The prevalence of oral human papillomavirus is nearly three times higher in men than in women, according to data from more than 5,000 individuals in the United States.
The findings were simultaneously published online in JAMA and presented at the Multidisciplinary Head and Neck Cancer Symposium in Phoenix on Jan. 26 (JAMA 2012;307: [doi: 10.1001/jama.2012/101]).
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Dr. Maura Gillison
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Oral HPV infection causes a subset of oropharyngeal squamous cell carcinoma (OSCC) that has increased in several countries, including the United States, over the past 3 decades, said Dr. Maura L. Gillison of the Ohio State University, Columbus, and her colleagues. "HPV has been directly implicated as the underlying cause," they noted. However, the epidemiology of OSCC has not been well studied.
The researchers conducted a cross-sectional study of HPV infection as part the National Health and Nutrition Examination Survey (NHANES) for 2009-2010. The study population included 5,579 men and women aged 14-69 years who were tested for HPV at mobile centers.
Overall, the prevalence of any HPV infection was 6.9%, and the prevalence of HPV type 16 (the type associated with OSCC) was 1%. The prevalence of any HPV infection was significantly higher in men than in women (10.1% vs. 3.6%, P less than .001). The peak prevalence of oral HPV occurred in people aged 30-34 years (7.3%) and 60-64 years (11.4%).
Infection in either gender was significantly more common in those with a history of any sexual contact (7.5%), compared with those who had no history of sexual contact (0.9%). The risk of infection also increased significantly as the number of sex partners for any type of sex increased. "One in five individuals with more than 20 lifetime sexual partners was infected," the researchers said.
Univariate associations between risk of oral HPV infection and alcohol and marijuana use did not remain significant in a multivariate analysis. However, cigarette smoking remained independently associated with an increased risk of oral HPV infection. The risk significantly increased with the number of cigarettes smoked daily for both men and women, but this trend was stronger in women.
In a multivariate analysis, age, gender, number of sexual partners, and number of cigarettes smoked daily remained independently associated with an increased risk of oral HPV infection.
"Our data provide evidence that oral HPV infection is predominantly sexually transmitted," the researchers said. Although HPV-positive OSCC has been associated with oral sex in particular, this study could not associate infection with a particular sexual behavior, they added.
The findings were limited by the emphasis on Alpha-papillomaviruses only, which likely underestimates the prevalence of oral HPV infection, the researchers said. But the findings suggest that vaccine trials to test the efficacy of the current HPV vaccine against oral HPV may be warranted. "Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men," they said.
For Cancer Prevention, Use Protection"Human papillomavirus–positive oropharyngeal tumors are increasing in incidence and exceed the number of tumors caused by the more traditional risk factors of tobacco and alcohol abuse," said Dr. Hans P. Schlecht in an editorial accompanying Dr. Gillison’s study (JAMA 2012 [doi: 10.1001/jama.2012.117]). The findings are noteworthy because they estimate oral HPV prevalence based on sexual experience, smoking history, and immune suppression, he said. In addition, the researchers found that HIV-negative individuals had lower rates of HPV infection of the mouth than at other sites, he said.
Additional research is needed to study how HPV-related oropharyngeal dysplastic lesions develop, said Dr. Schlecht. But "there is meaningful hope that prevention efforts will ameliorate the effects of HPV-related oropharyngeal cancer," he said.
Although HPV vaccination may eventually play a role in reducing cancers related to oral HPV infection, such an impact will take time, Dr. Schlecht noted. Meanwhile, "clinicians should encourage their patients who engage in oral sex to use barrier protection," he said. In addition, clinicians should be alert to signs of oropharyngeal cancer, including problems with speech or swallowing, ear pain, neck masses, and unexplained weight loss, he said.
Dr. Schlecht is affiliated with the division of infectious diseases and HIV medicine at Drexel University in Philadelphia. He reported no conflicts of interest.
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