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The oral cavity meets the cervix: What does HPV have to do with ENT?

A moment nobody wishes for: You go for your annual check-up with your gynecologist and receive the news a few days later that the smear test at the lab has tested positive for HPV. Thoughts race through your mind: What should I do? Do I have cancer now? And how does this affect my (sexual) partner?

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A situation like this occurs hundreds or even thousands of times each year in Austria alone. However, many readers might be thinking: Well and good, but what does HPV and gynecology have to do with the field of ENT (Ear, Nose, and Throat)? Affected individuals stop asking this question at the latest when they turn to a search engine for advice after receiving a positive test result. Because there, they quickly come across oropharyngeal carcinoma. Oro… what? Yes, a complicated name. Simply put: throat cancer, which could be triggered by HPV viruses. But from “down there” to way up here is quite a journey—do these two areas really have such a close connection when it comes to HPV? Let’s take a closer look at this topic.

HPV – What exactly is it?

The abbreviation HPV stands for Human Papillomavirus. It is a large group of viruses with about 200 subtypes that can cause abnormal cell growth in humans. Specifically, HPV can cause genital warts, precancerous lesions, and cancer. The most well-known is cervical cancer, which develops in the cervix and is almost always caused by the HPV virus. However, HPV can also trigger cancer in the vagina or vulva, on the penis, and in the anal area—and in the oropharynx, the mouth-throat area, which is the main focus here. By the way, in Austria alone, 11,000 cases of cervical cancer are diagnosed annually. Also, the number of diagnoses of oropharyngeal carcinomas is increasing—and among them, about 25% are associated with HPV. This trend shows a significant increase in recent years in this country.

How is HPV transmitted?

HPV is the most common sexually transmitted disease worldwide. In some cases, newborns can even be born with HPV viruses—perhaps because they were infected through the placenta or during passage through the birth canal. Oral sexual practices may potentially be a route of transmission, although this is not certain—because in one study, only about one percent of those practicing oral sex tested positive for HPV. However, having more than six sexual partners is considered a risk factor. But kissing, shaking hands, and sneezing cannot be ruled out as routes of transmission either.

What does the HPV virus cause in me?

Human Papillomavirus (HPV) is one of the most common viral infections due to its ease of transmission. Another peculiarity is that an infection typically progresses without symptoms and the virus disappears on its own in many cases after one to two years. This means that the infection often remains undetected for a long time. Only about ten percent of those infected remain infected.

But can cancer develop from this? In rare cases, yes, but much later. In fact, an infection usually occurs around the age of 30, while the most common HPV-related cancer diagnoses occur between the mid-30s and late 50s. So there are about 20 years in between, during which the virus slumbers in our bodies.

What should I do if my partner has a confirmed HPV infection?

Suppose your partner has a positive HPV test—what does that mean for me as a (sexual) partner? According to a study of 428 individuals, only a small number of men who were sexually in contact with HPV-infected women also showed HPV in the throat area—only three percent. This suggests that there may be an independent mechanism between infection in the genital area and in the throat area. Conclusion: The risk of sexual transmission of HPV seems relatively low. So, there is no reason to panic directly.

Can the HPV vaccine effectively prevent infection?

To explain this briefly: The HPV vaccine is generally recommended for women and girls aged 12 and older. The reason: it is extremely effective in preventing cervical cancer. In Austria, it is fully covered by health insurance until the age of 21—after that, you would have to bear the costs, which are about €650. But can it prevent oropharyngeal carcinoma? There is currently not enough evidence for this. However, the data looks promising that the vaccine may also be beneficial in this regard. Additionally, there have been studies with individuals cured of anal cancer showing that the risk of developing this cancer again could be greatly reduced by the vaccine.

How can I determine if I carry HPV viruses?

A few words beforehand: For healthy individuals, testing for HPV is meaningless. Because the presence of these viruses alone is not in need of treatment. The significance of the test without actual symptoms is therefore zero. If a test is necessary or recommended, it can be done through a swab or a simple mouth rinse, which is then analyzed in the laboratory. But beware: This procedure can detect the virus, but cannot provide information about its location or spread.

In my practice I offer clarification for HPV-related changes as well as HPV vaccination.

Book an HPV clarification or HPV vaccination

In conclusion, it can be said: Human Papillomavirus should not be underestimated. But its mere presence in our bodies is not a reason for panic. HPV infection is one of the most common viral infections, and in many people, the viruses simply “disappear” at some point without leaving a trace. Also, there is an average of at least 20 years between infection and the possible development of carcinoma—and the exact transmission routes are still not entirely clear. Conclusion: Only when symptoms appear in addition to infection should one remain vigilant and consult a doctor immediately. And until then, the HPV vaccine is the only thing that may help prevent oropharyngeal carcinoma—but it definitely helps prevent other types of cancer effectively. So, as often recommended: Vaccinate, vaccinate, vaccinate.

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