Warts on the Tongue: Types, Causes, and Treatment (2024)

Warts are small, fleshy skin growths that can form on your skin or mucous membranes, especially on your mouth, anus, and genitals. They are caused by human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States. Nearly all sexually active men and women contract HPV at some point in their lives.

HPV warts on your tongue are contagious, so they easily spread from person to person. Knowing how this occurs can help reduce your risk of getting them or spreading them if you are infected.

In most cases, HPV occurs without symptoms and resolves without your knowledge. When symptoms occur on your tongue, the warts appear as raised, fluid-filled structures. Though treatment isn't always needed, it can take years for HPV oral warts to resolve on their own.

This article describes warts on the tongue types, causes, and treatments. It also explains how to reduce your risk of spreading them or being infected.

Types of Warts on the Tongue

Since about 40 strains of HPV can cause oral warts on your tongue, the virus can manifest in many different types of bumps on your tongue. Oral HPV symptoms include these common types of HPV bumps on the back of your tongue:

Verruca Vulgaris (Common Wart)

Verruca vulgaris occurs from HPV strains 2 and 4. It is the main presentation of HPV infection, accounting for 70% of warts. Verruca vulgaris on your tongue can appear with the following characteristics:

• Well-defined in shape
• Less than 1 centimeter (cm) in diameter
• Stalkless and attached at the base of the lesion (sessile)
• Usually solitary in location
• White or pink, though lighter than the surrounding tissue
• Wartlike growth pattern
• Prominent hairlike projections
  

Squamous Papilloma

Squamous papilloma occurs from HPV strains 6 and 11. A squamous papilloma on your tongue has the following characteristics:

• Typically less than 1 cm in diameter
• Cauliflower-like surface
• Numerous tiny sharp or blunted fingerlike projections
• White to pink/red color
• Attached to the tongue by a stalk or stem (pedunculated)
• Also likely on your tonsils, gums, palate, pharynx, epiglottis, and other areas

Condyloma Acuminata

Condyloma acuminata is associated with HPV strains 2, 6, and 11. While it usually presents as anogenital warts, it can occur on your tongue with the following characteristics:

• Growth as a solitary lesion or in multiples, some of which may join to form larger growth
• Usually attached to the base of the lesion without a stalk, though a stalk can occur
• Cauliflower-like surface
• Pink to white color
• Commonly located on the tongue and upper lip when the mouth is affected

Multifocal Epithelial Hyperplasia

This type of lesion commonly occurs from HPV strains 13 and 32. Also called focal epithelial hyperplasia or Heck's disease, multifocal epithelial hyperplasia has the following characteristics:

• More common in children age 3 to 18 years, especially among Navajo Nation and Alaska Native populations
• Significantly more common among females
• Located on the back of the tongue
• Multiple lesions, ranging in size from 1 millimeter (mm) to 1 cm, may be joined
• Multiple lesions in various sites of the tongue and gingiva (gums)
• White or pink papules on the tongue and gingiva
• Usually stalkless and attached to the base of the lesion
  

Causes of Warts on the Tongue

There are multiple pathways for HPV transmission leading to warts on your tongue. Warts on your tongue can occur in the following ways:

Inter-Site Transmission Between Individuals

The genito-oral (genitals to mouth) method of transmission is the most frequent mode of HPV oral infection. This pathway of transmission includes:

• Oral sex
• Anal sex
  
• Indirect transmission through oral contact with virus-infected hands or fingernails
• Mouth-to-mouth transmission through deep kissing

Autoinoculation

Autoinoculation involves removing the cells from one area of your body and then placing them back into your body. This can occur with a transfer of HPV from genital or anal sites through intermediate contact with the hands, then transferring the virus from your hands to your mouth.

Perinatal

Perinatal transmission of oral HPV frequently occurs from an infected mother to her infant during delivery. HPV infection can be acquired in utero via the placenta or umbilical cord blood. It can also occur immediately after birth through skin-to-skin contact or breast milk.

You have a greater chance of developing warts on your tongue if you have any of the following risk factors:

• A higher number of sexual partners
• Smoking
• Break in the skin or mucous membrane
• A weakened immune system
• Excessive alcohol consumption
  

How to Treat Warts on the Tongue and Prevent Further Irritation

Warts on the tongue typically resolve without the need for medical attention. However, allowing them to clear on their own can take up to 2 years.

For most people, this means enduring a relatively unpleasant experience while talking and eating as long as the wart exists. While there is no treatment to cure HPV warts, several treatments can safely relieve symptoms and complications.

Consult your dentist or healthcare provider regarding the use of home treatments to try. Home and over-the-counter topical treatments for skin warts may not be appropriate for treating tongue warts.

Depending on the type and location of warts on your tongue, you may benefit from one of the following treatments:

Cryotherapy

Cryosurgery involves the application of an extremely cold substance, such as liquid nitrogen or carbon dioxide, to freeze off the abnormal cells and kill abnormal tissue growth. The benefits of this safe and relatively inexpensive technique include:

• Relative lack of discomfort and pain
• Absence of bleeding
• Minimal to no scarring
• Easy application
• Preservation surrounding bone structures
• Very low incidence of infection
• Useful for candidates for whom surgery is contraindicated due to medical history or age

However, cryosurgery treatment for oral warts can result in an unpredictable degree of swelling. The success of the treatment is also highly dependent on an operator's skill and experience.

