Oral HPV: What It Is, Related Health Risks, and More

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. [1] It can affect different areas of the body—meaning that getting HPV in mouth areas is a possibility.

HPV can also increase your risk for certain health conditions, so you need to address suspect symptoms right away.

In this guide, we’re breaking down everything you need to know about oral HPV: the basics of the disease, what HPV symptoms in mouth areas look like, possible complications, and a step-by-step treatment approach.

Let’s start at the beginning: What is HPV?

• HPV, or human papillomavirus, is a common sexually transmitted infection which has more than 200 unique strains. [2]

• Of all strains of the infection, 40 HPV types are capable of affecting the throat, mouth, and genital areas. [3]

• Luckily, the most infectious strains of HPV DNA are highly preventable with a vaccine called Gardasil. The current formula protects against nine strains of HPV, and it’s highly effective—since its initial recommendation in 2006, infections among adult women alone have decreased by 81%. [4]

Oral HPV occurs when the virus is transmitted to the mouth, typically through oral sex [3]. People of any gender can have oral HPV. While unprotected oral sex is the most common cause of oral HPV infections, other risk factors include multiple sexual partners and poor oral health. [3]

In general, HPV infections clear without treatment in 1-2 years, but this isn’t always the case because the virus can lie dormant in the body without going away. [2] So if either you or your partner has a dormant, undiagnosed HPV infection, the virus may become active at any time and continually pass between you.

Ultimately, over the course of several years, oral HPV may lead to the development of oropharyngeal cancer—or cancer that develops in the mouth and throat. [3] An estimated 70% of oropharyngeal cancer cases are thought to be caused by oral HPV. [3]

In most cases, oral HPV does not produce symptoms; however, that does not mean an asymptomatic infection is harmless or that it cannot be transmitted to a partner. In some cases, the virus goes undetected in a latent state for months or even years, but later becomes reactivated. [2]

In rare cases, oral infection with a low-risk strain of HPV may produce sores or warts in the mouth or on the lips (or, in some cases, in the throat). [6]

Even with no noticeable symptoms, oral infection with a high-risk strain of HPV can increase your risk of developing oropharyngeal and other cancers, which is why early detection is so critical. Early signs of oral cancer may include [3]:

• Difficulty swallowing

• Persistent sore throat and hoarseness

• Swollen lymph nodes or tonsils

• A sore, sometimes painful bump that does not diminish within three weeks

• A noticeable lump on the outside of the neck

• Discoloration of the tissues within the mouth and throat

• Jaw swelling and pain

• A persistent earache that does not resolve within three weeks

If you’re experiencing symptoms like these and don’t know why, talk with your healthcare provider to learn what next steps they recommend for you.

It’s worth keeping in mind that at-home lab HPV tests are designed to detect some, but not all high-risk strains of HPV. There are currently no clinically validated home oral HPV tests to detect the virus’s presence in your mouth or throat.

This is just one reason why access to high-quality healthcare is critical. Since HPV can be difficult to detect, there are few at-home options for diagnosis, and the consequences of leaving HPV untreated are so significant your healthcare provider can help you create a prevention plan that works for you.

HPV can cause a multitude of conditions—including cancers. [2] Let’s explore just a few potential severe conditions connected to high-risk strains of HPV.

Oropharyngeal cancer, also known as throat cancer, affects the tissues of the oropharynx, including [3]:

• The back of your tongue

• Your tonsils

• Your soft palate

• The walls of your throat

• Your head and neck

About 70% of oropharyngeal cancer cases in the United States are associated with HPV. [3] This is just one reason why prevention, testing, and treatment are so critical to both personal and public health.

Cervical cancer is the most common of all HPV-related cancers, with approximately 11,500 new cases associated with HPV diagnosed each year. [5] In cases of late detection, cervical cancer can be deadly; approximately 4,000 people die from cervical cancer each year.

Some common symptoms of cervical cancer include:

• Abnormal vaginal bleeding

• Pelvic pain

• Pain during intercourse

• Heavy vaginal discharge

• Unusual vaginal odor

Two high-risk strains of the virus—HPV-16 and HPV-18—are responsible for about 66% of cervical cancers. [6] Gardasil 9, the latest formula of the HPV vaccine, protects against both of these strains. [4]

Vaginal cancer is typically associated with vaginal intraepithelial neoplasia—abnormal cells within the vagina’s inner lining— and HPV is a common cause of this condition. [7]

HPV is just one of a few risk factors for vaginal cancers, and others include [7]:

• Being 60 years of age or older

• Exposure to the drug DES (prescribed in the 1950s) in the womb

• Past hysterectomy (to treat either cancerous or benign tumors)

Vulvar cancer, which is also associated with HPV infection, begins in the skin cells on the outer portion of the genitals—the labia majora and minora. [8]

Symptoms of both of these types of cancers include [7, 8]:

• Abnormal vaginal bleeding

• Watery discharge

• Painful urination

• Pelvic pain

• Constipation

• Persistent itching

• Tenderness

• Unusual skin changes

• Open sores

Anal cancer is a relatively uncommon condition. It’s slightly more common in women—there are approximately 2.3 new cases per 100,000 women each year but only 1.6 cases per 100,000 men each year. [9]

Researchers believe that HPV is the leading cause of anal cancer infections. [10]

There are several concerning symptoms of anal cancer to watch for:

• Anal itching

• Pain in the anal area

• Growths in the anal canal

• Anal or rectal bleeding

While these are hallmark signs of the disease, they can occur in other diseases as well. Rectal bleeding, for example, can be mistaken for bloody stools, which are a symptom of colon cancer. [12] If you suspect that you have colon cancer, consider an at-home colon cancer screening test.

