Differences in Oral Sexual Behaviors by Gender, Age, and Race Explain Observed Differences in Prevalence of Oral Human Papillomavirus Infection

Abstract

PurposeThis study explores whether gender, age and race differences in oral sexual behavior account for the demographic distribution of oral human papillomavirus infection (HPV) and HPV-positive oropharyngeal cancer (HPV-OSCC)MethodsThis analysis included 2,116 men and 2,140 women from NHANES (2009–10) who answered a behavioral questionnaire and provided an oral-rinse sample for HPV detection. Weighted prevalence estimates and prevalence ratios (PR) were calculated for sexual behaviors and oral HPV infection by gender, age-cohort (20–29, 30–44, 45–59, 60–69), and race, and contrasted with incidence rate ratios (IRR) of OSCC from SEER 2009. Multivariate logistic regression was used to evaluate predictors of oral sexual behavior and oral HPV16 infection.ResultsDifferences in oral sexual behavior were observed by gender, age-cohort and race. Most men (85.4%) and women (83.2%) had ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence than women (each p<0.001). 60–69 year olds (yo) were less likely than 45–59 or 30–44 (yo) to have performed oral sex (72.7%, 84.8%, and 90.3%, p<0.001), although oral HPV16 prevalence was similar. Prevalence ratios (PR) of ever oral sex in men vs. women (PR = 1.03), and 45–59 vs. 30–44 year-old men (PR = 0.96) were modest relative to ratios for oral HPV16 infection (PRs = 1.3–6.8) and OSCC (IRR = 4.7–8.1). In multivariate analysis, gender, age-cohort, and race were significant predictors of oral sexual behavior. Oral sexual behavior was the primary predictor of oral HPV16 infection; once this behavior was adjusted for, age-cohort and race were no longer associated with oral HPV16.ConclusionThere are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups.

Morbidity, mortality and cost from HPV-related oropharyngeal cancer: Impact of 2-, 4- and 9-valent vaccines

“…9,10 In addition, epidemiologic studies have suggested a trend of increasing oral sex partners in younger cohorts, which may increase OPSCC incidence in the future. 11 However, even saviolum-commonly known as 'French kissing'-can serve as a vector of HPV transmission. 12 …”

The Growing Epidemic of HPV-Positive Oropharyngeal Carcinoma: A Clinical Review for Primary Care Providers

“…The odds of HPVϩ OPSCC increase significantly with the lifetime number of oral sex partners (P trend ϭ 0.011), with a univariate OR of 5.7 (95% CI, 1.9 -13.7) for individuals with 6 to 15 lifetime oral sex partners. 9 In fact, D'Souza et al 10 found that the age-and race-related differences in the prevalence of oral HPV-16 infection-and likely HPVϩ OPSCC, since HPV-16 is responsible for the vast majority of cases-can be explained based on differences in oral sexual behaviors. They found that neither white race nor younger age were independently associated with oral HPV-16 once they adjusted for oral sexual behavior.…”

“…They found that neither white race nor younger age were independently associated with oral HPV-16 once they adjusted for oral sexual behavior. 10 Younger populations are more likely to engage in oral sex, and this seems to be the driving force for the epidemic increase that has occurred.…”

The Rise of HPV-Positive Oropharyngeal Cancers in the United States

“…There are differences in sexual practices by race. Whites are significantly more likely than blacks to report earlier oral sex and greater number of lifetime sexual partners (11). Although differences in sexual behavior (and tobacco use) may in part explain the epidemiologic differences in HPV-OPC, they remain disproportionate to the racial differences in incidence of HPV-OPC.…”

“…Although differences in sexual behavior (and tobacco use) may in part explain the epidemiologic differences in HPV-OPC, they remain disproportionate to the racial differences in incidence of HPV-OPC. For example, white men are 147% more likely to have performed oral sex at the time of sexual debut, yet the incidence of oropharyngeal cancer is only 20% higher among white men as compared with black men in the United States (11). Given that the majority of individuals are exposed to HPV, improved understanding of cofactors will likely elucidate the racial and geographic differences in cancer incidence after largely similar exposures.…”