Among sexually active adolescent girls, oral human papillomavirus (HPV) infection is not uncommon, but is significantly lower among those who have received an HPV vaccination, according to a study published in JAMA Network Open.

This longitudinal cohort study included 1259 sexually active adolescent girls in New York City, all of whom gave oral rinse samples between 2007 and 2017. Participants’ age ranged from 13 to 21 years, with a median age of 18 years. Participants were either planning to receive the quadrivalent HPV vaccine or had already received it. Follow-up appointments occurred every 6 months until age 25 years and included oral, vaginal, and anal samples that were analyzed for HPV. The primary outcome was presence of HPV in the oral cavity. Frequency distributions were used to assess study cohort characteristics. Associations with oral HPV were examined using logistic regression, with adjustments made for age. Logistic regression models were also used to examine the relationship between oral HPV and sexual risk behaviors. 

Among the 1259 participants, 6.2% (95% CI, 4.9%-7.7%; n=78) were found to have oral HPV at baseline; 1.7% (95% CI, 1.0%-2.5%; n=21) were found to have oncogenic oral HPV, and 0.2% (95% CI, 0.3%-1.3%; n=8) were found to have quadrivalent HPV vaccine types. Oral HPV was most common among participants aged 16 years (10.5% for all types; 3.9% for oncogenic types). Oral HPV rates were lower among those with greater time since initiation of sexual activities, with an odds ratio of 0.45 (95% CI, 0.21-0.96) for those who had initiated sexual activity ≥4 years vs ≤1 year prior to testing (P =.03). Multivariable logistic regression revealed an 83% lower prevalence of quadrivalent HPV types among vaccinated participants compare with those who were unvaccinated (odds ratio 0.17; 95% CI, 0.04-0.68). After adjusting for concurrent cervical quadrivalent HPV types, the odds ratio was 0.20 (95% CI, 0.04-1.00). 

Limitations to this study included an earlier start to sexual activity and a larger median number of sexual partners compared with participants in previous study cohorts, a higher presentation of oncogenic HPV types, and inability to assess correlations with individual HPV types.


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Researchers noted that the results obtained with this study were consistent with previous studies in finding that any sexual activity, not just oral sex, may be associated with oral HPV detection. In contrast with previous studies, however, there was no observation of an association between the likelihood of HPV detection in the oral cavity and number of oral sex partners, vaginal sex partners, or both. The study investigators concluded that, although not uncommon, the detection of HPV “decreases with age and time since the initiation of sexual activity” in sexually active adolescent women. However, the study researchers “observed a significant vaccination benefit reflected by the lower prevalence of [quadrivalent HPV] vaccine types,” suggesting that “concurrent detection of an HPV infection in the cervix may be a risk factor for detection of HPV in the oral cavity.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Schlecht NF, Masika M, Diaz A, et al. Risk of oral human papillomavirus infection among sexually active female adolescents receiving the quadrivalent vaccine [published online October 25, 2019]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2019.14031