Oral Human Papillomavirus (HPV) Infection - Symptoms, Diagnosis, Prevention and Treatment

Oral Papillomas (Warts) Diagnosis, Treatment, Pevention

In the photo above, there are images of the patient with a lesion compatible with the wart, which is gradually increasing in size, on the left upper side of the uvula, after excisional biopsy under local anesthesia and after oral cauterization with silver nitrate.

Human papillomavirus (HPV) and general characteristics

Human papillomavirus (HPV - human papillomavirus) is the virus most commonly known to cause cervical cancer. In recent years, it has been shown that the new species of this virus is associated with intrauterine cancer. Most HPV-associated lesions in the mouth are benign and tend to recur from time to time. Papilloma viruses are commonly found in mammals and are rarely seen in birds. Papilloma viruses that are isolated in more than 300 species and cause infection in humans are collectively referred to as human papilloma virus or HPV (human papillomavirus). HPV viruses are divided into high risk (HR) and low risk (LR) types according to their carcinogenic properties.

HPV viruses are mostly transmitted from the skin to the skin. The most common low-risk HPV virus infections in humans are seen and mostly asymptomatic. The papillomavirus genome consists of two-stranded DNA decorated and packed with histones of the host cell. These are two types of proteins, early (E) proteins and late (L) protein. Early HPV proteins maintain regulatory functions and are responsible for oncotransformation of the host cell (transforming into cancer), and late proteins constitute virion capsid.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States.

HPV is the most common sexually transmitted infection agent!

HPV, nearly all sexually active men and women at some point in their lives, are common enough to cause infection. There are many different types of HPV. Some species cause genital warts; some can cause different health problems, including cancer.

How does HPV spread?

Through vaginal, anal or oral sex, the HPV virus can be easily transmitted from one person to another. It is most commonly transmitted during vaginal or anal sexual intercourse. HPV can be passed even if an infected person has no symptoms or symptoms.

Anyone who is sexually active can take an HPV, even if only one person is involved. Even years after contact with an infected person, HPV infection may occur.

Why HPV causes health problems?

In most cases, HPV does not cause any health problems. In addition, HPV can cause genital and oral warts or health problems such as cancer. In the mucosal areas, it may cause large or small lesions, either swollen, smooth, or cauliflower-shaped, from the repetitive surface.

A physician interested in the subject can usually diagnose by looking at the warts.

How to understand HPV in the mouth?

HPV infection, usually in the mouth, tongue, tonsils, pharynx and small In the mouth, the HPV wart sometimes can not be seen easily, can occur in the tongue root and pharynx. Papilloma in the tongue is sometimes mistaken for taste buds (especially squamous papilloma with smooth surface and round lesions).

Almost all the mouth sections, including the tongue, are painless, swollen from the surface, usually mucosa-colored or more pale, smooth or rough, usually rounded lesions are seen. These lesions, called warts, warts or papillomas, can grow and new ones may appear in their environment.

HPV Wart Photos (Papillom Photos - Verru Photos - Oral Papiloma Photos - Tongue Wart Photos)

Below you can see the different oral wart photos:

Squamous papilloma of the tongue

Vocal cords - Larynx Warts (Papilloma)

Vocal cords - Larynx Warts (Papilloma)

Vocal cord papilloma

Papilloma on the uvula - oral wart

Papilloma on the pyarynx - oral wart

Papilloma on the uvula and soft palate - oral wart



Papilloma on the hard palate - oral wart

Papilloma on the hard palate - oral wart

Papilloma of the tonsil - Oral wart

Papilloma of the tonsil - Oral wart

 

Papilloma of the tonsil - Oral wart

Papilloma of the tonsil - Oral wart

Papilloma of the tonsil - Oral wart



Papilloma of the tonsil - Oral wart

Papilloma of the tonsil - Oral wart

Papilloma of the tonsil - Oral wart



Papilloma of the tonsil - Oral wart

Soft palate papilloma removal

Does HPV cause cancer?

HPV can cause cervical cancers, including vulva, vagina, penis, anus cancer, and mouth and all head and neck cancers (oropharyngeal cancer, tongue, mouth base, and tonsil cancer ...).