Surgery

Surgical removal of an oral tongue wart is the treatment of choice. This can be done with one of the following techniques:

Electrocautery

Electrocautery involves using a low-voltage electrical probe to cut through the wart and eliminate abnormal cells or tissue growth. The procedure burns off the wart to remove it. Electrocautery is typically used for small and isolated oral warts.

Laser-Assisted Therapy

Laser-assisted therapy involves using a concentrated diode laser to completely excise the wart. This involves the removal of the base of the wart and a small area of normal tissue surrounding it. Benefits of laser-assisted therapy include:

• Excellent hemostasis (ability to stop bleeding)
• High precision in tissue destruction
• No need for sutures
• Minimal postoperative pain
• Lack of edema (swelling)
• Rapid wound healing

Surgical Excision

HPV tongue warts can be removed with traditional surgical techniques. The procedure can involve general anesthesia. Traditional surgical excision may require a stitch or two to close the incision though its primary benefit is a low recurrence rate.

Trichloroacetic Acid

Trichloroacetic acid is effective for treating HPV bumps on your tongue. Three 30- to 60-second applications can remove oral warts within 45 days. Advantages of this treatment include:

• Can be a better option for widespread lesions
• Avoids potential side effects and complications of surgical options

Imiquimod

While Aldara (imiquimod) cream, a synthetic imidazoquinoline amide derivative, is often used as a treatment for external warts. Researchers have found this topical cream effective and well-tolerated for oral HPV warts. Advantages of imiquimod include:

• Self-administered treatment
• Ease of application
• Cost-effective means of maintenance therapy
• Avoidance of adverse effects possible with surgical intervention
  

How to Reduce the Risk of Transmitting Oral HPV

HPV can exist without symptoms. This means the disease can be spread even when an infected person has no signs of illness.

One of the best ways to reduce the risk of transmitting oral HPV is to get an HPV vaccine. Research indicates that the vaccine is highly effective in preventing cervical, anal, and genital HPV infections, warts, and cancers as well as the incidence of oral HPV infections.

The National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC) advises the following regarding the HPV vaccine:

• Initiation of the HPV vaccine is advised for all children at age 11 or 12 years, with two doses at least six months apart and completion of the two-dose series before the 13th birthday.
• It is appropriate to safely start the vaccine in children as young as 9 years old if preferred or if a child is at risk of HPV exposure due to suspected abuse.
• HPV vaccination is advised for all people age 13 through 26 years who have not been previously vaccinated or who have not completed the vaccination series.
• HPV vaccination is recommended for some adults age 27 through 45, based on shared decision-making with a healthcare provider.

Another way to prevent HPV is to avoid having sexual contact with another person. If you do have sexual contact, you can reduce your risk of transmitting or getting oral HPV with the following strategies:

• Use an external (male) condom,internal (female) condom, finger cot, or dental dam with all sexual partners in every sexual encounter. (A finger cot is a finger condom or finger glove. A dental dam is a small, thin piece of latex that can be used as a barrier between the mouth and the vagin* or anus during oral sex).
• Ensure that you and your partner are tested for HPV and all STIs. Discuss the results with each other before having sex.
• Talk to your partner about the number of partners they have had in the past. The fewer partners your partner has had, the less likely they are to have HPV.
• Strive to be monogamous and ask your partner to do the same. Having sex with just one partner and no one else after STI testing lowers your risk of HPV and all STIs.
• Do not douche. vagin*l douching can increase your risk of getting STIs because it removes some of the normal vagin*l bacteria that protect you from infection.
• Do not abuse alcohol or drugs. Alcohol and drug misuse increases risky behavior, which may make you more susceptible to sexual assault and possible exposure to any STI.

You can also reduce your risk of HPV transmission and infection by maintaining good oral health behaviors. These include:

• Visit your dentist twice annually for routine cleanings and oral examinations to identify signs of HPV, other STIs, and oral cancers.
• Practice twice-daily toothbrushing and daily dental flossing.
• Use daily toothbrushing sessions to look for changes in your mouth and throat so you can contact your healthcare provider as soon as possible if you notice anything suspicious.
  

Summary

Warts on your tongue are a common problem. They usually occur from HPV. These highly contagious warts are most often spread from oral or anal sex involving oral-genital interaction. Practicing safe sex, including regular condom use, can help avoid the spread of HPV.

Warts on your tongue can occur without symptoms and resolve without treatment. However, letting the warts run their course can mean years of discomfort that can affect how you speak and eat. While treating tongue warts does not destroy the virus, it can relieve symptoms of pain and discomfort.

Consult your dentist or healthcare provider for a proper diagnosis of any unusual bumps or lesions that you notice in your mouth. HPV warts can increase your risk of several oral cancers even if your warts don't have symptoms. Seeking an early and accurate diagnosis of tongue warts can help you get treated as soon as possible.