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

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.