Overview

You may already be familiar with Human Papillomavirus (HPV) as the virus behind cervical cancer. It’s important to know that the same high‑risk strains, especially HPV‑16 and HPV‑18, can infect your mouth and lips too. 

Every year, around 380,000 lip and oral cavity cancers are diagnosed globally. HPV accounts for approximately 60-70% of cancers in the oropharynx (that includes the tonsils and base of tongue), along with a significant share of tumours in the central oral cavity and lips. 

The good news is that in the UK, children are routinely vaccinated around age 12–13 to cut their risk of persistent oral HPV‑16/18 infection by 70–90%, which translates into a much lower lifetime risk of developing these cancers. And if HPV does play a role in a lip or oral tumour, HPV‑positive cancers typically respond far better to treatment, with about a 60% lower risk of death compared with HPV‑negative disease.¹

In this article you’ll discover what HPV is, how it reaches your mouth or lips, how it causes cancer, who’s most at risk, how these cancers are diagnosed and treated, the role of vaccination (including the UK programme), and what the latest research tells us about prognosis and prevention.

What is HPV?

Human papillomavirus, or HPV, is a very common group of viruses. There are over 200 different types. Certain HPV infection types can result in cancer, while others cause warts, which are growths on the skin. However, most of them do not cause any symptoms or problems. They are generally divided into two categories: low-risk and high-risk types.

The two most common low-risk types of HPV that affect moist areas like the genitals are HPV 6 and HPV 11. Together, they are responsible for about 90% of all cases of genital warts and neoplasms. The high-risk types of HPV can lead to serious health issues. They are the primary cause of a number of cancers, including those that affect the cervix, other genital and anal regions, and the head and neck region. Nearly all cases of cervical cancer (about 99.7%) and a large number of anal, penile, vulvar, and vaginal cancers are caused by high-risk HPV. Among these, HPV type 16 is the most common, followed by type 18. 

While HPV is frequently linked to cervical cancer, it is also an increasingly serious risk to oral health. The number of mouth and throat cancer cases has been rapidly increasing in recent years, particularly those that affect the tonsils, base of the tongue, and back of the throat. One of the main reasons for this rise in cases is HPV.

Modes of transmission

HPV can be acquired from: 

• Sharing sex toys
• Vaginal, anal, or oral sex
• Any skin-to-skin contact of the genital area

It is very common. Many people are unaware that they have it because it frequently has no symptoms and disappears on its own. One can carry the virus for years without any signs or health issues. 

Prevalence

People assigned male at birth (AMAB) and people assigned female at birth (AFAB) are equally affected by HPV. Studies show that the global rate of genital HPV infection in people AMAB is nearly the same as in people AFAB, and the transmission risk is similar for both sexes. This makes sense, as HPV is primarily spread through sexual contact.²

In people AFAB, cervical cancer was the fourth leading cause of cancer and cancer-related deaths in 2022, with approximately 660,000 new cases and around 350,000 deaths worldwide. More than 90% of these cervical cancer cases are directly linked to HPV infection, highlighting the serious impact this virus can have if left undetected or untreated.³

A recent global systematic review and meta‑analysis of nearly 45,000 men in 35 countries found that about 31% of people AMAB aged 15 years and older carry genital HPV, and around 21% harbour at least one high‑risk (oncogenic) HPV type (e.g. HPV‑16, ‑18).⁴ 

In very high‑risk groups, such as men who have sex with men (MSM) who also live with HIV, anal HPV prevalence can exceed 90%.⁵ London‑based clinic data (n = 511 MSM) show that at least one vaccine‑preventable HPV type was detected in 45 % of men, with high‑risk types found in 47 % which demonstrates similar burdens are present in the UK.⁶ 

Among heterosexual men worldwide, the lifetime number of sexual partners is the strongest risk factor for infection, and HPV infection prevalence remains broadly steady across adult age groups rather than declining with age.⁷ 

Interestingly, among people AMAB in general, HPV infection rates remain high across all age groups and do not vary much with age, showing that risk persists throughout life. When looking at different parts of the world, HPV infection rates tend to be higher in developing countries, with about 42%, compared to around 23% in developed regions.²

Mechanism of infection

HPVs are picky about where they live and grow, being a DNA virus. These viruses mainly infect the outer layers of the skin and the moist linings (squamous epithelia) of areas like the mouth, throat, and genitals. Scientists have identified over 200 different types of HPV.

