Human papillomavirus is the most common sexually transmitted infection (STI) in the United States. There are more than 100 different types of the virus, about 40 of which can infect the mouth, throat, and genitals.
In most cases, the immune system clears human papillomavirus (HPV) from the body before it can cause a full infection and symptoms.
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 in the saliva or mucus of someone with the virus enter someone without the infection through an open cut or sore in the mouth or throat.
During pregnancy, HPV can also pass to babies. In some cases, it may spread via oral contact with contaminated utensils or medical instruments.
The immune system usually destroys invading HPV particles before they cause disease. Healthy immune systems usually resolve HPV infections within 1–2 years. However, some HPV infections can persist.
HPV and oral HPV are very common. According to the Centers for Disease Control and Prevention (CDC), about 10% of men and 3.6% of women in the U.S. have oral HPV.
The most significant risk factor for developing oral HPV is having oral sex or mouth-to-mouth contact with someone who has acquired an HPV infection.
Researchers are still trying to determine the full range of risk factors for oral HPV, but some known factors include:
- not using barrier methods during oral sex
- engaging in deep kissing
- having multiple sexual partners
- smoking cigarettes and using other tobacco products
- engaging in sexual activities from a young age
- drinking alcohol
- sharing drinks and utensils
The symptoms that the many different strains of HPV cause can vary slightly. Many people with minor cases of HPV do not have any apparent 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. Cancer is most likely to result from 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, or 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
- a chronic sore throat or cough
- persistent hoarseness
- 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 the DNA that scientists have 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 through an examination alone.
There is currently no treatment that can cure HPV or even reduce its growth.
Researchers have tried and tested a range of topical medications on HPV growths to no effect. Currently, surgical removal is the only way to treat HPV growths. Some doctors will also use cryotherapy with liquid nitrogen to freeze and remove the growths.
After a person receives a diagnosis, they will need to undergo testing for HPV every 8–12 months until the infection has cleared, or it is no longer possible to detect it in DNA samples.
One of the best ways for people to lower their risk of developing HPV is by getting vaccinated.
In the U.S., a vaccine called Gardasil 9 offers almost 100% 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 of age have the HPV vaccination.
Children usually receive two doses, at least 6 months apart, between the ages of 11 and 12 years. Adolescents who receive their first dose of the vaccine at the age of 15 years or older will require three doses.
Aside from getting vaccinated, people can also reduce their risk of contracting HPV by:
- using barrier methods, such as condoms and dental dams, during sexual activity, including oral sex
- avoiding oral sex and deep kissing when any partner has open cuts or sores in the mouth
- having regular STI screening tests if sexually active
- talking to sexual partners about their STI status
They can also increase the likelihood of early detection by:
- 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 2–3 weeks
Most people who get HPV do not develop symptoms and clear the virus naturally.
However, those who experience symptoms will require medical monitoring to ensure that their body eventually rids itself of the virus and that growths do not become cancerous.
People with HPV can take steps to reduce the chance of the virus spreading to another person. For example, they can use barrier methods during sexual activity and communicate openly with any sexual partners about STIs.