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HPV and Head & Neck Cancer

Johns Hopkins head and neck surgeon Carole Fakhry answers questions about oral HPV, the HPV vaccine and recommendations for the vaccine’s use.

 Common questions & answers about HPV-positive oropharyngeal squamous cell cancer (HPV-OSCC)
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What is Human Papillomavirus (HPV)?

  • HPV is a sexually transmitted infection that can infect the oropharynx (tonsils and back of throat), anus, and genitals.
  • There are many types of HPV. HPV can cause cancer, warts or have no effect.
  • HPV is very common in the U.S. Over 20 million Americans have some type of genital or oral HPV infection.
  • In some people, oral HPV infection leads to HPV-OSCC (HPV-positive oropharyngeal squamous cell cancer) after many years.

What causes oropharyngeal cancer?

  • HPV now causes most oropharyngeal cancers in the U.S.
  • It is recommended that oropharyngeal tumors be tested for HPV.
  • Smoking and alcohol use can also cause oropharyngeal cancer.

How did I get an oral HPV infection?

  • HPV is transmitted to your mouth by oral sex. It may also be possible to get oral HPV by other ways.
  • Performing oral sex and having many oral sex partners can increase your chances of oral HPV infection.
  • Having an oral HPV infection does not mean your partner was/is unfaithful and does not suggest promiscuity.
  • Many people with HPV-OSCC have only had a few oral sex partners in their life.

Who has oral HPV infection?

  • Many people will likely be exposed to oral HPV in their life.
  • Around 10% of men and 3.6% of women in the U.S. have HPV in their mouths and HPV infection is more commonly nfound with older age.
  • Most people clear the infections on their own within a year or two, but in some people HPV infection persists.

Can I transmit oral HPV infection to others?

Family and Friends:

  • Oral HPV is not casually transmitted by sharing drinks or kissing on the cheek.
  • We do not know if open mouth kissing can transmit HPV.

Partners of people with HPV-OSCC:

  • You have already likely shared whatever infections you have.
  • You do not need to change your sexual behaviour.
  • Female partners should have regular cervical Pap screening.

New sexual partners in the future:

  • Many patients with HPV-OSCC no longer have HPV detectable in their mouth after treatment, while others do.
  • With new partners, discuss protection methods (e.g. condoms and barrier protection).

When did I get this infection?

  • We do not know the time from first oral HPV infection to cancer but it takes many years.
  • We know that some people have infection 15 years or more before cancer.

What does having HPV in my tumor mean?

  • Oropharyngeal cancer patients with HPV in their tumor live longer, on average, than people without HPV (i.e. HPV-positive tumors usually respond well to therapy).
  • However, patients who currently smoke tobacco or have smoked for a long time in the past do not live as long as patients who never smoked. Patients who are current smokers should consider quitting.

Will the HPV vaccine help me?

  • The HPV vaccine prevents people from getting new HPV infections.
  • The vaccine will not help you clear an infection you already have.
  • The vaccine is recommended for people ages nine to 26 years old.

Will my spouse/partner also get Oropharyngeal Cancer?

  • The risk of HPV-OSCC (HPV-positive oropharyngeal squamous cell cancer) may be slightly higher among spouses of HPV-OSCC but this cancer remains rare among spouses.
  • There are no recommended screening tests for HPV-OSCC.

**Modified from Fakhry C, D’Souza G. Discussing the diagnosis of HPV-OSCC: Common Questions and Answers, Oral Oncol (2013), with permission from Elsevier

 

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