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Oral Human Papillomavirus (Oral HPV)

There exists more than 170 subtypes of the HPV virus. About 40 of these are transmitted sexually. HPV found in the mouth and throat is called “oral HPV.”  

Some types of oral HPV (known as “high risk types”) can cause cancers of the head and neck area, particularly in men.

Other types of oral HPV (known as “low risk types”) can cause warts in the mouth or throat.

Transmission

How common

At any point in time, around 10% of men and 3.6% of women in the U.S. have an active HPV in their mouths. Cancers resulting from exposure to the HPV virus are commonly seen in the older people HPV prevalence in oral squamous cell carcinomas (SCCs) was similar in Europe and North America (16.5%), but greater in Asia with 33%.  In the throat, HPV prevalence was higher in North America – 47% as compared to Europe’s 28.2%.

Chances of being infected

While some of us might freak out about the possibility of getting oral HPV from an infected partner, a new research study led by John Hopkins University researched through spouses and long-term partners of patients with HPV-related oral cancers. The researchers took mouth-rinse samples from 164 patients with HPV-related oropharyngeal cancer and 93 partners. They then ran DNA tests for 36 strains of HPV. More than half of the cancer patients had detectable HPV in their saliva at the time of the test, but the virus showed up in only 1.2 percent of the partners tested. In this case, we can assume that spouses and long-term partners of patients with HPV-related oral cancers appear to have no increased risk of oral HPV infections.

How to detect if someone has it

While human papillomavirus (HPV) is most notable for its involvement in cervical cancer, it should also be understood that HPV is commonly found in the oral cavity (The part of the mouth behind the teeth and gums that is bounded above by the hard and soft palates and below by the tongue and the mucous membrane connecting it with the inner part of the mandible) as well. There are some common HPV-associated lesions, the most common one may be found anywhere in the mouth with a predilection for the ventral tongue (the underside of the tongue which forms a V like structure) and frenum (a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue) area, palate, and mucosal surface of the lips.

Oral Human Papillomavirus - Detect

Prevention

The Food and Drug Administration (FDA) has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. In the trials that led to approval of Gardasil and Cervarix, these vaccines were found to provide nearly 100 percent protection against persistent cervical infections with HPV types 16 and 18 and the cervical cell changes that these persistent infections can cause. The three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70 percent of cervical cancers and an even higher percentage of some of the other HPV-associated cancers. All three vaccines are given through a series of three injections into muscle tissue over a 6-month period.

  • Gardasil

Gardasil is a vaccine used to prevent anal, cervical, vulvar, and vaginal cancer caused by human papillomavirus (HPV) types 16 and 18 and genital warts caused by HPV types 6 and 11. Gardasil is approved for use in males and females aged 9 to 26 years. It is a type of quadrivalent vaccine (a vaccine that works against four different viruses or other microorganisms). This vaccine is also called recombinant human papillomavirus quadrivalent vaccine.

  • Gardasil 9

A vaccine used to prevent anal, cervical, vulvar, and vaginal cancer caused by human papillomavirus (HPV) types 16, 18, 31, 33, 45, 52 and 58 and genital warts caused by HPV types 6 and 11. Gardasil 9 is approved for use in males aged 9 to 15 years and females aged 9 to 26 years. It is a type of nonavalent vaccine (a vaccine that works against nine different viruses or other microorganisms). This vaccine is also called recombinant human papillomavirus nonavalent vaccine. Gardasil 9 is as effective as Gardasil for the prevention of diseases caused by the four shared HPV types (6, 11, 16, and 18), based on similar antibody responses in participants in clinical studies. The trials that led to approval of Gardasil 9 found it to be 97 percent effective in preventing cervical, vulvar, and vaginal disease caused by the five additional HPV types (31, 33, 45, 52, and 58) that it targets.

  • Cervarix®.

A vaccine used to prevent cervical cancer caused by human papillomavirus (HPV) types 16 and 18. Cervarix is approved for use in females aged 9 to 25 years. It is a type of bivalent vaccine (a vaccine that works against two different viruses or other microorganisms). This vaccine is also called recombinant human papillomavirus bivalent vaccine.

 

Please note the three vaccines provide strong protection against new HPV infections, but they are not effective at treating established HPV infections or disease caused by HPV

 

For routine vaccination, HPV vaccine is given as a 3-dose series

  • 1st Dose – Now
  • 2nd Dose – 1 to 2 months after Dose 1
  • 3rd Dose – 6 months after Dose 1

Catch-up vaccination

This vaccine is recommended for the following people who have not completed the 3-dose series:

  • Females 13 through 26 years of age.
  • Males 13 through 21 years of age.

The vaccines may be given to:

Vaccination is not recommended for:

  • Males and females over 26 years of age as there is no evidence indicating such vaccinations are effective.
  • Those who have had a serious allergic reaction (anaphylaxis) to a previous HPV vaccine, yeast or any other vaccine components.
  • Pregnant women

Treatment

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause, for example genital warts.

Medications to eliminate warts are typically applied directly to the lesion and usually take many applications before the warts are completely eradicated.

Here are some methods:

  • Salicylic acid

You can try Over-the-Counter treatments that contain salicylic acid to remove layers of a wart a little bit at a time. Salicylic acid is for use on common warts. Please note it can cause skin irritation and isn’t for use on your face.

  • Imiquimod cream (Aldara, Zyclara)

This prescription cream may enhance your immune system’s ability to fight HPV. Common side effects of imiquimod include redness and swelling at the application site.

  • Podofilox (Condylox)

Another type of topical prescription, podofilox works by destroying genital wart tissue. Podofilox may cause pain and itching where it’s applied.

  • Trichloroacetic acid

This prescription chemical treatment burns off genital warts and may cause local irritation.

 

If medications don’t work, your doctor may suggest one of the following procedures, which physically remove warts by:

  • Freezing with liquid nitrogen (cryotherapy)
  • Burning with an electrical current (electro cautery)
  • Surgical removal
  • Laser surgery

Best sources for more information

  • Human Papillomavirus Types in Head and Neck Squamous Cell Carcinomas Worldwide: A Systematic Review

http://cebp.aacrjournals.org/content/14/2/467/T3.expansion.html

  • HPV (Human Papillomavirus) Gardasil® VIS

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html

  • Oral lesions caused by human papillomavirus

http://www.clinicaladvisor.com/cmece-features/oral-lesions-caused-by-human-papillomavirus/article/193918/

  • Oral squamous papilloma and condyloma acuminatum as manifestations of buccal-genital infection by human papillomavirus (Buccal is referring to side of a tooth or gingiva facing the cheek or lip)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168039/

  • HPV-Linked Oral Cancers May Not Be ‘Contagious’

http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20140429/hpv-linked-oral-cancers-may-not-be-contagious

  • HPV Infection Treatments and Drugs

http://www.mayoclinic.org/diseases-conditions/hpv-infection/basics/treatment/con-20030343

The risk chart is the heart of this guide, and it can be found here

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