HPV and Oral Cancer

Dear Dr. G,

I hope to put Dr. G on the spot this week regarding the safety of oral sex. My wife and I have been sexually active throughout our marriage.

Over the years, we have been enjoying more oral sex as my wife is experiencing pain on penetration after her menopause. This is now a very much integral part of our sex life.

I was horrified after I read in the news and medical articles about oral sex being one of the root causes of throat/tongue cancer among men.

Apparently, due to the transmission of HPV during oral sex, it can subsequently turn cancerous, as admitted by Hollywood actor Michael Douglas.

Who would have guessed the Basic Instinct star’s admission would throw the awareness of HPV and oral cancer into the limelight, after the portrayed “sex addict” admitted to the association of his cancer with his love for oral sex.

As this news has got us quite concerned, my wife and I would like to put Dr. G on the spot for some clarification on the true association of HPV and oral cancer.

Firstly, what exactly is HPV? And how common is this infection?

I often associate HPV with cervical cancer, how can it induce oral cancer? How common is Oral Cancer in general? And how can this be prevented?

Finally, I have heard about the HPV vaccine; do you think we should both get it for cancer prevention?

Yours truly, Oral Oliver

Human Papillomavirus (HPV) is an infection thought to be contracted by nearly all sexually active individuals at some point, making it the most common sexually transmitted infection. The initiation of sexual activities, such as oral and anal sex, can lead to the transmission of the virus.

Although HPV is highly contagious, about 90% of infections remain asymptomatic and resolve spontaneously within two years, although persistent infections may result in warts and precancerous lesions.

HPV increases the risk of genital warts and cancers of the penis, vulva, vagina, anus, mouth, and throat, particularly among at-risk individuals. The most devastating and commonly HPV-induced cancer is cervical cancer.

Almost all cervical cancers are caused by HPV. In 2018, an estimated 569,000 new cases of cervical cancer were reported, with over 310,000 deaths, particularly in developing countries. Conversely, about 40% of oropharyngeal cancers are caused by HPV.

The prevalence of oropharyngeal cancer is significantly lower, with approximately 50,000 cases reported globally per annum. Men have a four times higher risk of contracting oropharyngeal cancers as compared to women.

Also, oropharyngeal cancer more commonly affects developed countries in the USA, Europe, and Australia.

As the trend of cervical cancers declines in these countries, the prevalence of oropharyngeal cancers gradually increases over the decades. This has led to campaigns inclusive of men in HPV vaccination programs.

Early sexual intercourse, multiple sexual partners, and weakened immunity are factors associated with the persistence and progression of HPV infections.

Other risk factors, such as smoking and high alcohol consumption, also increase the risk of viral transition to malignancy. Reports have highlighted the protection offered by condoms against HPV transmission during vaginal and anal intercourse, but their use and effectiveness in oral sex are less reported and practiced.

Oral sex is generally considered an enjoyable and healthy part of sexual intimacy, often performed as foreplay to incite arousal before penetrative intercourse or as an intimate act in its own right.

Like any sexual act that involves the exchange of bodily fluids, oral sex can pose a risk of contracting sexually transmitted infections (STIs).

However, scientists generally agree that the transmission risk is significantly lower than with vaginal or anal sex. Pathogens transmissible through oral-genital contact include chlamydia, gonorrhea, herpes, hepatitis, HIV, and HPV.

The link between oral sex and HPV-induced oral cancers is generally based on two studies. In 2005, Malmo University indicated that 36% of oral cancer patients had HPV compared to only 1% of healthy individuals.

Another study in The New England Journal of Medicine suggested a correlation between oral sex and throat cancer, concluding that those with one to five oral sex partners in their lifetime had about double the risk of throat cancer, which increased 250% with more than five partners.

However, oral sex does not directly result in cancer. Typically, 90% of HPV infections clear up within two years due to the body’s immunity. Those who smoke and drink excessively are less likely to clear the virus due to impaired oral mucosal immunity.

The introduction of the HPV vaccine may be a game-changer for the prevention of HPV-linked cancers from oral sex. The up-and-coming generation of vaccinated women is expected to see a decline in oral cancers.

The importance of protecting boys with this vaccine advancement is also being recognized. While evidence for the vaccine’s protection in non-virgins is limited, it is still believed to offer some level of protection.

For those whose fear of oral sex risks dampens enjoyment, loyalty to one partner, reduced smoking and alcohol consumption, and vaccination can help mitigate concerns.

Dr. G advises that while all forms of sex involve risk, the joy of a sexual relationship can be heightened when consistently faithful and vaccinated, making sexual experiences less challenging and safer.