HPV infected cells

More than 50% of cancers of the mouth, head, and neck are now due to the human papilloma virus (HPV). While there are over 100 unique strains of HPV, there are several that are known to be sexually transmitted and these are the ones that doctors and researchers are seeing in ever increasing numbers in the 37,000 cancers of the mouth diagnosed every year.

A sexually transmitted virus makes its way from the vulva or the penis to the mouth via oral-genital contact. Oral sex.

Many people don’t consider oral sex to be “sex”, and while it isn’t vaginal (or anal) intercourse, it is still sex. (By the way, it’s not only HPV that can be transmitted by oral sex, but herpes, gonorrhea, chlamydia, hepatitis B, and HIV as well. And the transmission goes both ways, so you can technically be a virgin when it comes to vaginal/penile penetration, but engage in oral sex and either catch an STD in your mouth or on your genitals).

So just how strong is the oral sex – oral cancer link? Well, Dr. Maura Gillison, a leading researcher in the field, says there is research to say that individuals who have practiced oral sex on six or more lifetime partners have an eightfold increased risk of developing oral cancer. Eight times!

How can you protect yourself and/or your kids?

  • Education. Understand that oral sex is sex with all the same risks except pregnancy. A 2005 study published in Pediatrics tells us that 20% of kids in grade nine have already tried oral sex (compared to 13% who have tried vaginal sex), and 31% said they intended on having oral sex within the next six months! Most teens in this study perceived oral sex as safe and ranked oral sex as less risky than vaginal sex. One in seven believed there was no risk of sexually transmitted diseases with oral sex.
  • Limit your partners. It’s a numbers game. More oral sex with different people, more HPV exposure.
  • Avoid the use of alcohol/drugs around sex because that clouds decision making. Beer googles make most people look “safe” and all of a sudden everything looks like a good idea.
  • Use a barrier methods for oral sex. There are a variety of different options, all with pros and cons. Sutter Health has a web page on the subject with excellent, explicit information about why barrier methods are needed for oral sex and specific instructions. Read this for yourself and/or print it out and give it to your kids.
  • Encourage the HPV vaccine for everyone ages 9-26 years of age.

Join the Conversation


  1. Thanks for the article. I actually do research in this area, so I have a few points to add. Dr. Gillison’s and others work does show that the majority of oropharyngeal (tonsils and base of the tongue) cancers are caused by HPV. However when including the other head and neck cancers (oral cavity and larynx), HPV causes only about 25% of head and neck cancers in the US. This has been a misstated at multiple news outlets lately. Smoking is still the leading cause of head and neck cancers.

    Also the HPV vaccines hasn’t been tested yet on whether they can prevent oral HPV and its related cancer, but it makes biologic sense. Another interesting point is that men seem to be much more likely to get HPV-related cancer

    1. Dan, thanks for your comment.

      The greater than 50% of oral cancers are HPV related comes from a study in the NEJM (July 2010) that I suspect everyone is using. In this study almost 64% of patients with oral cancer had HPV positive tumors http://www.nejm.org/doi/full/10.1056/NEJMoa0912217

      While the HPV vaccine has yet to be studied with oral cancer, it seems intuitive that if we reduce HPV viral persistence in the genital tract we will reduce oral transmission.

      1. Yes that study and others are restricted to oropharyngeal cancers, which is only a subset of oral cancers. The numbers aren’t exactly clear, but HPV likely causes close to 10K oral cancers a year while smoking/drinking cause most of the other 25K cases. You may be interested in this abstract which has some nice data on how HPV-related cancers has been increasing over the past few decades (http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=102&abstractID=84621)

        I agree that it seems intuitive, but the FDA aren’t going to approve the vaccines to prevent oral cancer without data. This actually likely impacts vaccine policy as the CDC and others may recommend boys to get the series if they were certain that they would prevent oral cancer.

  2. Isn’t there some controversy regarding the HPV vaccine? I read somewhere that adverse events in teens were quite horrific. If you had a teen would you encourage her getting this vaccine?

  3. Dr Gunter – I stumbled across your website as I was googling the difference between HSV1 and HSV 2. Want to thank you for all the great info you’ve posted about this topic, seeing how my own OB/GYN was much more knowledgable in selling me “hair removal services” than answering this question.

    I’ve not had any luck finding good reliable information on three other questions I had:

    1. What does >5.00 HSV Type 1 and 1.47 HSV type 2 results mean?
    2. Does this mean I also have HPV? I don’t specifically see “HPV” anywhere on the print-out (HCV, Hepatitis, RPR, and HIV are all negative OR nonreact); is this a specific test I have to request?
    3. If I do have HPV, should I go get vaccinated?

    I would appreciate any feedback you might have on these questions, whether its other websites or specific medical articles that I can access. Thank you in advance for your time.

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