Oral Human Papillomavirus (HPV) Infection among Unvaccinated High-Risk Young Adults

Abstract

Oral HPV infection, the cause of most oropharyngeal cancer in the U.S., is not well studied among high-risk young adults. Men (n = 340) and women (n = 270) aged 18–25 years attending Baltimore County STD clinics were recruited if they declined HPV vaccination. Each participant had a 30-second oral rinse and gargle sample tested for 37 types of HPV DNA, and a risk-factor survey. Factors associated with prevalent infection were explored using log binomial regression. Men had higher prevalence of any oral HPV (15.3% vs. 7.8%, p = 0.004) and vaccine-type oral HPV (i.e., HPV16/18/6/11: 5.0% vs. 1.1%, p = 0.007) infection than women. In multivariate analysis, male gender (aPR = 1.93, 95% CI = 1.10–3.39), number of recent oral sex partners (p-trend = 0.013) and having ever performed oral sex on a woman (aPR = 1.73, 95% CI = 1.06–2.82) were associated with increased oral HPV prevalence. Performing oral sex on a woman may confer higher risk of oral HPV acquisition than performing oral sex on a man.

Prevalence and risk factors for HPV infection in normal oral mucosa of Chilean dentistry students.

“…This can be attributed to the fact that the patients they studied may have had some type of sexually transmitted disease. Regarding smoking and alcohol consumption, it can be clearly seen that alcohol is more prevalent than smoking, finding that coincides with those of D'Souza et al 7 The effects of smoking and alcohol on HPV in the oral mucosa remains unclear. On the one hand, stimulation of the harmful elements would cause a thickening of the oral mucosa and eventually increased keratinization of it 14 , preventing a potential HPV infection in the basal layer of the oral epithelium.…”

“…Sanchez et al 18 and D'Souza et al 7 reported similarly high rates regarding sexual habits. However, unlike our study, they found a high prevalence of HPV in the oral mucosa in both sexes.…”

“…In general, the presence of HPV in the oral mucosa, associated or not with clinical lesions, has been favored by the presence of predisposing risk factors that facilitate its spread. These are mainly: sexual habits, family history of cancer, use of immunosuppressive drugs, smoking and alcohol consumption [4][5][6][7][8] .…”

Oral sex and human papilloma virus-related head and neck squamous cell cancer: a review of the literature

“…A population-based study in the USA reported a higher prevalence of oral HPV infection in men compared with women (10.1% (95% CI 8.3 to 12.3) vs. 3.6% (95% CI 2.6 to 5.0), respectively, p<0.001) 46. Another study showed that men had a higher prevalence of oral HPV infection and suggested that cunnilingus may confer a higher risk of acquiring oral HPV infection than fellatio 17. Studies have shown an increased incidence of HPV-related HNSCC in men as compared with women, but the reasons are unclear 10 17 19 20 35 43 45.…”

“…In fact, there is little awareness among health professional regarding HPV infection and its role in HNSCC. Patients also lack information concerning the risks associated with HPV infection 17. The aim of this review of the literature is to determine whether there is strong evidence to correlate oral sex with HNSCC, thus suggesting patients should be counselled regarding sexual behaviour.…”