Oral HPV: symptoms, causes, risks and when to see a doctor

Human papillomavirus (HPV) infection is one of the most common viral infections worldwide. Known primarily for its association with genital lesions, HPV can also affect the oral cavity and oropharynx (the tonsils, soft palate and pharyngeal walls). 

Oral HPV often causes no symptoms or complications, as it is a transient infection that is cleared spontaneously by the immune system. However, certain strains of HPV can lead to persistent lesions or, over time, be associated with the development of certain forms of oropharyngeal cancer.

For this reason, it is important that any change in the oral cavity persisting for more than two weeks is assessed by a dentist or an ENT specialist. A timely consultation can make the difference between a benign lesion and one requiring further investigation.

Oral HPV refers to human papillomavirus infection affecting the tongue, the lining of the cheeks, the soft palate, the tonsils or the lateral and posterior walls of the pharynx. According to the NHS, HPV is a very common group of viruses, and most infections cause no symptoms and are cleared by the body spontaneously.

There are over 200 types of HPV, only some of which infect the oral mucosa. Some are considered low-risk strains that cause no symptoms or may lead to the development of papillomas or benign growths. However, there are also strains classified as high-risk, which are linked to the development of certain oropharyngeal cancers, particularly HPV 16. 

“It is important to emphasise that not every oral HPV infection progresses to cancer. In most cases, the immune system clears the virus within 1–2 years, with no long-term consequences.” – Dr. Vanda Popa, Doctor of Medical Sciences, dentist specialising in periodontology and cosmetic dentistry.

Oral transmission of HPV occurs primarily through direct contact between mucous membranes. Oral sex is the most common route of transmission demonstrated in clinical studies, although the virus can also be transmitted through other forms of close intimate contact.

The risk of infection may increase with the number of sexual partners or in the presence of other factors that affect the immune response. 

Smoking and excessive alcohol consumption do not cause the infection, but they do promote the persistence of the virus and increase the risk of precancerous or cancerous lesions developing.

“The transmission and progression of the infection vary from person to person. Many people are carriers of the virus without realising it and without ever developing any clinical symptoms.” – Dr. Vanda Popa. 

Oral HPV can remain asymptomatic for a long time, which is why many people are unaware that they are carriers of the virus. When clinical symptoms do appear, they can range from visible lesions in the mouth to persistent symptoms in the throat. 

Lesions or growths in the mouth

The most common manifestations of oral HPV are small growths or papillomatous lesions located on the tongue, the inner lining of the cheeks, the soft palate or the tonsils. These are usually painless and are discovered by chance during a dental check-up.

“These lesions may resemble other benign conditions of the oral mucosa, which is why they cannot be diagnosed simply by observation alone. In some cases, a biopsy is required to determine their nature.” – Dr. Vanda Popa

Symptoms affecting the throat

When the infection affects the oropharynx, symptoms such as the following may occur:

• persistent sore throat
• hoarseness
• difficulty or pain when swallowing
• a sensation of a foreign body or a lump in the throat.

These symptoms are not specific to HPV and may have numerous other causes, including viral infections, chronic tonsillitis or gastro-oesophageal reflux. However, if they persist, you should seek medical advice.

Signs that need to be checked promptly

There are a few symptoms that should not be ignored: 

• an oral lesion that does not heal within two weeks
• the appearance of a lump in the neck
• spontaneous bleeding
• unexplained earache
• unintentional weight loss.

These symptoms do not necessarily indicate cancer, but they may be warning signs that warrant further investigation. According to the Centres for Disease Control and Prevention (CDC), persistent sore throat, swollen lymph nodes, hoarseness and difficulty swallowing are symptoms that require medical assessment.

Most oral HPV infections clear up spontaneously and do not cause any health problems. However, in certain situations, the virus persists in the tissues, and this persistence is the main factor associated with the development of precancerous or cancerous lesions.

High-risk HPV strains, particularly HPV 16, have been linked to cancers of the tonsils, the base of the tongue, the soft palate and the walls of the oropharynx. The development of these cancers, however, depends on several factors, including:

• the duration of the infection
• smoking
• alcohol consumption
• the patient’s immune system.

“In dental practice, we frequently see oral lesions that are not related to HPV. That is why it is essential for the diagnosis to be established following a clinical examination and, where necessary, through further investigations.” – Dr. Vanda Popa, dentist specialising in periodontology and cosmetic dentistry.

Diagnosis begins with a thorough examination carried out by a dentist or an ENT specialist. The appearance, location, size and any associated changes of the lesion are assessed.

If a high-risk lesion is suspected, the doctor may recommend a biopsy and histopathological examination. In certain cases, imaging investigations or molecular tests may be indicated, depending on the clinical context.

“It is important to note that a diagnosis cannot be made solely on the basis of photographs or the symptoms described by the patient. Numerous oral conditions can have a similar appearance.” – Dr. Vanda Popa

At present, there is no treatment that can eliminate the HPV virus from the body. Treatment focuses on the lesions and conditions associated with the infection, and in many cases the immune system manages to clear the virus naturally within one to two years.

Small, stable lesions may only require regular monitoring. Persistent or suspicious growths, on the other hand, may be surgically removed, treated with a laser or by other methods recommended by a specialist.

Self-medication and the use of various topical solutions without a doctor’s recommendation are not advised and may delay an accurate diagnosis.

HPV vaccination is the most effective method of preventing infection with oncogenic strains and is recommended in accordance with national vaccination programmes and international guidelines.

Furthermore, giving up smoking, limiting excessive alcohol consumption, practising safe sex and having regular dental check-ups help to maintain oral health and enable the early detection of any changes.

Seek medical advice if you notice:

• an oral sore that does not heal within two weeks
• a lump in your neck
• if you have persistent pain when swallowing
• hoarseness
• changes to your tongue or tonsils.

An assessment is also recommended if you have previously been diagnosed with HPV in another part of the body and notice changes in your mouth. In Romania, the initial consultation can be carried out by a dentist, an ENT specialist or, in certain situations, a dermatologist, who will decide whether further investigations are necessary.

“Regular dental check-ups are not only important for dental health. During the clinical examination, we assess the entire oral mucosa and can identify lesions at an early stage which might otherwise go unnoticed by the patient.” – Dr. Vanda Popa

In conclusion, oral HPV is a common infection which, in most cases, causes no symptoms and is cleared naturally by the body. Although some strains may be associated with the development of oropharyngeal cancer, this does not mean that every infected person will develop such a condition.

Regular dental check-ups, recognising warning signs and seeing a doctor when persistent changes occur in the mouth are essential for early diagnosis. Accurate information and preventative measures, including vaccination against HPV, help to reduce the risk of complications and maintain oral health.

1. National Cancer Institute (NCI) – HPV and Cancer, 2025
2. Centres for Disease Control and Prevention (CDC) – HPV and Oropharyngeal Cancer, 2024
3. National Health Service (NHS) – Human papillomavirus (HPV), 2026
4. Gillison ML, Chaturvedi AK, Anderson WF, Fakhry C – Epidemiology of Human Papillomavirus–Positive Head and Neck Squamous Cell Carcinoma, Journal of Clinical Oncology. 2015