HPV is one of the hot topics in the news today as it is one of the most common virus groups in the world. According to the Centers for Disease Control, at least 20 million people in the United States are infected with HPV and there are approximately six million new cases each year.
A recent oral detection during a routine six month recall exam on a patient prompted me to give this review for anyone who might be interested. By the way, I excised the lesion and the patient is doing great!
What is HPV?
One of the most common virus groups in the world today affecting the skin and mucosal areas of the body is the human papilloma virus. Over 150 different types/versions of HPV have been identified, and different types are known to infect different parts of the body. The most visible forms of the virus produce warts (papillomas) on the hands, arms, legs, and other areas of the skin. Most HPVs of this type are very common, harmless, non cancerous, and easily treatable.
In the oral cavity, papillomas are the most common benign epithelial neoplasm. They appear as small, pink-white, exophytic (cauliflower) masses that are usually less than 1cm in diameter. The surface of the papule may be smooth, pink, and pebbly (vegetative like) or have numerous small fingerlike projections. The base of the lesion is pedunculated and well circumscribed. Lesions are generally solitary, but multiple lesions are occasionally seen. HPV types 6 and 11 have been detected in more than 50 percent of oral papillomas.
If I have it, how did I get it?
The human papilloma virus is a double-stranded DNA virus that infects the epithelial cells of skin and mucosa. The moist epithelial surfaces (squamous cells) include all areas covered by skin and/or mucosa such as the mouth, throat, tongue, tonsils, vagina, penis, and anus. Transmission of the virus occurs when these areas come into contact with a virus, allowing it to transfer between epithelial cells. While it is established that sexual contacts, both conventional and oral, are means of transferring the HPV virus, it is still poorly understood what other transfer pathways may exist.
It is not known why certain HPV types target skin on the hands or feet, while others attack the cells lining the mouth, and still others the genitalia of both males and females. The most dangerous HPVs, 16 and 18, are commonly transmitted through sexual contact. These HPVs can produce two kinds of abnormal tissues, condyloma tissue and dysplasia tissue. Condyloma tissues are the wart-like growths. These warts are usually painless, but can cause some irritation, itching, or burning. This tissue appears like a small, cauliflower-type growth on the skin. It can be treated whenever it flares up, and is non malignant. Dysplastic tissue is the presence of abnormal cells on the surface of the skin. Dysplasia is not cancer, but it is a precursor tissue change prior to malignancy. In one example of a cell’s transition from normal to cancerous, dysplasia can be detected on the female cervix through a Pap smear test (and the following lab histopathology process), or visually can be seen by using a magnifying glass called a colposcope.
What the studies show…
The Journal of American Medical Association JAMA by Gillison et al, in January 26, 2012 evaluated more than 5,000 people for oral HPV. Their demographic data analysis attempted to determine risk factors associated with HPV carriers. The results:
- 6.9% of people ages 14-69 have an active HPV in their mouth
- The peak prevalence of oral HPV infection is ages 30-34 and 60-64
- Men are more likely to have oral HPV than women (10.1% vs. 3.6%)
- Sexual contact is a risk factor for oral HPV: 0.9% of people who have never had sexual contact had HPV versus 7.5% who had ever been sexually active.
- The number of oral sex partners has a big effect on oral HPV. The prevalence is basically the same for 0 or 1 oral sex partner (3.5% and 3.3% respectively), but by the time you hit 21 or more sexual partners the prevalence of oral HPV jumps to 21.5%
What can be done?
Any rapidly advancing papillomatous oral lesion should be suspected to be more aggressive and potentially malignant. Treatment options for papillomas are excision of the projections and base. Recurrence is rare.
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