Case Report Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, 2016; 2(4):244-247 244 The HPV connection – correlation of oral papillomas in husband and wife Juhi Hussain 1,* , Mohammad Iqbal 2 , Mohd. Abu Khan 3 , Satya Prakash Gupta 4 1,2 Senior Lecturer, 3,4 PG Student, 1 Dept. of Oral Medicine & Radiology, 2,3 Dept. of Conservative Dentistry & Endodontics, Rama Dental College Hospital & Research Centre, Kanpur, 4 Dept. of Oral & Maxillofacial Surgery, Chandra Dental College, Lucknow *Corresponding Author: Email: juhihussain@yahoo.com Abstract Literature analysis confirms the link between Human Papilloma Virus (HPV) and benign lesions of the oral cavity such as papillomas, condilomas and oral warts. Factors that contribute to increased HPV prevalence in the oral cavity are – reduction in host immune response for the virus, having more than one sexual partner and practice of oral sex. HPV diagnosis in the oral mucosa may be done by clinical examination of the lesion, family history, cytology and biopsy, however molecular biology allows detection of HPV DNA in cell, Polymerase Chain Reaction (PCR) being the most sensitive method for detection. We report two cases of HPV linked squamous papilloma in husband and wife on the same unusual site in the oral cavity (hard palate), contemplating saliva to be a possible mode of transmission as the patients had no genital lesions with emphasis on diagnostic methods, treatment, recurrence and complications of such lesions. Keywords: Human Papilloma Virus, Squamous Papilloma, Hard Palate, Polymerase Chain Reaction. Introduction Papillomatous and verrucous skin and genital lesions described since ancient Greece and Rome. In 1842, Italian physician Rigoni-Stern noted a high frequency of cervical cancer in married women, widows and prostitutes, but their rare occurrence in virgins and nuns. In 1983 & 1984, the first HPV types (HPV 16 and 18) were isolated from cancer biopsies of the cervix and were cloned. (1) Papilloma viruses are epitheliotropic viruses of which several types have been discovered so far. They are members of the Papillomavirus family and together with Polyomaviruses form the species Papovaviridae. (2) These types have been divided into two categories according to those causing mucosal/ genital lesions (40 types) and those causing non mucosal cutaneous lesions (60 types). The first category is further subdivided into high risk types- type 16, 18, 31 and 45 mainly causing anogenital cancers and its precursors and low risk types –type 6 and 11 mainly, causing benign genital and oral warts. Transmission occurs from the following routes- Skin-to-skin contact with an infected individual, from vaginal, oral, or anal sexual contact, and can occur whether or not warts or other symptoms are present, vertical transmission, nonsexual routes. (3) Squamous papilloma is an exophytic growth of the oral cavity commonly occurring between age 30 and 50 years. It is divided into two types: Isolated-solitary and multiple-recurring, the former being confined to an adult's oral cavity. Although tongue is the most prone area, it can also occur on the palate, buccal mucosa, gums, lips, tonsils and uvula. (4) It is mainly caused by HPV types 6 and 11. (5) The following case reports are of a couple who had identical growths on their hard palate provisionally diagnosed as Squamous Papilloma. Case Reports Case 1 A 32 year old female reported with the chief complaint of a growth in the palate region since 6 months. The growth had been gradually increasing in size and caused discomfort during eating. She gave a history that her husband also had a similar growth on his palate. On intra-oral examination, a solitary growth was present on the posterior hard palate, towards the right of the midline. Growth was roughly ovoid in shape, approximately 2 cm in diameter, pink in color with a lobulated surface giving a cauliflower like appearance. On palpation, it was pedunculated in nature, soft and firm in consistency and non tender to touch. (Fig. 1) Fig. 1: Intraoral Clinical Appearance (Case 1)