I recently gave a lecture about the importance of oral HPV infections and oropharyngeal carcinoma and was surprised about the many unknown issues on this theme. So my questions are:
If a woman has a positive HPV-test in the cervical region, would you (as an ENT-doctor) also perform an oral HPV-Test?
And would you regularly perform oropharyngeal endoscopy if someone has a persistent oral HPV-Infection?
Conference Paper Oropharynxkarzinom: eine sexuell übertragbare Viruserkrankun...
The studies about oral HPV infections are few in relation to cervical infection. But up to now the data do not support necessity of screening for HPV oral infections in immunocompetents even if the person has a cervical infection.
In the other hand if a HPV infection is supected and the patient is immunocompromised is important to make a oropharyngeal endoscopy to identify any lesion ant treat.
Thanks for your answer!
in USA there is an oral HPV Test available some time now which is performed mainly from dentist (OralDNALabs).
The idea is that if the first test is positive then a second one is performed 1-2 years later and if this is also positive a chronic oral HPV infection is diagnosed.
The problem I see is that we don’t know the percentage of patients with chronic oral HPV infection that will develop an oral/oropharyngeal carcinoma. Probably this percentage is so low that periodical endoscopic examinations are not indicated
This is an interesting topic that confuses me. If a woman is positive for an oncogenic HPV, isn't the main concern her sexual partner (and of course vice versa).
I am not an MD and therefore HPV-positive pre-malignant or non-malignant lesions are not known to me. How do they look like, or are they supposed to look like? If you carry an oncogenic HPV, are you always producing and "shedding" virus? Or is it more like oral/skin HSV that stress induces viral replication?
Why are most oral HPV-positive/driven cancers in the Waldeyer's ring and therefore associated with immune organs?
Do sexual partners of cervical cancer patients have a higher risk for HPV-driven oral cancer and penile cancer?
We understand the biology of this subgroup of oral cancers relatively well but is there much knowledge about HPV transmission, where HPV "lives" and survives in squamous epithelia, why it is not cleared by innate and adaptive immunity?
More questions, no answers. But I would always be more concerned about the sexual partner than the HPV-carrier him/herself since I think this is the way the virus travels around and not within a person... Does that make sense?
Thank you for your answer!
You are definitive right, the transmision has mainly to do with sexual behaviour. Therefore oral sex is considered the main reason for increase of oral HPV carcinomas. it is also proven that the risk of HPV infection increases in persons with many sexual partners.
Fortunately 90% of the acute infections with HPV heal spontaneously within some months and only a small part becomes a chronic infection causing pre-malignant lesions.
Hi Georgius,
where did you get these numbers from? Any citation? Is this for oral HPV the same or are these numbers for oral lesions? I am astonished how frequent cervical cancer occurs taken into acoount how small the ectocervix is. I don't think there is any other tissue with such high cancer rates. There must be a lot of HPV out there!
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