Table 1 a Summative points regarding oral sex, HPV infection, and oropharyngeal cancer development
General relevance – systemic health | |
|---|---|
HPV is a frequently and commonly transmitted infection worldwide | HPV is likely transmitted by skin and mucosal contact “But how much contact is enough for this transmission to actually occur? I mean, is it a one time enough and you get it or…. is it also about the intensity of contact, say, a touch or else?” Male dentist |
There are more than 120 different strains of HPV (200 strains according to some studies) | More than 40 types of HPV can be isolated in the mouth and genital tracts concomitantly - they are the same strain |
It is estimated that about 75% of all sexually active men and women are infected with HPV. The majority will remain asymptomatic, but highly infectious “Ok, so that means that potentially 3 out of 4 of us here are carrying the HPV virus, right? That is very telling and somewhat scary, really, when you think about it.” Male dentist | A common clinical manifestation of HPV is a skin wart caused by HPV 1, 2, 3, and 4; Warts are skin growths, not cancers; Genital warts are caused by HPV 6 and 11, different from those causing skin warts; Genital warts are not considered cancers |
HPV 16, 18, 31, 35, and 45 do not cause visible warts in genital areas, but have been associated with pre-cancerous lesions in the cervix and anal mucosa | 95% of cervical cancers are associated with HPV 16 and 18. In British Columbia, 6 cases of anal cancer in men are diagnosed every year “It looks like 95% is basically the majority. If transmission is almost inevitable given what it is know, is it actually preventable? Or is something that we will all have at some point, but I understand that also the majority of us will be just fine … reassuring! Female dentist |
HPV prophylactic vaccination appears to be an optimal primary prevention method | The first-generation prophylactic HPV vaccines, Gardasil® and Cervarix® cover the most prevalent high-risk types, HPV 16 and 18; five additional oncogenic HPV types (31, 33, 45, 52 and 58) were added to the existing Gardasil quadrivalent (6, 11, 16, 18) to develop a nanovalent HPV vaccine. |
“We apply anesthetic inside the oral cavity multiple times a day, every day of the week. I read that we could also be offering HPV vaccine, as we do with point-of-care HIV testing. That makes sense, but I do not know how patients would perceive that coming from dental providers. Male dentist | |
Specific relevance – oral health | |
Oral sex appears to be a potential vehicle for HPV transmission even though it is difficult to prove | Oral sex is defined as an intimate contact of teeth, gums, lips, and tongue with genital (vagina, scrotum, penis), groin, and anal areas |
“I guess kissing is here too. Well, that is almost the same to say that if you take a breath, you will get it. How can you not? I would be very careful in how people would interpret this. Wasn’t that Hollywood actor that once mentioned that his oral cancer was from oral sex, or something like that? I cannot remember his name now.” Male dental hygienist | |
Some oral cancers (oropharyngeal area) have been associated with HPV infection | HPV 16 and 18 are risk factors for the development of oral cancer, the same strain associated with anogenital malignancies. |
As a multifactorial disease, there is no single cause for oral cancer. Risk factors are associated with oral cancer but do not cause it | People infected with HPV are 30 times more likely to develop oral cancer than those who are not “I had no idea it was that high.” Female dental hygienist “Does it matter if you are re-infected? Do those odds increase with reinfection or do they remain the same … once you get it, you are done? Male dentist |
High risk individuals include those with more than 5 different oral sexual partners during a life-time and earlier oral sex experience | High frequency of oral sex, about 3 to 5 times a week in the past 30 days, increases the risk for developing oral cancer 9-fold |
Patients might not feel comfortable discussing oral sex practices with a dentist | Patients might feel that oral sex practices are not meant to be discussed in a dental office |
“That is tricky. I mean, can we comfortably talk about that [oral sex] during a dental appointment? I certainly do not feel that way, and with a male patient even less so… perhaps not at the first visit, like, to ‘spill the beans’ like that. Also, what about the one timers, say, those patients that come for a consult or emergency treatment and we never see them again? Where does the responsibility lie? Female dentist | |