What are the symptoms of oral Human Papillomavirus (HPV) and can it be tested for?

Oral HPV Symptoms and Testing

Currently, there is no FDA-approved screening test for oral HPV infection, and most oral HPV infections are asymptomatic until they potentially progress to cancer. 1

Symptoms of Oral HPV Infection

Oral HPV infection typically presents in two ways:

• Asymptomatic infection: The vast majority of oral HPV infections cause no visible symptoms 1
• Visible lesions: In some cases, HPV may cause:
  • Warts or papillomas in the oral cavity
  • Persistent abnormalities that last more than 2 weeks (which should be reevaluated and considered for biopsy) 1

HPV-related oropharyngeal cancer may present with:

• Persistent sore throat
• Earache
• Difficulty swallowing
• Swollen lymph nodes
• Unexplained weight loss

Testing for Oral HPV

Despite growing interest in oral HPV testing, current guidelines do not support routine screening:

1. No FDA-approved test: Currently, no screening test for oral HPV infection has been approved by the U.S. Food and Drug Administration 1, 2

2. Research methods only: While HPV detection through polymerase chain reaction (PCR) is commonly performed for pathologic analysis and scientific studies, these are not approved for clinical screening 1

3. Promising research: HPV 16 E6 antibodies may hold promise as a future marker of oncogenic infection, with research showing approximately one-third of patients developing HPV-positive cancer have detectable levels of E6 antibodies prior to diagnosis 1

4. Clinical examination: The primary method for detecting potential HPV-related abnormalities is a systematic clinical examination of the oral cavity, which should include:

   • Visual inspection of face, neck, lips, labial mucosa, buccal mucosa, gingiva, floor of mouth, tongue, and palate
   • Palpation of regional lymph nodes, tongue, and floor of mouth 1

Risk Factors for Oral HPV Infection

Several factors increase the risk of acquiring and maintaining oral HPV infection:

• Sexual behavior: Number of lifetime oral sexual partners is strongly associated with oral HPV prevalence 3
• Tobacco use: Current smoking significantly increases risk, especially when combined with multiple sexual partners 3
• Gender: Men have higher prevalence than women 3
• Age: Prevalence increases with age, peaking in men 50-59 years old 3

Important Clinical Considerations

1. Low progression rate: While oral HPV infection is relatively common (3.5% of adults age 20-69), the lifetime risk of developing oropharyngeal cancer remains low (37 per 10,000) 3

2. Transient nature: Most oral HPV infections are cleared by the immune system, with a median duration of approximately 7 months 1

3. Partner concerns: For patients with known oral HPV infection:

   • Existing evidence does not support a need for abstinence between stable partners
   • The rate of oncogenic oral HPV infection in partners of those with HPV-positive oropharyngeal cancer is similar to the general population (1.2% vs 1.3%) 1
   • Barrier methods may decrease risk of disease transmission 1

4. Vaccination: HPV vaccination is the primary method of prevention, ideally administered at 11 or 12 years of age, regardless of sex 4

Common Pitfalls to Avoid

1. Mistaking examination for testing: Many patients erroneously believe an oral examination includes HPV testing 2

2. Overreliance on acetic acid: Using acetic acid application as the sole diagnostic method for subclinical HPV infection leads to high false-positive rates 2

3. Unnecessary anxiety: Given the high prevalence of transient HPV infection and low progression to cancer, avoid causing undue concern about oral HPV infection 3

4. Inappropriate testing: HPV testing is not recommended for deciding whether to vaccinate, general STD screening, or testing adolescents under 21 years 2

In summary, while oral HPV infection is common, there is currently no approved screening test. The best approach is regular dental examinations with attention to persistent oral abnormalities, combined with HPV vaccination for prevention.