HPV in the mouth

Reviewed by our clinical team

HPV (human papillomavirus) is a very common virus that most of us (up to 8 out of 10) will get at some point in our lives. There are over 100 types of HPV and not all of them will cause problems. However, some types can affect the genital area, throat, and mouth.

In this article we will look at what causes oral HPV, how you can prevent it, risk factors, how it's diagnosed, and treatment. We'll also discuss how oropharyngeal cancer (cancer that starts in the oropharynx, the part of the throat behind the mouth) is linked to HPV in the mouth, the symptoms of this cancer, and its prognosis.

What causes oral HPV?

It is thought that over 80% of sexually active people will come into contact with a sexually transmitted form of HPV. Of the more than 100 strains of HPV that exist, around 40 can affect the mouth, throat and genitals. Other strains can cause hand warts or verrucas. 

At this moment in time, there's little research about how oral HPV affects people. But we do know that some cancers found in the mouth and throat are caused by HPV, however, this is very rare. 

Symptoms of oral HPV

Oral HPV usually doesn’t cause symptoms and is not widely tested for. In rare cases, some strains of HPV can cause abnormal tissue to grow in the mouth, triggering mouth cancer. 

HPV can cause warts on the skin, including genital warts. However, not all strains of the virus cause warts, and testing positive after cervical screening won’t necessarily mean you get genital warts. 

What increases the risk of oral HPV?

Oral HPV is spread between individuals through oral sex and deep kissing (kissing involving prolonged contact and/or use of the tongue). Therefore, any activities that cause you to have skin-to-skin contact in this way can increase your risk of contracting oral HPV.

Oral sex

Oral sex, including rimming, is a way of transmitting HPV from the genitals to the mouth and throat. Using condoms/dental dams consistently can reduce the risk of HPV transmission.

Multiple sexual partners

The more sexual partners you have, the more likely you are to come into contact with someone who has the virus. 

Smoking

Various studies have found a link between smoking and the risk of oral HPV. Whilst the exact nature of this relationship is still being established, it is believed that smoking may suppress the body’s ability to fight HPV, make individuals more susceptible to the virus and/or prolong the duration of an HPV infection.

Alcohol

Like with smoking, a correlation between alcohol consumption and the risk of oral HPV has been established but the reason behind this is still unclear. It may be because alcohol has an immunosuppressive effect on the body and promotes inflammation.

Kissing

Deep kissing can transmit the virus, but this is relatively rare - most infections are transmitted via oral sex. A brief kiss on the cheek or mouth does not transmit the virus.

Gender

Studies have found that men are more than three times more likely to contract oral HPV compared with women.

How to prevent oral HPV

You can reduce your risk of oral HPV by using condoms consistently for oral sex and being proactive about your sexual health. Ways to do this include:

STI Prevention

Use condoms or dams consistently when having sex. Also, get regular STI screenings, especially between different sexual partners.

Vaccination

Being vaccinated against HPV can reduce your risk of contracting strains of the virus that are linked to certain cancers and genital warts. 

Whilst the vaccine was originally developed to prevent cervical cancer, the latest versions also protect against genital warts and most likely against HPV related oropharyngeal cancers.

Communicate 

Talk to your sexual partners about their sexual history and discuss sexual health screenings. During sex, including oral sex, use appropriate skin barrier contraceptive methods such as condoms and dental dams.

Dental check ups

Going for regular dental check ups can allow your dentist to do a thorough inspection of your mouth, tongue and your throat to check for any signs of oral HPV or oropharyngeal cancer.

Can you get oral cancer from HPV?

It's thought that around 70% of oropharyngeal cancers are linked with HPV. HPV can also cause cancer, including oral cancer. HPV is responsible for 95% of cervical cancer and it’s also associated with cancers of the penis, anus, head and neck. 

Whilst most of the time, the body clears an HPV infection on its own, some high-risk types of HPV stay in the body. 

