First to reiterate, there are no visible HPV lesions. There are cascade lesions like precancerous tissue changes, those are something more now than HPV. So there is nothing to see to tell you it’s there. Testing is a blind superficial swab or a more effective brush cytology cell collection commonly used in cervical. Bush cytology works very well in cervical, and since its introduction in the early 1950s is responsible for the dramatic drop in the death rate from cervical cancer. It is also a blind collection of cells, and as it is an abrasive collection of cells, it is nothing like swab collection. The idea works in cervical because it’s a relatively small area, unlike the oropharynx which is a huge amount of territory to scrape cells from, especially for a cancer that is not on the superficial tissues.,.

Abrasive brush collection of cells and then the following pathology to look at them under a microscope has many positives. It’s inexpensive, it collects a large number of cells from a specific area, so the pathologist has a decent sampling for a screening exam, but not as much information as from a real incisional or punch biopsy. A company tried to market brush cytology to the dental community for several years as an alternative to conventional biopsy, but failed. Part of their logic was that since general dentists are disinclined to do biopsies (ugh blood, eek), they might do this instead on visible lesions and catch early precancers that were visible but undefined as to what they actually were. But pathologists found the samples too small, and worse there was no cellular architecture, the layers of cells in proper positions from the outer epithelium down to the basal layer. Instead of nicely structured layers of cells like a punch or incisional biopsy, you got scrabbled eggs. Cells from all strata of tissue out of relationship to each other. Not as useful or definitive.

So other collection ideas were tried like gargling in the back of your throat with saline, but again while it dislodged some cells, who knows from where any suspicious cell came from. Add to that oropharynx cancers in the tonsil for instance, are within the tonsil not on the surface, so not visible, or collectible,or in the tonsilar crypts which are folds of tissues and again nothing early in there is easily accessible or visible.

From all this you can see that not being visible, and not being sampled easily is the problem with early discovery outside the cervix.

The vaccine is systemic. Non vaccinated people need to get the infection in each individual site, and can get them at different times in their lives depending on exposure. But they are seldom synchronous cancers. If you had and cleared a cervical HPV infection, the odds are very much in your favor that exposed elsewhere you would also clear those as well.

In oropharynx cancers version 16 is almost always the culprit. In determining oropharynx etiology (viral or something else) there, the p16 test is often used because it’s the most likely to cause those cancers. In the cervical areas it is a major player but so are a few other versions, most never found in oral. As stated earlier, no visible lesions means no easy detection. Oropharynx cancers are usually found late as a neck node metastasis, which Is hard to miss.