Oral human papillomavirus infection

Many people are exposed to oral HPV in their life. About 10% of men and 3.6% of women have oral HPV, and oral HPV infection is more common with older age. Most people clear HPV within 1 to 2 years, but HPV infection persists in some people.

HPV and Oropharyngeal Cancer

Human papillomavirus (HPV) can cause serious health problems, including warts and cancer.

What is HPV?

HPV is the most common sexually transmitted infection in the United States. Of the more than 100 types of HPV, about 40 types can spread through direct sexual contact to genital areas, as well as the mouth and throat. Oral HPV is transmitted to the mouth by oral sex, or possibly in other ways.

Many people are exposed to oral HPV in their life. About 10% of men and 3.6% of women have oral HPV, and oral HPV infection is more common with older age. Most people clear HPV within 1 to 2 years, but HPV infection persists in some people.

HPV can infect the mouth and throat. It usually takes years after being infected with HPV for cancers to develop in the oropharynx (back of the throat, including the base of the tongue and tonsils). This is called oropharyngeal cancer. HPV is thought to cause 60% to 70% of oropharyngeal cancers in the United States. HPV is not known to cause other head and neck cancers, including those in the larynx, lip, nose, or salivary glands.

The oral cavity includes the lips, the labial and buccal mucosa, the front two-thirds of the tongue, the retromolar pad, the floor of the mouth, the gingiva, and the hard palate. The oropharynx includes the palatine and lingual tonsils, the back one-third base of the tongue, the soft palate, and the posterior pharyngeal wall.

Symptoms

Symptoms of oropharyngeal cancer may include a long-lasting sore throat, earaches, hoarseness, swollen lymph nodes, pain when swallowing, and unexplained weight loss. Some people have no symptoms. If you have any symptoms that worry you, be sure to see your doctor right away.

The HPV vaccine and oropharyngeal cancers

The HPV vaccine was developed to prevent cervical and other cancers of the reproductive system. The vaccine protects against the types of HPV that can cause oropharyngeal cancers, so it may also prevent oropharyngeal cancers.

CDC recommends HPV vaccination for 11- to 12-year-olds. CDC also recommends HPV vaccination for everyone through age 26, if not vaccinated already.

Vaccination is not recommended for everyone older than age 26. However, some adults age 27 through 45 who are not already vaccinated may decide to get the HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.

HPV vaccination prevents new HPV infections but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV.

Other ways to lower your risk

Condoms and dental dams

When used consistently and correctly, condoms and dental dams can lower the chance that HPV is passed from one person to another.

Alcohol and tobacco

Alcohol and tobacco products may contribute to oropharyngeal cancers. The risk is higher when both tobacco and alcohol are used. Don’t smoke or use smokeless tobacco products, and avoid smoke from other people’s cigarettes. Limit the amount of alcohol you drink.

On This Page

• What is HPV?
• Symptoms
• The HPV vaccine and oropharyngeal cancers
• Other ways to lower your risk

Oral human papillomavirus infection

Human papillomavirus infection is the most common sexually transmitted infection. The infection is caused by the human papilloma virus (HPV).

HPV can cause genital warts and lead to cervical cancer. Certain types of HPV can cause an infection in the mouth and throat. In some people, this can cause oral cancer.

This article is about oral HPV infection.

Causes

Oral HPV is thought to spread mainly through oral sex and deep tongue kissing. The virus passes from one person to another during sexual activity.

Your risk of getting the infection goes up if you:

• Have more sexual partners
• Use tobacco or alcohol
• Have a weak immune system

Men are more likely to have oral HPV infection than women.

Certain types of HPV are known to cause cancer of the throat or larynx. This is called oropharyngeal cancer. HPV-16 is associated with almost all oral cancers.

Symptoms

Oral HPV infection shows no symptoms. You can have HPV without ever knowing it. You can pass on the virus because you don’t know you have it.

Most people who develop oropharyngeal cancer from an HPV infection have had the infection for a long time.

Symptoms of oropharyngeal cancer may include:

• Abnormal (high-pitched) breathing sounds
• Cough
• Coughing up blood
• Trouble swallowing, pain when swallowing
• Sore throat that lasts more than 2 to 3 weeks, even with antibiotics
• Hoarseness that does not get better in 3 to 4 weeks
• Swollen lymph nodes
• White or red area (lesion) on tonsils
• Jaw pain or swelling
• Neck or cheek lump
• Unexplained weight loss

Exams and Tests

An oral HPV infection has no symptoms and cannot be detected by a test.

If you have symptoms that concern you, it does not mean you have cancer, but you should see your health care provider to get it checked.

You may undergo a physical exam. Your provider may examine your mouth area. You may be asked about your medical history and any symptoms you noticed.

Your provider may look in your throat or nose using a flexible tube with a small camera at the end.

If your provider suspects cancer, other tests may be ordered, such as:

• Biopsy of suspected tumor. This tissue will also be tested for HPV.
• Chest x-ray.
• CT scan of chest.
• CT scan of head and neck.
• MRI of the head or neck.
• PET scan.

Treatment

Most oral HPV infections go away on their own without treatment within 2 years and do not cause any health problems.

Possible Complications

Certain types of HPV can cause oropharyngeal cancer.

When to Contact a Medical Professional

Contact your provider right away if you notice any of the symptoms of mouth and throat cancer.

Prevention

Using condoms and dental dams may help prevent the spread of oral HPV. But be aware that condoms or dams cannot fully protect you. This is because the virus can be on the nearby skin.

The HPV vaccine can help prevent cervical cancer. It’s not clear if the vaccine can also help prevent oral HPV.

Ask your provider whether vaccination is right for you.

Alternative Names

Oropharyngeal HPV infection; Oral HPV infection

References

Bonnez W. Papillomaviruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 143.

Centers for Disease Control and Prevention website. HPV and oropharyngeal cancer. www.cdc.gov/cancer/hpv/oropharyngeal-cancer.html?CDC_AAref_Val=https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm. Updated November 4, 2023. Accessed June 19, 2024.

Rettig E, Gourin CG, Fakhry C. Human papillomavirus and the epidemiology of head and neck cancer. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 74.

Review Date 6/4/2023

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 10/3/2023.

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