In the lower layers of skin, the virus replicates quietly, maintaining about 50 to 100 copies in each cell. During this phase, high-risk types like HPV 16 and 18 tightly control their cancer-related genes, E6 and E7, keeping them at very low levels while the cells are still dividing.⁸

When infected cells move upward and begin to mature, the virus receives a signal to ramp up its activity, replicating thousands of viral copies and activating all its genes. In the upper layers, it produces proteins to form new virus particles, which are released to infect others. The entire process, from initial infection to the release of a new virus, can take at least three weeks. In cancer-prone cases, loss of control over E6 and E7 gene expression leads to disruption of normal cell function, contributing to cancer development.⁹

The way HPV causes cancer is through two viral proteins called E6 and E7. These proteins inactivate your body’s key tumour‑suppressor proteins, p53 and pRb, and effectively disable their ability to control cell growth. That lets infected cells divide abnormally and resist normal cell death, increasing the risk of carcinoma.¹⁰

HPV in head and neck cancers

Infection with certain high‑risk HPV types, especially HPV 16, is recognised as a major risk factor for a growing number of head and neck cancers, particularly cancers of the throat (oropharyngeal cancers, including the tonsils and base of the tongue). By comparison, HPV is found much less often in cancers affecting the lip or surface of the mouth (oral cavity). 

Meta‑analyses show HPV detected in only around 2–6% of oral cavity squamous cell carcinomas worldwide, with a far larger portion of oropharyngeal tumours being HPV‑positive. That means while HPV is strongly linked to throat cancers, it has a very limited role in most lip or other mouth cancers.¹¹

HPV-related mouth and throat cancers can cause symptoms like: 

• Persistent sore throat 
• A hoarse voice
• Ear pain on one side
• Swollen lumps in the neck
• Pain or trouble swallowing
• Unexplained weight loss
• A white or red patch on your tonsils

Risk factors and transmission of HPV in the oral region

Sexual contact, particularly oral sex, is the primary way that oral HPV infections are transmitted. Some risk factors for Oral HPV can be: ¹²

• Having many oral sex partners
• Having genital warts
• Smoking and alcohol consumption

HPV-related mouth and throat cancers are often harder to detect than those caused by tobacco because their symptoms can be very mild or painless. This makes it difficult for both the person affected and their doctors to notice the problem early. 

Other than sex, transmission is possible through:

• Finger-to-mouth contact, particularly in individuals with damaged skin
• Mother to child during pregnancy

Diagnosis of HPV-related oral and lip cancers

If your GP, dentist, or ENT specialist spots an unusual lump, sore spot, or patch in your mouth, lip or throat (including the back of the tongue or tonsils), the first step is a physical exam. If there’s concern, a biopsy is taken. A biopsy is when a tiny piece of tissue is removed and looked at under a microscope (histology) to confirm if it’s squamous cell carcinoma, the most common cancer type in these areas.

If cancer is confirmed in the oropharynx (throat area), NHS‑approved UK guidelines (via NICE) require testing the tissue for a protein called p16 using immunohistochemistry (IHC). A result is only considered p16-positive if more than 70% of tumour cells show strong staining, both in the nucleus and cytoplasm. A p16-positive tumour usually undergoes a second-line test i.e., either high-risk HPV DNA or RNA in‑situ hybridisation (ISH), to confirm whether HPV is actually present. This two‑step testing helps ensure only oropharyngeal cancers truly driven by HPV are classed as such.¹³

For cancers arising in the lip, inner cheek, floor of the mouth or tongue, HPV is much less common and p16 testing is not usually performed unless there is a specific reason to suspect HPV involvement. HPV-driven cancers are so rare in these sites that UK pathology guidelines advise not to test routinely for HPV in non-oropharyngeal tumours.

