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HPV/Throat cancer
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HPV/Throat cancer

I contracted HPV, 5 years ago from my husband who I am now married too. He is the only person I have ever been with. I first found out I had HPV, when I became pregnant and went to my first doctors visit. I then was told I had dysplasia, and after I had the baby I had cryosurgery. Since then all pap smears have been normal. Also, during that time I had gential (genital) warts as well, used Aldara(sp?) to clear that up. My husband and I have only had oral sex a couple times early in our relationship, but I have noticed I do for FACT have some oral warts in my mouth and in my throat, but not many. I have been reading that HPV is linked to throat cancer, so i am EXTREMELY worried and anxious!! I am going to the doctor next week. My questions are....
1. My GYN told me I was now immune to the strain of HPV i have, even though I may be immune could i still get warts?

2. I thought low risk strains caused warts and high risk strains caused cancer. I had both warts and dysplasia....Is there a strain that can cause both? or do i have 2 strains?

3. Is it possible to get HPV in the mouth and it not develop into cancer, but have warts?

4. Should I be worried about throat cancer??

Your help would be great appreciated!! Thanks
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239123_tn?1267651214
First to your presumed FACT of having oral warts:  I do not accept that diagnosis if it has not been professionally made.  Assuming you are not a health professional (and even if you are), you need to see a provider to determine the cause of your oral bumps.

To the specific questions:

1) Your ObG is correct.  Once someone has been infected with a particular HPV type, s/he is immune to catching the same type again.

2) You are correct that separate HPV starins generally are responsible for warts versus pre-cancerous changes of the cervix.  However, the low-risk (wart-causing) types often cause pap smear abnormalities.  Also, many sexually active people are infected with several HPV types during their sexually active lives.  

3, 4) Oral warts are rare, but they can occur.  The large majority of oral HPV infections don't go on to cause either warts or cancer.  There are only a few thousand cases of oral cancer per year in the entire US, compared with millions and millions of oral exposure to HPV.

See your dentist or your primary care provider to see whether you in fact have oral warts.  My bet is that you don't.

Regards---  HHH, MD
8 Comments
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Avatar_n_tn
Dr. Hunter,

With all due respect, the incidence of oral cancer is significantly higher than "only a few thousand cases per year in the entire US".  In fact, there are more than 30,000 cases per year and the numbers are on the rise.  Moreover, as I'm sure you are aware, there is evidence that HPV can cause oral cancer.
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239123_tn?1267651214
Thanks for the opportunity to elaborate a little bit.  It seems you have some medical and/or epidemiologic knowledge, so I will respond at that level.

Sixteen thousand is the number I have in mind, but this isn't my area of expertise.  The difference might be in oral alone versus oral plus other head and neck cancers (pharynx, nasopharynx, salivary, etc).  The association with HPV is strong, and the HPV types involved are mostly the classical oncogenic genital types, i.e. HPV-16 and 18.  However, the link is not as strong as for cervical cancer.  Last I heard, HPV markers can be found in something like 60-70% of such cancers, certainly nowhere near the almost 100% rate for cervical and anal cancer.

It seems likely that the rising rate of oral and head/neck cancers is related to HPV and perhaps to increasing frequencies of oral sex.  On the other hand, among women with high rates of newly acquired genital HPV infection, the proportion who also develop positive oral swab tests for HPV is under 5%, even though most performed oral sex on the partners who gave them their genital infections (look up research by Winer and Koutsky).  Further, oral warts are rare even in persons who are orally exposed to genital HPV 6/11.  So genital to oral HPV transmission appears to be uncommon; and in addition, the proportion of orally exposed persons who actually develop HPV-related disease seems to be very small.

This is a moving target, and we can expect our understanding of the "truth" to change as research progresses.  However, even 30,000 cases per year is a trivial number compared with total genital HPV infections and the frequency of cervical and anal HPV-related neoplasia.

Bottom line:  Nobody should go to sleep worried about oral/throat cancer just because they have genital HPV or have been exposed to it, even by oral sex.
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Avatar_n_tn
Fair enough.  My concern is that I've seen too many health care professionals dismiss oral sores as nothing more than that.  

Yes, in the scheme of things, oral cancer numbers are not huge.  Perhaps that's why there seems to be a nonchalance when a patient presents with one.  However, it should be stressed that any oral sore persisting beyond two weeks should be looked at by a specialist.  It may be considered a rare cancer, but it spreads rapidly.



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Avatar_f_tn
Isn't smoking and heavy drinking also a requirement for oral cancers?
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239123_tn?1267651214
Both comments are true; thanks.  I'm not sure smoking and heavy drinking are "requirements", but the association is strong and might explain why only two thirds of cases appear to be associated with HPV.

That's enough discussion unless/until the original questioner has a follow-up.
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Avatar_f_tn
I thank you for your response to my questions. And this will be my last question, I know this is a stupid question, but it helps to hear the answer from someone else and be reassured....
When I last saw my Gyn, my question to her was, "will the dysplasia ever come back?" and thats when she said "No, you are immune....", So, in your opinion if I have already had the dysplasia in one part of my body, and it was cured and being supposedly immune now....could the same thing be growing in another part of my body, 3 years later?

The reason im so worried is I have had these large red bumps in my throat for a long time( at least a year), but never really thought about them until now. I have had alot of anxiety about my health since I had the dysplasia...
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239123_tn?1267651214
The statement about immunity is limited only to new exposure, i.e. you can't be reinfected with the same HIV type. But recurrent dysplasia is different issue.  Some women with abnormal pap smears have recurrences in the future.  When that happens, it usually is not possible to know whether it is due to an entirely new infection (with a different HPV type) or to reactivation of an old one.  There is no way to know whether your HPV infection is completely gone or persists in your cervix in latent form.

This is exactly why women who have had dysplasia need to continue with repeat pap smears, even if they have no new sex partners.  It is also the reason that women who have had abnormal paps still can benefit from the HPV vaccine (Gardasil).  You should discuss the vaccine with your ObG provider.
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