Usually a person needs years or even decades to develop after contact with HPV. HPV types that can cause genital and oral warts are not the same as HPV types that can cause cancer.

HPV (human papilloma virus) is the most common sexually transmitted virus. 70% of the sexually active adults will find HPV at any point in their lives. In 99.7% of cervical cancer biopsies, human papillomavirus DNA was detected and the greatest causal relationship was found for any cancer. According to theCenters for Disease Control and Prevention, CDC, several other types of cancer are associated with HPV: 95% of anal cancers; 60% of oropharyngeal cancer; 65% of vaginal cancer; 50% of vulvar cancer; And 35% of penile cancer (source link: Japanese mushroom extract active hexose correlated compound (AHCC) may have role in prevention HPV-related cancers).

Is it possible to test the development of cancer with the HPV virus?

People with HPV will develop cancer or other health problems, there is no possibility to know laboratory tests or imaging methods. People with a poor immune system may be less skilled in eliminating HPV and may be more likely to develop health problems from HPV due to it.

Treatment of skin warts

Although there is no definitive treatment method for warts (skin papillomas), different chemical drugs and cauterization methods are available as localized treatment tools. It can behave differently depending on the characteristics of the virus and the body resistance of the infected person. Generally, after localized treatment, hpv benign lesions tend not to recur. Local laser applications are also neurotic. Details on this topic can be found on the source links.

HPV protection (HPV vaccine)

HPV virus predominantly tends to be sexually transmitted and condom use alone is not sufficient for protection. From the skin to the skin or mucosa may be transmitted to the mucosa. There are many resources linking to monopoly abroad. The HPV vaccine is currently the most effective and the only protection tool. It is especially important for the introduction of carcinogenic strains to the immune system, even if the protective power is limited (although not all HPV strains).

Who should have the HPV vaccine?

The HPV vaccine is typically administered in a total of 3 doses over 6 months. The ideal age for boys and girls is 11 or 12 years of age (a better immune response is achieved at this age).

In order to get the best response within the HPV vaccine, it is important to vaccinate without exposure to the virus. So the vaccination should be done before the beginning of the sexually active life, and the HPV vaccine can be initiated as early as 9 years old.

As a general recommendation, HPV vaccination for girls is between 13-26 and 13-21 years of age. HPV vaccine has a reduced effect on cancer risk in men or women after 21 years of age.
You can find information about the HPV vaccine on the American Cancer Society website at >> American Cancer Society Updates HPV Vaccine Recommendations to Include Males

You can find the 9-valent HPV vaccine Gardasil 9 in Turkey. The HPV vaccine with the most protective effect at the moment.

Intraoral lesions caused by HPV and its treatment

Recent studies have shown the relationship between HPV and intraoral cancers. Different lesions and diseases may occur due to the balance between the characteristics of this virus with many subtypes, the intracellular maintenance of the host, and the immune system response.

Most of the lesions associated with HPV in the mouth are benign!

Depending on HPV, usually benign lesions with asymptomatic or recurrent features occur in different areas within the mouth.

Squamous papilloma and its treatment

The most common type of epithelial epithelial epithelium is benign epithelial neoplasm. Squamous papillomas, especially lips, ventral tongue and brake area, palate and mucosal surface can be found anywhere in the mouth with a special interest. These lesions usually have a white appearance and can be seen in all age groups. Squamous papillomas are usually caused by HPV type 6, 11, 32 and 33 infection. Typical treatment is surgical excision. In the excision, removal of the lesion is recommended, including at least 1 mm intact border and mucosa gold. Surgical excision alone is usually curative, and no more lesions appear. The appearance of relapse or new lesions indicates the possibility of condensation or conversion to acuminate or cancer.

