Are you curious about the potential risks of oral sex, human papillomavirus (HPV), and its connection to mouth and throat cancer?

Have your questions answered by reading this article, which delves into the intriguing link between oral sex, HPV, and the increased risk of developing cancer in the oral and throat regions. By exploring this important topic, we hope to empower you with knowledge and foster a greater understanding of the impact that oral sex and HPV can have on your health.

Is HPV Virus an STD?

But first, what exactly is HPV?

HPV, also known as Human papillomavirus, can infect various parts of the body, but when it affects the genital areas through skin-to-skin contact, it is considered an STI.

Although the term STI can evoke concern, it's important to note that not all HPV strains are dangerous. Most are benign and result in conditions like genital warts. However, certain high-risk types of HPV are associated with more severe outcomes, including cervical and other forms of cancer.

Types of HPV

HPV and its various identified types thrive in specific cell environments known as squamous epithelial cells. These cells are prevalent in two main forms:

• Cutaneous: Cutaneous HPV types are primarily associated with the skin, manifesting as common warts on visible areas like hands, feet, arms, and legs. These skin warts are distinct from genital warts, having no implications on the mucosal areas.

• Mucosal: Mucosal HPV types inhabit the mucous membranes of the body, which include more intimate regions such as the inner layers of the vagina, anus, cervix, and vulva, as well as the mucosal linings of the mouth and throat. These types are often referred to as genital or anogenital HPV because of their 'preference' for these areas.

Mucosal HPVs can be further classified based on their cancer-causing potential: low-risk types, such as HPV 6 and HPV 11, generally cause benign conditions like genital warts and are rarely linked to cancer; high-risk types, such as HPV 16 and HPV 18, pose significant risks as they can evade the immune system, linger over time, and transform normal cells into malignant ones, leading to cancer.

How is HPV Transmitted?

The primary ways through which HPV can be transmitted include:

• Sexual Contact: The most prevalent form of transmission. HPV can be passed during vaginal, anal, and oral sex through direct skin-to-skin contact with an infected partner. Even without penetration, genital-to-genital contact can spread HPV.
• Non-Sexual Skin-to-Skin Contact: Although less common, HPV could potentially spread through non-sexual contact involving infected areas of the body, such as hand-to-genital interactions.
• Mother to Child: Rarely, HPV can be transmitted from an infected mother to her newborn during childbirth, leading to respiratory or laryngeal papillomatosis in the child.

HPV, however, cannot be contracted through casual contact such as sitting on toilet seats, hugging or holding hands, swimming in pools or using hot tubs, sharing food or utensils, or being unclean. It's also important to note that HPV can infect someone without showing symptoms and can be unknowingly passed to others.

Is HPV Contagious for Life?

While it's true that HPV can remain in your body without symptoms, many individuals clear the virus naturally over time. This means that when the immune system eradicates HPV, the person is no longer contagious, reducing the risk of transmission even without the presence of symptoms like genital warts.

Is Oral HPV Different from HPV?

Now, how exactly is oral HPV different from other types of HPV?

Oral HPV refers specifically to the subtypes of human papillomavirus that affect the mouth and throat. Among the numerous strains of HPV, about 40 have the potential to influence both genital and oral regions.

How Does Oral Sex Transmit HPV?

Engaging in oral sex, an intimate act of foreplay to pleasure a partner, carries the potential risk of transmitting HPV.

Here are some of the critical pathways for HPV transmission during oral sex:

• Sexual Contact: The primary method of HPV transmission is through direct skin-to-skin contact during oral sex. The virus thrives in mucosal membranes, making the mouth and throat particularly susceptible.
• Autoinoculation: Transfer from one’s own genital area to the oral region can occur, possibly through hands or contact with other body parts.
• Deep Kissing: Intimate mouth-to-mouth contact, especially with prolonged and deep kissing, can facilitate the spread of HPV to the oral cavity. Studies suggest that the more oral sex a person has, the higher their risk of oral HPV, but it's difficult to isolate the role of kissing in these cases. HPV relies on close skin-to-skin contact for transmission, so it's possible the virus travels from one person's mouth to another during kissing.

How Would You Know If You Have Oral HPV?

Identifying oral HPV can be challenging as it often presents no obvious symptoms. However, some individuals may experience subtle signs that should not be overlooked. Awareness of these symptoms is vital for early detection and potential treatment:

• Warts in the Mouth or Throat: These may appear as small, painless growths that are white, pink, or red. They can be flat or slightly raised and may have a smooth or rough texture. Also, look for any unusual changes in the colour or texture of your tongue or the soft palate at the back of the roof of your mouth.
• Oral Sores: HPV can sometimes lead to the development of sores in the mouth. These might appear on the lips, tongue, or the soft palate at the back of the mouth.

Can HPV Go Away?

For cases where the virus leads to the development of warts or other symptoms, medical interventions are available. Treatments such as surgery, cryotherapy, or injections of interferon alfa-2B are effective methods used to manage these manifestations of the virus. While there is no cure that directly targets HPV, these treatments help manage and mitigate the effects of the virus, allowing individuals to lead healthy lives.

