Oral HPV Prevalence Higher in Men With Concurrent Genital HPV

Oral human papillomavirus (HPV) prevalence is high among US men, according to research recently published in the Annals of Internal Medicine.¹ Given that HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men,² the findings from this study raise policy implications to guide future OPSCC prevention efforts.

Data obtained from the National Health and Nutrition Examination Survey (NHANES) conducted from 2011 to 2014 on men and women aged 18 to 69 years were used to determine HPV prevalence and concurrent oral and genital HPV infections.

Overall prevalence of oral HPV was 11.5% (95% CI, 9.8%-13.1%) in men and 3.2% (CI, 2.7%-3.8%) in women. Prevalence of high-risk oral HPV was also higher in men vs women (7.3% [6.0%-8.6%) vs 1.4% [CI, 1.0%-1.8%]). For men concurrently infected with genital HPV, the prevalence of oral HPV and high-risk HPV was 19.3% and 13.7%, respectively; this dropped to 4.4% and 3.9% without concurrent infection. In women, the prevalence of oral and high-risk HPV was increased 3-fold when genital infections were also present.

Oral HPV prevalence was especially high in men reporting many (>16) oral sex partners (29.8%), men who have sex with men (18.2%), and men with concurrent genital HPV infection (19.3%). Associations with oral HPV and demographic and behavioral risk factors were similar regardless of concurrent genital infection.

The results from this study confirm previous findings of a higher rate of oral HPV infection in both men and women, noted Patti E. Gravitt, PhD, from George Washington University in Washington, DC, in an editorial commentary.³ “A notable exception was found in the trend for increasing HPV infections with increasing age, which seems to be reversed in women without concurrent genital HPV infections,” she noted.

This study represents the largest current survey of HPV rates; however, the link between oral and genital HPV prevalence and the disproportionately higher risk of HPV-related OPSCC in men remains unclear. Future research such as type-specific concordance studies of oral and genital HPV is needed to assess the roles of co-transmission or auto-inoculation and to prioritize interventions among high-risk male populations.

Disclosures

Dr Chhatwal has received grants and personal fees from Merck and Gilead Sciences. Dr Wilkin has received grants from Gilead Sciences and Bristol-Myers Squibb and grants and personal fees from GlaxoSmithKline/ViiV Healthcare. Dr Sikora has received grants from Advaxis.

References

1. Sonawane K, Suk R, Chiao EY, et al. Oral human papillomavirus infection: differences in prevalence between sexes and concordance with genital human papillomavirus infection, NHANES 2011 to 2014 [published online October 17, 2017]. Ann Intern Med. doi: 10.7326/M17-1363
2. Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus-associated cancers – United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2016;65:661-666.
3. Gravitt PE. Unraveling the epidemiology of oral human papillomavirus infection [published online October 17, 2017]. Ann Intern Med. doi: 10.7326/M17-2628