The four photographs above are of a patient with progressively increasing lesions on the tip of the tongue, which are raised from the surface. The patient applied to our clinic because of the lesions at the tip of the tongue, raised on the surface, pale pink in color, one of which was close to 5 mm in size, and the others were several mm in diameter for several months. In the patient, the preliminary diagnosis of warts was considered, and after the lesion was excised under local anesthesia, silver nitrate was applied by including adjacent areas with a diameter of approximately 1 cm. As a result of the histopathological examination of the lesion, it was found as "squamous papilloma". Oral HPV DNA screening was recommended to the patient, and follow-up was planned.

Verruca vulgaris and its treatment

The most common HPV skin lesion is verruca vulgaris, but can also be found in the oral cavity, also known as "wart" in the public. These lesions are usually associated with HPV type 2 and 4. Verruka vulgaris lesions are most commonly found in the mouth, on the keratinised surfaces of the gum and palate. Some oral lesions are thought to occur following autoinoculation. These lesions are usually seen in children, but can be seen in any age group. Verruca lesions usually grow rapidly (average size <5 mm) and then remain stable for several years. The same treatment is surgical excision and the clinical differentiation of the lesion from squamous papilloma is not vital.

Focal epithelial hyperplasia and its treatment

Focal epithelial hyperplasia, also known as Heck's Disease, is associated with HPV types 13 and 32, and was first detected in Eskimo natives. Heck's disease is frequently seen in children and is increasingly seen in the HIV-positive population. This lesion is usually located in the lip, cheek and tongue mucosa. Focal epithelial hyperplasia lesions are usually similar to the normal mucosa color but sometimes appear to be white and papillary. Clinically, most soft, smooth, dome-shaped papules are usually 3 - 10 mm in size. Lesions usually persist for months or even years, and spontaneously resolve without any treatment. There is little risk of repetition.

Condyloma acuminata and its treatment

Normally, the lesions of the condyloma acuminatum are located in the genital area and are considered a sexually transmitted disease. Oral condylomas are associated with HPV types 2, 6 and 11. Clinically these lesions are similar in appearance to papilloma but are generally clustered in larger size and more. In addition, the condylomas are more commonly clustered and deeper than the papilloma. It is frequently found in the lip mucosa, soft palate and tongue syphilis. Condylomes occur as a result of oral sex via autoinoculation or maternal passage. Often, condylomas in the oral cavity are related to oral sexual contact. When these lesions are diagnosed in children, the clinician should be aware that they may be indicative of possible sexual abuse. This is a common disease of the wart formation, which can cause deformity in the mouth and difficult to treat. Surgical removal of lesions at the same time to reduce the possibility of autoinoculation is the most appropriate approach. Laser excision is not recommended as it may lead to the spread of the virus through airborne particles. Podofilox (Condylox), an antimitotic topical agent used for the treatment of genital and anal condyloma, has not been approved by the FDA for oral use, but may also be effective in the treatment of oral condylomas.

Links between HPV and oral cancer

Some HPV types are of great importance for clinicians as possible linkage between oral and orophyrangeal carcinoma. HPV cervical cancer has a clearly defined role in almost all cases. The similarity of morphological features of genital and oral HPV-related lesions suggests that HPV may contribute to the development of oral and laryngeal squamous cell carcinoma (SCC). HPV is the most common type of high-risk HPV virus found in type 16 and 18. In areas where HPV viruses were isolated, the normal mucosa showed dysplasia and then cancer development, and the rates changed according to the test method and detection sensitivity. In many studies, HPV virus DNA was found in 25-35% of oral cancers. Some HPV proteins are inactivated by binding to the tumor suppressor p53 gene and Retinoplastoma gene (Rb). Intraocular cancer development may occur due to mutation or inactivation of these genes. Therefore, HPV is a risk factor independent of smoking and alcohol for intra-oral cancer development. The genes responsible for the oncogenic mechanism of the HPV virus are known as E6 and E7. The E6 gene breaks down p53 and E7 causes the development of carcinogenesis by inactivating the Rb gene. The risk of recurrence of HPV infection increases with age.

