains of HPV associated with types of cancer, specifically HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Currently, doctors recommend that people up to 45 years old have the HPV vaccination.
Girls and boys usually receive 2 doses, at least 6 months apart, between the ages of 11 and 12 years old. Adolescents who receive their first dose of the vaccine at the age of 15 years or older will require 3 doses.
Aside from getting vaccinated, people can also reduce their risk of contracting HPV or help catch infections early by:
- practicing safe sex, including oral sex, by using condoms and dental dams
- avoiding having multiple sexual partners
- avoiding oral sex and deep kissing when there are open cuts or sores in the mouth
- having regular STI screening tests if sexually active
- talking to sexual partners about their STI status
- avoiding oral sex with a new partner
- having regular dental checkups
- checking the mouth and tongue monthly for changes and abnormal growths
- seeking medical attention from a doctor or dentist for sores or growths in the mouth or on the tongue that last for more than 2 or 3 weeks
Most people who get HPV do not develop symptoms and clear the virus naturally.
But people who develop HPV will require medical monitoring to ensure their bodies eventually rid themselves of the virus and that growths do not become cancerous.
People with HPV must also ensure they avoid exposing people who do not have HPV to the virus. They should do this by practicing safe oral sex, as well as avoiding deep kissing and sharing drinks or utensils.