Newer research in the UK and worldwide has explored using saliva or mouth-rinse tests to detect HPV DNA (especially HPV‑16) as a non‑invasive way of monitoring or screening, particularly for throat cancers. These tests show high accuracy in some clinical studies, up to 90% specificity and decent sensitivity, but they remain in the research phase and are not currently part of NHS diagnosis or routine care.

How can you prevent HPV cancers?

The best way to prevent HPV-related oral cancer is to get the HPV vaccine. The NHS routinely offers it free to all people AMAB and AFAB aged 12-13, with catch-up vaccination available up to your 25th birthday, and it’s also offered to people AMAB who have sex with other people AMAB (MSM) up to age 45 through sexual health or HIV clinics. 

If you've missed vaccination at school, you can still receive it later. Even if you’ve already had some sexual activity, getting the vaccine in your early adult years can still significantly lower your chances of long-term infection from high-risk HPV types like HPV-16, which is most strongly linked to oral cancers.

Making healthy lifestyle choices can also help reduce the risk. These could entail:

• Don’t smoke or chew tobacco, and limit alcohol intake
• Protect your lips from strong sunlight using SPF and covering them, especially outdoors
• Keep your teeth, gums and mouth clean, brush twice a day with fluoride toothpaste, floss regularly, and see your dentist for check-ups
• Use condoms or dental dams if having oral or other sex to help prevent HPV transmission
• Talk openly with your sexual partners about sexual health as this builds awareness, encourages safer behaviours, and supports mutual protection

Together, these precautions support NHS guidance and are practical ways to take control of your oral and general health.

Oral health plays a crucial role in preventing serious diseases like HPV-related oral cancers and is fundamental to healthy ageing. Maintaining good oral health not only supports overall well-being, nutrition, and social interaction but also helps reduce the risk of infections and cancers in the mouth and throat. 

Despite its importance, oral healthcare remains undervalued and often neglected in public health programs, especially for older adults who may be more vulnerable to both cancer and other oral diseases. Age-related barriers and discrimination further restrict access to essential oral care and support services. 

To protect older adults from HPV-related oral cancers and improve their quality of life, oral health must be prioritised within global ageing initiatives. Integrating oral health into person-centred, coordinated care models will ensure comprehensive prevention, early detection, and effective management of oral diseases, enabling older adults to live healthier, more fulfilling lives.

Treatment approaches

In the UK, HPV‑linked cancers of the lip or general oral cavity (like tongue, gums, cheek lining) are not treated differently simply because HPV is present. These tumours are managed exactly like any other oral squamous cell carcinoma. 

Surgery is the main treatment choice, and if your pathology report shows high‑risk features (such as cancer cells very close to the edge of the removed tissue, or spread into lymph nodes), post‑operative radiotherapy or chemoradiotherapy is added to reduce the chance of recurrence.¹⁴

When cancer develops in the throat region (oropharynx) and tests positive for HPV, the NHS standard treatment becomes intensive radiotherapy delivered over six to seven weeks with cisplatin chemotherapy. 

For people whose cancer is advanced (cannot be surgically removed) or has recurred, and whose tumour testing shows it expresses a protein called PD‑L1, immunotherapy with pembrolizumab is offered on the NHS. NICE technology appraisal TA661 specifically recommends it as a safe and effective second‑line option for eligible head and neck cancers, including oropharyngeal and oral tumours.

Summary

HPV is a common virus that can lead to throat and oral cancers. Certain high-risk types of HPV, like HPV 16, are strongly linked to cancers of the tonsils and the back of the tongue. Sexual contact is one of the main routes of virus transmission. Protecting yourself with vaccines, practising safe sex, and keeping good oral hygiene are essential. This not only lowers your risk but also supports overall well-being, especially as you get older. Take charge of your health today because prevention begins with awareness and action.