TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.
High-risk human papillomavirus (HPV) is responsible for the growing incidence of oropharyngeal cancer (OPC) in the United States. Oral HPV infection is the putative precursor to HPV-related OPC (HPV-OPC), and is acquired through oral sexual contact. Oral HPV infection is relatively uncommon. The prevalence of HPV16 in the United States, which is responsible for >90% of HPV-OPCs, is 1%, whereas the prevalence of all high-risk (cancer causing) HPV types is 4%, and that of any HPV (including low-risk) is 7.3%. These rates are higher among men, smokers (of tobacco or marijuana), and individuals who report higher numbers of sexual partners. In comparison, the prevalence of genital infection is 23% for high-risk HPV and 42.5% for any HPV. Although the details of the progression from oral HPV infection to cancer are not fully understood, it is clear from studies thus far that most infections clear spontaneously within six to 18 months, whereas a small subset persist. Based upon available data, it appears that it takes at least a decade for a persistent infection to transform into malignancy.
There is some evidence that oral HPV infection can be acquired through open-mouth kissing (deep or French kissing). Patients in the both the general (noncancer) and HPV-OPC populations may enquire whether they should avoid open-mouth kissing to prevent either acquiring or transmitting oral HPV infection. This best practice guideline is intended to assist physicians in advising patients regarding open-mouth kissing practices; that is, to kiss or not to kiss.
Open-mouth kissing is associated with oral HPV infection transmission based on limited evidence available thus far. However, considering the relative rarity of high-risk oral HPV infection, and the apparent infrequency with which infections transform to malignancy, physicians should not advise patients to avoid open-mouth kissing beyond usual safe sex practices. Regarding the special case of HPV-OPC patients, although their partners may have a slightly increased exposure to oral HPV infection, there is no evidence that this is due to transmission of tumor-associated HPV DNA rather than to a history of shared exposures. Although HPV-OPC patients and their partners should adhere to established HPV-related anogenital cancer screening guidelines, there is not enough evidence at this time to recommend that they change their kissing practice (Laryngoscope. 2019;129:4–5).