Human papillomavirus (HPV) can affect the inside of the mouth, the tongue, and the lips. Symptoms of HPV in the mouth can include small, hard, bumps or growths. They may be slightly raised or flat, and they may be painless.

In most cases, the immune system clears human papillomavirus (HPV) from the body before it can cause a full infection and symptoms.

Some strains of HPV result in harmless oral lesions that usually resemble common warts, but healthcare professionals have linked some others with oral cancers.

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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 infants. 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.

How common is HPV?

HPV and oral HPV are very common. According to the Centers for Disease Control and Prevention (CDC), about 10% of males and 3.6% of females in the United States have oral HPV.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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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
  • drinking alcohol
  • sharing drinks and utensils

Read more about HPV.

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, or red
  • the same color as the surrounding skin
  • slightly raised or flat
  • painless
  • 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

According to the CDC, HPV is the cause of around 60 to 70% of all oral cancer in the U.S. However, it is unclear whether HPV alone can cause cancer, or if it is a combination of the infection and other factors, such as tobacco use.

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
  • 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
  • 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 does not go away
  • drooling

It is important to speak with a healthcare professional if any symptoms last for more than 2 weeks.

Read more about the link between HPV and oral cancer.

There is currently no easy way for a healthcare professional 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 healthcare professional 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 healthcare professionals 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, healthcare professionals 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 old. Adolescents who receive their first dose of the vaccine at the age of 15 years old 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 sexually transmitted infection (STI) screening tests if sexually active
  • talking with 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 healthcare professional for sores or growths in the mouth or on the tongue that last for more than 2–3 weeks

Read more about the HPV vaccine.

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.