Table 3: HPV-Positive Diagnosis – Areas of Patient Concern Areas of Patient Concern FAQ
Response
Transmission How, when, or from whom did I get HPV?
• Prevalent infection has been associated with both recent and lifetime sexual behaviors. Most of the time it is difficult to determine how, when, or from whom the infection was acquired. • HPV is the most common sexually transmitted virus, and most sexually active adults have it at some time in their lives. • Sexual behaviors and the number of partners are indicators of exposure to the virus. A positive test does not suggest promiscuity. Many patients with positive HPV test results have not had a high number of sexual partners, and some report never having had oral sex. The relevant sexual encounter(s) leading up to the positive test results likely occurred many years ago – sometimes a decade or more. • Mutual monogamy or abstinence are the best ways to prevent transmission. Consistent condom use and barrier protection is recommended, as are fewer partners. Definitive risk factors for partners of HPV-positive individuals have not yet been determined. Changing sexual behaviors in established relationships is not recommended. • The evidence for transmission of genital HPV through oral sex is strong. Transmission of the virus is via skin-to-skin contact in all anal and genital areas, regardless of penetration. • Several studies have associated current tobacco use with oral HPV infection. Specifically, the studies report that tobacco use may increase either the likelihood of becoming infected when exposed to the virus or the persistence of the virus once infected. The data suggest that tobacco cessation is beneficial. • Most oral HPV infections are cleared within 12 to 24 months by the body’s immune system; for unknown reasons, only a small subset of infections evade clearance. • Re-infection with the same type of HPV is unlikely. More research in this area is needed.
Does a positive test signify promiscuity or unfaithfulness on the part of a partner?
Prevention
How can I avoid transmitting HPV to others?
Can a person get or give HPV through oral sex?
Does current or past tobacco use affect oral HPV infection?
Duration of Infection
Will I always have HPV?
Can partners re-infect each other?
Treatment
Can I be treated for HPV? • There are currently no treatments available once a person has acquired the virus. However, the symptoms of HPV infection, such as genital warts, can be treated. Does HPV cause oral cancer? • High-risk oral HPV types are associated with development of oropharyngeal cancer. The precise length of time required for oral HPV infection to progress to development of HPV-positive oral cancer is unknown, but the time period is suspected to be decades. However, it is important to note that not every oral HPV infection will result in oropharyngeal cancer. Regular oral exams and associated oral cancer screenings are highly recommended.
Information for partners
What should I tell my partner?
• HPV is a common virus. Having the virus does not imply infidelity or promiscuity. A diagnosis of oral HPV should not include shame or blame. • The vaccine is unlikely to provide protection against the virus given the likelihood of exposure to the virus prior to its detection.
Should my partner receive the HPV vaccine?
Note . Adapted from Dodd, Racheal H., Forster, Alice S., Marlow, Laura A. V. and Waller, Jo. Psychosocial impact of human papillomavirus-related head and neck cancer on patients and their partners: A qualitative interview study. Eur J Cancer Care (Engl). 2019 Mar; 28(2):e12999. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC/6559265/; You, E. L., Henry, M. and Zeitouni, A. G. Human papillomavirus-associated oropharyngeal cancer: review of current evidence and management. Current Oncology. Vol. 26.No. 2 (2019). https://current-oncology.com>index.php>oncology>view; National Cancer Institute. HPV and Cancer. September 12, 2022. Https://www.cancer.gov>risks>infections-agents>hpv... HPV AND ORAL CANCER
The human papillomavirus is a major risk factor for head and neck squamous cell cancer, and in particular for oropharyngeal cancer (Kline, et al., 2018; American Dental Association, 2022b). Approximately 15% of human cancers are believed to be associated with viral infections (Morgridge Institute for Research, 2019). Cancers in the back of the throat, base of the tongue, and tonsils are associated with HPV. This area is known as the “oropharynx,” and these cancers are called “oropharyngeal cancers” (American Dental Association, 2022). Based on epidemiologic and molecular evidence, a causal role for HPV, primarily HPV type 16, has been established in patients with head and neck cancer (Stenson, n.d.). HPV 16 and HPV 18 contribute
The work of Dr. Harald zur Hausen identified HPV genotypes 16 and 18 and their association with cervical cancer in the mid 1980’s thus the search for the oncogenic potential of these HPV genotypes in other organs and systems was a logical progression (Syrjanen, 2017). The International Agency for Research on Cancer (IARC) has classified HPV-16 as carcinogenic (Taberna et al., 2017). It is important to note that although HPV-16 has the lowest clearance rate of all high-risk HPV infections, only a small percentage of HPV infections have a sufficient duration to become carcinogenic (Wood, 2017).
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