Painless, Single and Growing Tongue Mass: Papilloma (Wart)

Tongue Papilloma

Oral wart - Tongue papilloma

An example photo of oral papilloma, a lesion in the mouth, often seen in the tongue, it is caused by Human Papilloma Virus (HPV). The lesion was excised with local anesthesia. 10 days after the operation is shown in the right photo. HPV (Human papillomavirus infection) virus is mostly sexually transmitted and can cause genital warts, cervical and vaginal cancer in women; It is a virus with more than 100 subtypes. It can cause warts (condyloma), cell proliferation and cancer in different parts of the body.

HPV leads to the formation of warts within 2-3 months after ingestion. Warts are most common in the genital area, but can occur anywhere in the body. 80-90% of HPV is destroyed by the body's defense cells. The process of cancer formation of HPV virus is 10-15 years. HPV is positive in 99% of oral cancers. HPV virus, men, penis, scrotum and anorectal cancers are among the causes. The very common HPV virus is easily transmitted and can cause serious health problems. Vaccination can now be performed against the most common types of virus with close to 100 species. Two commercially available HPV vaccines are particularly safe from common types of cancer-causing viruses.

What are the types of HPV?

There are nearly 200 different types of HPV. About 40 of these types cause warts in the genital area. It is divided into two groups as low and high risk according to the potential of HPV to cause cancer.

HPV types 6 and 11, which are the most common anogenital verrucas, have low risk for cancer development.

Low-risk HPV types; HPV types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72 and 81

High-risk HPV types; HPV types 16 and 18, especially 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82 are high risk types.

How does HPV transmission?

The causative agent is human papillomavirus (HPV), which has more than 100 species. It is not possible to determine the date of transmission. It is transmitted through skin contact, the main transmission of the virus is sexual intercourse. It is transmitted by contact with an infected person's penis, scrotum, vagina or external genitalia. Contamination also occurs if an oral genital area is touched orally. Using a condom does not always prevent infection because the virus can also be transmitted from a genital area that is not covered by a condom. Infection usually occurs as cellular changes that the naked eye cannot see. These can be detected in women with a cervical cancer diagnostic test. Sometimes the infection manifests itself with conventional cauliflower warts (condyloma acuminata). In most cases the infection comes and occurs unnoticed. Genital warts have a high potential for infection. Genital warts are often transmitted by oral, anal and vaginal sexual contact. The transmission rate between partners is approximately 60%. Due to the high rate of transmission, lifelong genital wart incidence in sexually active individuals has approached 50%.

Risk factors for HPV transmission

  • Early sexual intercourse
  • Excess number of sexual partners
  • Unprotected sexual intercourse
  • History of sexually transmitted infections
  • Immune system deficiency

Can HPV be transmitted other than sexual intercourse?

HPV can be transmitted outside sexual contact. Although the most common form of transmission is sexual contact;

It can also be transmitted by contact with warts or warts in different areas of the person's body and by contact with the person or persons with HPV.

Prevention for HPV infection transmission

Polygamy is the most important risk factor for HPV transmission! 

Avoiding polygamy is an important factor in protection. Even if you are not polygamous, one of the spouses' previous exposure to HPV may also lead to HPV transmission. Although it does not prevent 100%, using a condom significantly reduces contamination. Vaccine is another method for the protection of HPV. One vaccine contains antigens only against the types of cancer (types 16 and 18) and the other against both the types of cancer and the types most known to cause warts (types 6 and 11). HPV vaccination is used for prophylactic purposes.

HPV vaccination

Since HPV vaccination is prophylactic, it is recommended to be given before the virus is encountered and sexual activity starts. It is appropriate to administer 3 doses (at 0, 2 and 6 months) to girls who have not started sexual activity between 11-28 years of age.

Treatment of oral warts

Surgical excision of the lesion, electrocauterization, cryotherapy, laser applications and silver nitrate can be used in the treatment. The complete treatment of HPV virus is still controversial. It can be found without any lesions in the mouth, making diagnosis and treatment difficult. The use of condoms during sexual intercourse alone is not enough. Vaccination is available for protection (the protection of the vaccine is not one hundred percent!). In the presence of uncontrolled sexual activity, oral sexual intercourse, multiple sexual partners, the frequency of transmission of HPV virus increases and such lesions may become more frequent.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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