Oral human papillomavirus (HPV) made headlines in 2013 when Michael Douglas, the actor, disclosed that he was being treated for stage 4 throat cancer. Douglas stated, correctly, that this type of cancer can be caused by HPV, which in turn can be transmitted through oral sex.
Though Douglas didn’t specifically implicate HPV or oral sex in his own cancer (and indeed he had two other noteworthy risk factors, a history of smoking and alcohol use), the flurry of publicity that followed the interview helped bring attention to one of the main risk factors for oral HPV, which affects some 7 percent of adults in the U.S. It is to blame for an increase in mouth cancer incidence, particularly in men. Who is most at risk for infection? How can you prevent it? Do most people who are infected even know they have it? Here are eight things you should know about oral HPV.
What is HPV?
HPV is the most common sexually transmitted infection in the U.S., causing warts (including in the genital area) and most cases of cervical cancer. But there are more than 100 strains of HPV, and most of them are actually harmless, and the infection is usually transient, lasting a few weeks to a few years. There are about a dozen “high-risk” strains of HPV that can lead to cancer.
High-risk strains can also lead to several other cancers, including cancer of the vagina, vulva, penis, and anus. HPV, which can be transmitted through oral sex, has increasingly become recognized as a cause of cancers of the oral cavity and throat. Oral HPV is less common than genital HPV, which affects some 40 percent of adults in the U.S., according to the CDC. In total, 79 million Americans have HPV infection, with the majority of them in their late teens and early 20s. It’s estimated that about 14 million Americans become infected each year.
Among the various strains of oral HPV, a strain called HPV-16 is most often linked with oral cancers. Other oral HPV strains can result in non-cancerous warts in the mouth, larynx, or throat, albeit they are less frequently linked to oral cancer.
Who is at risk for oral HPV?
Men are almost four times as likely to be infected with oral HPV as women, and they’re far more likely to be infected with the high-risk HPV-16, according to a 2017 study in the Annals of Internal Medicine. The researchers found that oral HPV in general affected 11 percent of men and 3 percent of women. And 7 percent of men were infected with HPV-16, versus just over 1 percent of women. Other risk factors include multiple lifetime sex partners and use of tobacco. Research has also found that both men and women with same-sex partners have a higher rate of high-risk oral HPV infection than those without same-sex partners. People who are immunocompromised are also at increased risk for both oral and genital HPV infection.
The risk of oral HPV infection can be increased by gum disease and poor dental hygiene, perhaps because these conditions make it easier for the virus to enter the oral tissues.
Why is oral HPV more common in men?
It’s not entirely clear. Men tend to have more sex partners than women, on average, but that alone wouldn’t likely account for the magnitude of the difference in prevalence. There’s some evidence that it takes longer for men to produce antibodies against HPV and clear it from the body than women. This may also help explain why more men go on to develop oral cancer. Another factor may be that cunnilingus (oral sex performed on a woman) is associated with an increased risk of oral HPV compared with oral sex performed on a man.
Are people with high-risk genital HPV at higher risk for oral HPV?
Yes. In the Annals of Internal Medicine study mentioned above, having high-risk genital HPV more than tripled a person’s likelihood of also having high-risk oral HPV.
Does the HPV vaccine protect against oral HPV?
Yes. Since the vaccine protects against several types of HPV—including HPV-16—and since the same high-risk strains that cause cervical cancer are also responsible for mouth and throat cancers (mainly in men), it’s expected that the vaccine will be protective against oral HPV (and thus the oral cancers it causes) as well.
Are there screening tests for oral HPV?
While there are saliva tests that are marketed mainly to dentists, none have been approved by the FDA as a screening test for oral HPV, and no medical or dental organization recommends using them. That’s largely because the vast majority of people with oral HPV do not go on to develop cancer—and when they do, it often isn’t until decades later. The U.S. The Preventive Services Task Force states that there is insufficient data to weigh the advantages and risks of routine oral cancer screening, and does not recommend either doing it or not. If you notice any unusual signs or symptoms, such as a swelling or a red or white discoloration in your mouth or throat or an oral sore that doesn’t heal in a couple of weeks, consult your doctor or dentist.
How can you get rid of oral HPV?
Most of the time, HPV is eradicated by the immune system. If oral HPV causes a lesion, whether or not it is malignant, your healthcare provider will identify the type of lesion and the best course of treatment for it. The methods vary depending on the lesion but can include surgical excision or using a laser, cryotherapy, or electrocautery to either freeze or burn the lesion off. Chemotherapy or radiation may also be advised.
How may oral and other HPV infections be prevented?
The HPV vaccine offers the best protection against the high-risk strains. But just a small portion of Americans have gotten it because it has been available only since 2006 and is recommended primarily at ages 11 or 12 (and is approved only through age 26). And even many young people have not gotten vaccinated, despite urging by public health officials. The vaccine’s additional protection against oral cancers is all the more reason for young people to get the HPV vaccine—both for themselves and for society.
