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Oral human papillomavirus infection can appear in many different ways, from subtle changes in the tissue to more noticeable lesions that may cause discomfort or affect a person’s appearance. Understanding what it looks like, how it is identified and managed, and how it differs from other oral conditions such as thrush helps patients make informed decisions about their health.



What does oral HPV look like in the mouth?

When human papillomavirus infects the oral cavity, the most common visible manifestation is a painless white or flesh-colored lesion on the tongue, inside of the cheek, floor of the mouth, tonsils, or palate. These lesions are often flat and may have a slightly rough surface; they can be single or multiple in number. In some cases, the virus causes small papillary growths that resemble cauliflower (this is called oral warts) and these may appear as clusters on the tongue or along the gum line. Because many people with oral HPV do not experience any symptoms at all, the infection can remain undetected until a routine dental check-up reveals an abnormal area. When symptoms do occur, they may include mild soreness, a burning sensation in the mouth, or a feeling of something stuck on the tongue. In rare cases, persistent lesions can grow larger and cause difficulty swallowing or changes in speech.



The diagnosis of oral HPV typically involves visual inspection by a dentist or physician, followed by a biopsy if a lesion appears suspicious for malignancy. The tissue sample is examined under a microscope, and polymerase chain reaction testing may be performed to identify specific high-risk HPV types such as 16 or 18. Once the virus has been confirmed, treatment options vary depending on the size and location of the lesions. Small, asymptomatic warts can often be left alone because many resolve spontaneously; however, for persistent lesions that interfere with function or raise concern for dysplasia, options include topical agents like imiquimod, cryotherapy to freeze the tissue, laser ablation, surgical excision, or photodynamic therapy. For high-risk HPV infections that show cellular changes suggestive of early cancer, more extensive monitoring and possibly partial removal of the affected oral mucosa may be recommended.



What is oral HPV?

Human papillomavirus is a group of DNA viruses that infect skin and mucous membranes throughout the body. While certain strains are known for causing genital warts or cervical cancer, other high-risk types can infect the mouth and throat. Oral HPV infection is most commonly spread through close contact such as kissing or oral sex. In many adults, the immune system clears the virus within a few months to two years, resulting in no lasting disease. However, when clearance does not occur, persistent infection may lead to cellular changes that, over time, can develop into squamous cell carcinoma of the head and neck region. Because symptoms are often minimal, routine screening and awareness among healthcare providers are essential for early detection.



Oral thrush

Oral thrush is a fungal infection caused by Candida species, most commonly Candida albicans, rather than a viral pathogen like HPV. It presents as white curd-like patches on the tongue, inner cheeks, palate, or gums that may be scraped off to reveal a red base and sometimes bleeding. Unlike the usually painless lesions of oral HPV, thrush often causes soreness, burning, or a metallic taste in the mouth. Risk factors for thrush include weakened immune function, recent antibiotic use, dentures, diabetes, or steroid inhalers. Treatment typically involves antifungal medications such as nystatin suspension, clotrimazole lozenges, or fluconazole tablets, depending on severity and patient tolerance.



Although both oral HPV lesions and thrush can coexist in the same individual, they are distinct conditions with different causes, clinical appearances, and management strategies. Recognizing the subtle differences—such as the texture of a lesion, whether it bleeds upon touch, and the presence or absence of pain—helps clinicians choose appropriate diagnostic tests and treatment plans. Regular dental examinations, open communication about sexual health practices, and prompt evaluation of any oral changes are key steps in preventing complications from both viral and fungal infections of the mouth.