Some background info:

The Human Papilloma Virus has many types, some pretty harmless, causing warts for example. About 40 strains of HPV involve genital skin. HPV is so common, having HPV is considered a natural consequence of being sexually active. Almost every person will have HPV on their skin at some point in their life, regardless of sexual practice or sexual preference. It is possible for a person to infect another without even knowing they have the virus.

It is impossible to know when an HPV infection occurred. HPV can lie dormant for months, or even many years, before the emergence of genital warts or cell abnormalities. There is no way to know which partner it came from or how long ago. Having HPV does not mean that a person or their partner is having sex outside the current relationship.

A couple of strains of HPV,  16 and 18, can cause genital and head & neck cancers and are spread by sexual contact. Head and Neck Cancers usually affect the  oropharynx – the base of the tongue, the tonsils and the back of the throat. Most (~70%) of  oro-pharyngeal cancers are HPV related.

Head and neck cancers caused by HPV usually shows up years or decades after sexual contact ( 99% certain to be oral sex) so a middle aged person might be very surprised and perhaps embarrassed to find out they have a cancer caused by a sexual relationship a long time ago in their past.

Genital HPV is so common that anyone who gives oral sex may be exposed to oral HPV during their life. HPV statistics in the United States show that around 10% of men and 3.6% of women have HPV in their mouths at any given time. Most people will clear the HPV infection on their own within a year, but in some people the HPV infection persists. These unfortunate people will have the HPV genetic material incorporate itself into their own DNA. Over decades the HPV genetic material can damage the repair process of the infected person’s DNA and lead to cancer changes.

1. Can the virus be caught without having oral sex? Genital HPV strains are usually transferred by skin to skin sexual contact. For genital cancers this is most often from genital to genital contact and for head and neck cancers with oral sex.
2. Is there any relation between cervical cancer and throat cancer? If a woman has one, could she get the other? Having HPV related cancer in more than one body site would be unusual. (“You can have HPV infections in both the genital and oral areas. This is because you have not developed immunity and these would be two separate infections. This virus does not travel within the body, or from one area to another.” From Tammy von Keisenberg who also runs an HPV FB support group.)
3. Is there a test like the pap smear for oro-pharyngeal cancer? There is currently no screening test for oro-pharyngeal cancer. The oro-pharyngeal cancers most often involve the base of the tongue or tonsils which makes screening smears difficult.
4. How do we remove any stigma from the oral sex/ oro-pharyngeal cancer connections? The reality is that many people enjoy receiving and giving oral sex and it’s not an unusual or uncommon sexual practice. Any stigma about oral sex is unjustified and limits sensible conversations about sexual behaviour and associated risks.
5. I have been treated for cervical or throat cancer. Could I infect my current sexual partner? If one partner has an HPV infection then the other partner is likely to have been exposed to the infection. You do not need to change your intimate sexual contact if you discover that one or both of you has HPV.Partners with a cervix, inclusive of those who identify as men (transmen), should continue to have regular cervical (PAP) screening as usual. Many people with HPV throat cancer have no HPV detectable in their mouth after treatment, while others do. With new partners, discuss protection methods (eg. vaccination, condoms, dental dams or barrier protection).
6. How can I get help with intimacy issues after this cancer? How can I keep my relationship/marriage healthy? Treatment for oro-pharyngeal cancers can be complicated, stressful and lead to lifelong disability which is difficult for relationships. Having your partner being kept informed and involved in the cancer treatment journey will keep you closer together and improve how you both cope with issues of intimacy and your relationship. Seek counselling if things get difficult and tell each other how you are feeling about things as much as possible will keep your relationship healthy.
7. Why is throat cancer increasing? Is it because attitudes to oral sex changed in the 20^th Century or has the virus changed? It’s likely that there has been an increase in how often people have oral sex compared with sexual practices in the past. This has lead to an increase in genital to oral transmission of the HPV virus.
8. Boys and girls can now be vaccinated against this virus. Does the vaccination prevent other types of HPV like genital warts? In New Zealand we use a HPV vaccination called Gardasil 9- this covers 9 strains of genital HPV which are known to cause the majority of cancer causing and visible wart causing HPV infections.
9. HPV cancer seems more curable than ordinary HNC. Is this true? Can some HPV patients have a really hard time or even die from this cancer? People with oro-pharyngeal cancer, with HPV in their tumour, live longer on average than people without HPV (i.e. HPV-positive tumours usually respond well to therapy). However, people who smoke tobacco or have smoked for a long time in the past do not live as long, on average, as people who have never smoked. Current smokers are strongly encouraged to stop. Although treatments for oro-pharyngeal cancers have high cure rates some patients will die from the HPV related cancers.
10. Are there other non-cancerous HPV lesions that can occur in a persons mouth? Although quite rare, it’s possible to get HPV related warts in the mouth. However these visible warts are not associated with cancer and will usually disapper without treatment.

And a final question for us all:

Australia is on track to wipe out cervical cancer because they have an excellent record of vaccinating girls against cervical cancer. NZ is not doing too badly. Since 2017 the Gardasil vax has been available for boys too and it is hoped that we can wipe out all these HPV related cancers in future. But the vaccine has to be given in the intermediate school years before puberty and some parents cannot get their head around the long term risk of HPV cancers. At only 60% at the most vaccinated, how can we improve these numbers?

This is a $1M question. There is a wonky bit of thinking going on by parents in NZ who consent to about 90% immunisation of their children for rare diseases like measles, mumps, rubella, polio, diphtheria, meningitis etc but then when their children are a bit older don’t consent to having them immunised against an infection that almost all of us get exposed to. Parents struggle with the connection between sexual activity in their children’s future and the risk they put their children at by not giving them HPV immunisation. I think the communication and health education about HPV isn’t working and maybe they have it better explained in Australia.

This post is based on a Q and A with Dr Andrew Miller, GP, oro-pharangeal patient and a sexual health educator