How Does Oral HPV Get Diagnosed?

Detecting oral HPV typically involves an examination during routine dental or medical check-ups, especially if symptoms are present. Here's how the process generally unfolds:

• Routine Examinations: During regular health screenings, your healthcare provider might identify lesions or abnormalities that suggest oral HPV.
• Biopsy: If suspicious areas are detected, a biopsy may be conducted.
• Diagnostic Confirmation: Often, the presence of HPV is confirmed through these biopsies, especially if the lesion is associated with oropharyngeal cancer.

Understanding HPV And Its Link To Cancer

HPV is notably pervasive, with nearly all sexually active individuals likely to be infected at some point in their lives, often shortly after becoming sexually active. This includes infections with high-risk types of HPV, which are more likely to lead to cancers if they persist.

HPV infections that linger are always cause for concern, as persistent infections with high-risk HPV types can lead to significant cell changes. Over time, these changes may progress from precancerous to cancerous, especially if they are not detected or treated early.

HPV is linked to different types of cancers, such as cervical, oropharyngeal, anal, penile, vaginal, and vulvar cancers. In regions like Southeast Asia, which includes Singapore, around 3% of women are estimated to carry HPV types 16 or 18 at any given time, which are among the most cancerous strains of the virus. These two types alone are responsible for over 70.4% of invasive cervical cancers in the area.

When HPV infects the mouth and throat, it can contribute to the development of oropharyngeal cancer, encompassing cancers in the back of the throat, base of the tongue, and tonsils.

It is important to note that HPV-related throat and mouth cancers typically exhibit a less aggressive nature compared to cancers in these regions unrelated to HPV. However, it is crucial to understand that an HPV infection can potentially progress to cancer, although it often takes several years for cancer to manifest following the initial infection.

What Type of HPV Causes Oral Cancer?

Among the vast array of HPV strains, 40 are known to infect mucosal areas, which include the mouth and throat. Of these, a select few are classified as high-risk due to their potential to cause cancer. The most notable among these high-risk strains is HPV-16, which is strongly linked to the development of oropharyngeal cancers. This type of cancer typically affects regions such as the base of the tongue and tonsils.

Signs And Symptoms of Mouth & Throat Cancer

Recognising the signs and symptoms associated with mouth and throat cancer is essential for early detection and timely treatment. While these symptoms can also be caused by other conditions, it is important to consult with a cancer specialist in Singapore with a subspecialty in head and neck cancers from a reputable clinic such as OncoCare if any of the following persist for more than two weeks:

• Sores in the mouth or on the lips that do not heal
• Patches of red or white tissue inside the mouth
• Thickening or lumps in the cheek, lip, mouth, neck, or throat
• Persistent sore throat or sensation of a ticklish throat
• Change in voice or hoarseness
• Numbness in the mouth or tongue
• Mouth pain or bleeding
• Difficulty in moving the mouth, swallowing, or chewing
• Chronic bad breath
• Changes in speech patterns
• Unexplained weight loss
• Fatigue
• Loss of appetite

Regular dental check-ups and oral cancer screenings also play a crucial role in the early detection of mouth and throat cancer. By staying proactive and vigilant, you increase your chances of successful treatment outcomes.

Prevention And Protection Against HPV-Related Cancers

Prevention is key when it comes to HPV-related cancers, such as oropharyngeal cancer, anal cancer, and cervical cancer.

Vaccination against HPV is highly recommended as a preventive measure, particularly for individuals who have not been previously exposed to the virus. HPV vaccinations, like the HPV2 (Cervarix) and HPV9 (Gardasil 9), can significantly reduce the risk of developing HPV-related cancers, including those affecting the mouth and throat.

HPV2 (Cervarix):

• Offers protection specifically against HPV types 16 and 18, which are responsible for approximately 70% of cervical cancer cases.
• Approved for use exclusively in females.

HPV9 (Gardasil 9):

• Expands protection to include additional cancer-causing HPV types, covering up to 90% of HPV-related cancers.
• Available for vaccination in both females and males, ensuring broader population coverage.
• Provides added protection against more strains of HPV compared to HPV2.

Safe sex practices, such as consistent condom use and limiting the number of sexual partners, can also help reduce the risk of HPV transmission. Open and honest communication with your partner about sexual health is essential for ensuring mutual protection.

Importance Of Screening and Early Detection

At OncoCare, we emphasise the significance of regular screenings for mouth and throat cancer. Our experienced team of cancer specialists in Singapore is dedicated to providing comprehensive care and early intervention.

Treatment of mouth, nose and throat cancers may vary depending on the specific type and stage of the cancer. It may involve surgery, radiation, chemotherapy and/or immunotherapy. Oftentimes, more than one modalities are required. For more information on the risks of mouth and throat cancer, learn more at our head and neck cancer page.

“Expert knowledge means better care for cancer”

Written by:

Dr Tan Chee Seng

MBBS (Singapore)

MRCP (United Kingdom)

Dr Leong Swan Swan

MBBS (Singapore)

M.Med (Singapore)

MRCP (United Kingdom)

FAMS (Medical Oncology)