Over time, the virus can cause changes to the DNA inside cells, leading to them growing out of control and causing cancer.

How to diagnose oral HPV

If you’re concerned that you may have HPV of the mouth, you might be wondering if and how it can be formally diagnosed.

Can you test for oral HPV?

Unlike the cervical screening programme (which tests for HPV), there is currently no national screening programme for oral HPV. This is because HPV usually clears all by itself and oral cancers are rare. 

Treatment for oral HPV

There are currently no treatments for oral HPV. This sounds alarming, but over 90% of HPV infections go away all by themselves without any treatment - the body clears the infection itself. This is the case for other HPV infections as well. You might have wondered why no immediate treatment is being offered when your cervical screening comes back HPV positive. That's because in many cases, the virus will clear within the next two years. 

Can you cure oral HPV?

As has already been mentioned, early HPV cannot be cured and there is no treatment. However, if it has developed into oropharyngeal cancer, a complete cure is possible.

Symptoms of oropharyngeal cancer

Sometimes oropharyngeal cancer does not cause early signs or symptoms, however, some symptoms include:

• Trouble swallowing and/or moving the tongue
• Difficulty opening the mouth fully
• Ear pain (in the absence of an ear infection)
• Bad breath
• Unintentional weight loss
• Persistent sore throat
• Unequal looking tonsils
• Enlarged lymph nodes/lumps in the neck
• A white patch on the tongue or mouth or red patch on the tongue or inside the mouth
• Lumps/swelling on the neck

Can you test for mouth and oropharyngeal cancer?

There are no routine screenings for oral cancer, but they can be detected during visual exams. The presence of these cancers can be confirmed through a variety of methods including a biopsy, CT scan, MRI or X-ray.

How do you treat oropharyngeal cancer?

There are three main treatment protocols for oral and oropharyngeal cancer: surgery, radiation therapy and medication. Treatment options are affected by a range of factors including the stage of cancer, a person’s overall health and any potential side effects.

Prognosis for oropharyngeal cancer

According to Cancer Research UK, 75% of people survive all mouth cancers for one year or more after diagnosis. 

Does the HPV vaccine prevent oral HPV?

The HPV vaccine protects against some of the high risk strains that can lead to genital, anal and oral cancers, and the newer vaccines also protect against genital warts. The vaccine is thought to be highly effective in preventing cervical cancer, but it's not yet known how it will affect oral cancers. However, it seems likely that oral HPV related cancers will also reduce over time as more people get vaccinated. 

We probably won't see those effects for some years because oral cancers tend to affect people in their 50s and 60s, so we'll need to wait until the first groups of people who had the HPV vaccine reach that age.

Where to get the HPV vaccine

The HPV vaccine has been used by the NHS since 2012. Boys and girls aged 12 and 13 are eligible through the National Immunisation Programme. 

If you didn’t have the vaccine whilst in school, you can get it for free on the NHS until your 25th birthday. 

Men who have sex with men (MSM), and some trans men and trans women are also eligible for a free NHS HPV vaccine if they are aged 45 or under when they visit a specialist sexual health clinic.

If you don't fit into any of these groups, you can get the HPV vaccine privately through a service like ours. 

In summary, HPV of the mouth is contracted through contact such as oral sex and kissing with those that have the virus. Your risk of catching HPV can be increased through unprotected sexual contact, having multiple sexual partners, and smoking and alcohol consumption. There's no cure for HPV and whilst it usually goes away on its own, it can lead to oral cancer which is rare. 

If you’d like to learn more about HPV, you can check out our article about different strains of HPV and how they can affect your health.

References

https://www.jostrust.org.uk/information/hpv/what-is-hpv
https://www.nhs.uk/conditions/human-papilloma-virus-hpv/
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https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1065283/HPV-greenbook-chapter-18a.pdf
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https://link.springer.com/article/10.1007/s10389-020-01337-5
https://www.sciencedirect.com/science/article/abs/pii/S0196070920302866#
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