# Diagnostic challenges and clinical management gaps in HPV-related oral lesions

## TL;DR

This paper discusses the challenges in diagnosing and managing HPV-related oral lesions, especially in people with HIV, and highlights the need for better treatment and prevention strategies.

## Contribution

The paper identifies diagnostic and treatment gaps in managing HPV-related oral lesions and emphasizes the role of HPV vaccination.

## Key findings

- HPV-related oral lesions are challenging to diagnose due to overlapping clinical and histological features.
- Topical treatments for HPV-OL lack safety evidence for oral use, making surgery the primary option.
- HPV vaccination may help reduce both low- and high-risk HPV infections and related diseases.

## Abstract

The oral mucosa, the gingiva, and the salivary glands are effective reservoirs for HPV. Although HPV-related oral lesions (HPV-OL) have been described since ancient times, their diagnosis and management remain challenging, particularly in people living with HIV. In the oral mucosa, HPV can establish productive or latent infections in basal epithelial cells following microabrasion, resulting in four HPV-OL: squamous papilloma, verruca vulgaris, condyloma acuminatum, and multifocal epithelial hyperplasia, each with characteristic clinical and histological features, though overlapping patterns often complicate diagnosis. While there is strong evidence indicating that HPV can be transmitted through routes other than sexual, misconceptions about sexual transmission and the potential for malignancy continue to persist. Regarding treatment, topical drugs initially designed for the skin or anogenital mucosa lack evidence of safety for the oral mucosa; thus, conservative surgical excision remains the main option. HPV vaccination may contribute to reducing both low- and high-risk HPV infections, with potential impact on related diseases.