Papilloma in the mouth and its treatment

Papilloma excision from hard palate 

oral papilloma - before the excision

The above picture shows the lesion on the right side of the hard palate of the patient with a surface rough, painless, round shaped papilloma with the diagnosis of HPV virus.

oral papilloma - after the excision and silver nitrate application

The patient's lesion was excised with a bisturia at least 1 mm after the local anesthetic was injected.

oral papilloma - after the excision and silver nitrate application

After excision, silver nitrate, an antiseptic silver salt, was applied to the lesion base.

oral papilloma - one week after the excision and silver nitrate application

During the 1-week follow-up visit, the excision area is still hyperemic and mucosal healing continues.

oral papilloma - one week after the excision and silver nitrate application

Pathological diagnosis came as "viral papiloma".

In oral HPV infections, the appearance of lesions may vary according to host resistance, oral hygiene, and characteristics of the active virus.

Uvula papilloma

Papilloma excision from uvula

Here you can see the photos of the mouth of the patient with small tongue papilloma, including the tip of theuvula:

Papilloma excision from uvula - Oral wart treatment

In the photo above, the patient with wart in the mouth (uvula) is seen before and after papilloma excision after local anesthetic injection. The surgical procedure was performed under office conditions.

Partial Uvulectomy and Papilloma Excision From Uvula Video

The video above shows the uvulectomy of a patient with a wart on the uvula, which is an ulcer associated with HPV. A patient with complaints of stumbling and coughing while swallowing, applied to the office of Dr. Murat Enoz and in his examination, a painless mass lesion (papilloma) with a rough surface, 0.5 cm in diameter, connected to the tip of the uvula with a long stem (pedicle) was detected. The papilloma of the patient was resected under general anesthesia and under hospital conditions, together with the tip of the uvula to which the pedicle was attached. Tissue removed after partial uvulectomy and excisional biopsy is seen. You can monitor the wart itself and the uvula area to which it is attached. Oral wide-panel HPV virus DNA screening was recommended to the patient and follow-up of the patient was planned.

Nutritional recommendations for oral HPV infection

In patients with HPV infection in the mouth, there is no complete cure for full cure. Apart from this, it is important to pay attention to the following as a general precaution:

• Attention should be paid to the hygiene of the mouth (regular teeth cleaning, tooth brushing, etc.)
• Continuous use of continuous alcohol-based oral cleansing solutions may damage the protective, beneficial bacterial block in the mouth, so they are not suitable for continuous use.
• With the use of perbiotic and probiotic natural products, beneficial bacteria in the mouth should be supported and consumed as they are beneficial to body resistance (such as garlic, ground apple, home yogurt, kefir, onion etc.)
• Foods of Mediterranean cuisine that increase body resistance should be selected (lemon peel, body resistance in green mandarin shell and tissue regeneration with antioxidant flavonoid group vitamins are available)
• Avoiding alcohol and smoking (no additional carcinogens needed)
• All food and beverages, except water, should be avoided 2-3 hours before bedtime to prevent reflux
• Perhaps it may seem irrelevant, but; saliva is the most useful antiseptic secretion that makes the most beautiful cleansing of the throat. In patients who sleep with open mouth due to nasal obstruction, the saliva dries and may not provide sufficient amount of throat clearance. If you have open mouth and nasal obstruction, medical treatment or surgical treatment may be helpful.
• Consumption of fruits and vegetables in antioxidant season
• Regular life
• Regular exercise and of course happiness ...

AHCC (Active Hexose Correlated Compound (AHCC) - Active Hexose Associated Compound)

For more than a decade, we have evaluated the safety and efficacy of AHCC through chemotherapy. "AHCC", a nutritional supplement that modulates the sensitivity of the immune system and prevents tumor growth, has been subjected to safety and efficacy tests for more than 10 years.

What is AHCC?

AHCC is a common, well-tolerated dietary supplement that has been used in Japan for decades. It is a natural immunoregulatory compound derived from the unique fraction of the specially cultivated medicinal mushroom micelle. In recent years, AHCC has been implicated in the prevention of HPV-related cancers. The active ingredients of AHCC are mostly polysaccharides comprising b-glucan and acetylated α-glucan. The main active compound is an oligosaccharide with a molecular weight of 5,000 daltons (a relatively small molecule) and is readily absorbed in the intestine with an alpha, 1-4 glucan structure. The micelle portion of the fungi is rich in α-glucans and the long culture process causes acetylation of [alpha] - glucans.