HPV strains 6 and 11 can cause genital warts: contagious (but often benign) growths that can develop on the outer surface of both the male and female genitals. [13] Those infected with wart-causing strains of the virus typically experience genital itching, swelling in the genital area, clusters of cauliflower-shaped growths, and bleeding during intercourse. In many cases, genital warts are so small they’re virtually undetectable.

With some information about the kinds of general HPV-related health complications let’s zoom in on oral HPV again.

In most cases, oral HPV does not exhibit symptoms; however, depending on the strain of the infection, some people may experience growths within the oral cavity of their mouths that are [14, 15]:

• Pink, red, flesh-colored, or white

• Small and dense to the touch

• Flat or slightly raised

• Slightly rough or smooth

• Singular or in a group that resembles a pebble- or cauliflower-like mass

While some researchers refer to these as “asymptomatic lesions,” this is a slightly misleading phrase from a patient perspective. While the lesions themselves are a symptom of oral HPV, the lesions themselves aren’t responsible for any future health complications (like oropharyngeal cancer). They’re a sign that it’s time to visit a provider as soon as possible.

Approximately 3.6% of women and 10% of men in the US are living with an oral HPV infection. [3] Among all age groups, the infection is most common among older adults.

But this is just one possible presentation of HPV; researchers estimate that nearly every sexually active person who isn’t vaccinated against HPV will be exposed to at least one strain during their lifetime. [16]

What’s next if you think you might have an STI like HPV? Let’s break down the diagnosis and treatment process step by step.

Since HPV doesn’t always present with symptoms, it may be difficult (or impossible) to tell if you have an infection. [2] But if you do experience any unexpected symptoms, be sure to log:

• Frequency – If your symptoms come and go, take note of how often they appear.

• Vital signs – Data like your body weight, temperature, blood pressure, and pulse can help your provider fine-tune your diagnosis and assess your general health—especially if you can provide data over time.

• Pain levels – If any of your symptoms are painful, track your pain level on a scale from one to ten.

• Your recent sexual activity – Jotting down details about any new or recent partners could help you determine when you were exposed to HPV. But since HPV is so widespread and can be asymptomatic for a long time, this isn’t always the case.

There are a few important things to note about HPV testing:

• HPV tests don’t test for every strain – Since there are many strains of HPV (and some aren’t connected to any major health complications), tests don’t detect every strain. HPV tests are typically targeted to identify high-risk or cancer-causing strains.

• Providers don’t always recommend testing – If you visit your healthcare provider with acute symptoms like genital warts or bleeding, your provider may skip HPV testing. Instead, they may test for other STIs or treat your present condition.

• Test over time – If it makes sense for your lifestyle, consider testing for STIs regularly—perhaps every time you have a new partner, for instance. While testing can be a helpful tool for diagnosis when you’re symptomatic, they can also help you detect and treat potential infections early.

Whether you choose to take a test before you visit a healthcare provider or make an appointment to request a test, a provider is the best person to help you navigate a suspected STI.

Why should you visit a provider instead of waiting for STI symptoms to go away?

• Left untreated, STIs can cause serious health issues – Even mild to moderate STIs can cause long-term health issues if they aren’t treated promptly. [1] To prevent major complications in the future, seek testing and treatment right away.

• STIs can share symptoms – Many symptoms (like genital itching or lesions) can occur in multiple different STIs—so, it can be difficult to self-diagnose your condition without the help of a professional.

When you visit your provider, bring your symptom documentation with you to help ease the diagnostic process.

While there isn’t a specific treatment for the HPV virus, providers can treat any associated health conditions you may experience as a result of an HPV infection: from benign genital warts to HPV related throat cancer. [16]

No matter what your treatment plan looks like, do your best to follow it to the letter. Following all of your provider’s instructions is key to a full recovery and improved quality of life.

If you’ve been diagnosed with any STI, you should inform all of your recent partners. Why?:

• It will help prevent further HPV transmission – If you expose a partner to an STI, they could be infectious and not know it. To keep them from exposing another person to an illness, let them know that they could be at risk.

• It can give them a chance to identify infections early – If your sexual partner contracted an illness and is asymptomatic, they may never know that they’re contagious. Informing them of their possible exposure offers them the chance to make informed choices about their sexual health.

While you may not ever know that you have a case of oral HPV, proactively testing and communicating with your partners can help you detect infections early, prevent the spread of disease, and protect your long-term health.

When you need a provider who can help you create a long-term plan for your general health and wellness, Everlywell is here to provide STI treatment online. Our network of providers are available via telehealth—a convenient, accessible option no matter your existing conditions or goals.

Unlock the power of at-home healthcare with Everlywell and schedule a virtual care visit today.