AHCC was produced by culturing basidiomycetes micellar (fungal root threads) in a large holding tank for 45 days, as shown in the video below. The whole culture process is processed in this way to keep the identity of the cells the same throughout the development. The cells are transferred to the incubation tank for 12 hours. Finally, the liquids are separated from the solids and the liquid is freeze-dried into a powder.

AHCC was developed in 1987 at the University of Tokyo Faculty of Pharmaceutical Sciences with other researchers, a natural product that regulates high blood pressure. However, AHCC is currently known to provide protective immunization against viruses, cancers and infections (source: Japanese Medicinal Mushroom Immune Enhancer: AHCC . Pleasant Grove, UT: Woodland Publishing; 2001 - This is a book about the AHCC)!

How Does AHCC Affect?

AHCC works as an immunotherapy agent, a treatment that uses the body's own immune system to combat disease. Human studies and in vivo studies have shown that AHCC increases the number and / or activity of Natural Killer (NK) cells, dendritic cells, and cytokines, which enable the body to effectively respond to infections and prevent the proliferation of tumors. Two recent human clinical studies have shown that AHCC increases anti-body titers more than vaccines in healthy adults when taken with the flu vaccine (Sources: AHCC Research Association / Clinical Perspectives on the Role of the Human Papillomavirus Vaccine in the Prevention of Cancer).

There is not enough current information to know how the AHCC can work. Some researchers believe that "natural killer cells" will increase activity in people with cancer. Animal research shows that it can protect the liver against certain toxic chemicals and prevent diabetes (sources: AHCC: Uses, Side Effects, Interactions and Warnings - WebMD).

How to Use AHCC?

In the article entitled "Integrating Complimentary and Alternative Medicine in Form of Active Hexose Co-Related Compound (AHCC) in the Management of Head & Neck Cancer Patients" that published in The International Journal of Clinical Medicine there is a dosage suggestion that it can be safely used up to 3 grams and can help patients with cancer to reduce the side effects of chemotherapeutic drugs. AHCC is primarily available in capsules. The manufacturer's dose setting guidelines may suggest 2 capsules of oral administration, or 2 capsules per well, for oral administration of the two 500 mg capsules in an empty abdomen 3 times a day. In one study, the dose of 3 mg AHCC per day resulted in increased innate immunity within 4 weeks (source: The use of mushroom glucans and proteoglycans in cancer treatment).

According to the ClinicalTrials.gov website of the US National Institutes of Health (NIH), the estimated completion date of this AHCC HPV phase 2 study is December 2018 Phase II Evaluation of AHCC for the Eradication of HPV Infections (AHCC4HPV) / International Congress on Nutrition and Integrative Medicine (ICNIM)).

Contraindications of AHCC

It should not be used against any component of the AHCC or if it is not used against basidiomycete fungi.

Can AHCC be Used during Pregnancy and Breastfeeding?

There is not enough information about safety and efficacy in pregnancy and lactation.

Side Effects of AHCC

In a phase I study, mild GI complaints such as nausea, diarrhea, and bloating were reported. Some patients also reported a fluid form of AHCC with headache, fatigue, and foot cramps.

AHCC Drug Interaction

There is not enough information and no reported drug interactions.

In the medical literature, the use of AHCC as an immunomodulatory agent (active hexose-associated compound) and its efficacy in the treatment of cancer and various infections have been documented; however, there is limited information supporting the use of this product under any circumstances (source: AHCC Uses, Benefits & Dosage). When the information on the use of AHCC in patients with HPV virus becomes clear, I share it when I have time.

American Food and Drug Administration (FDA) 's AHCC page >> https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/advisory-letters/advisory-letter-rockwell-nutrition

Sources:

• Oral lesions caused by human papillomavirus
• Poster "The Human Papillomavirus"
• STD Facts - Human papillomavirus (HPV) - CDC

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:

Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52

E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199

Fax: +90 212 542 74 47