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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Prevalence of both overall and high-risk oral HPV infection was markedly high in males than females.

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2. Concurrent oral and genital HPV infection as well as sexual behaviors such as number of sex partners suggest that genital-oral transmission may be taking place in these individuals.

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Evidence Rating Level: 4 (Below Average)

Study Rundown:

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Human papillomavirus (HPV) infection, which can lead to cancer, is common among both males and females. Oropharyngeal squamous cell carcinoma (OPSCC), which is more common in males, is the most common HPV-related cancer. Prophylactic HPV vaccination may protect against oral HPV infection. However, vaccination rates are low in males, and most people at risk of OPSCC may already have HPV exposure or are over 26 years old. Therefore, other OPSCC prevention strategies are needed for high-risk individuals, which makes HPV epidemiology and transmission data necessary. This study evaluated the prevalence of oral HPV infection and the relationship between oral and genital HPV infection in the U.S. population. Using a survey and polymerase chain reaction (PCR) data from oral rinse and penile or vaginal swab specimens, the authors studied adults from 18 to 69 years of age from the National Health and Nutritional Examination Survey (NHANES) from 2011 to 2014. Researchers found that the prevalence of high-risk oral HPV infection was markedly higher in males (7.3%) than females (1.4%). The prevalence of HPV 16, which is linked to an increased risk of OPSCC, was 6-fold higher in males than females. Prevalence of oral HPV infection was 4-fold higher among males with concurrent genital HPV infection than those without. The authors suggest that additional research should be focused on enhancing prevention and improving early detection for those at high risk of OPSCC.

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A strength of the study is use of data from NHANES, which is run by the National Center for Health Statistics of the Centers for Disease Control and Prevention. In addition, this study provides the most current national estimates for the prevalence of oral HPV infection in U.S. males and females. A limitation of the study is the self-reporting of sexual behavior data.

In-Depth [survey]:

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This study utilized questionnaires as well as PCR data (detecting 37 HPV types) from oral rinse and penile or vaginal swab specimens from adults 18 to 69 years of age from NHANES. Overall oral HPV infection prevalence in males and females was 11.5% and 3.2%, respectively. High-risk HPV infection was markedly higher in males (7.3%) than females (1.4%), which corresponds to approximately 7 million males and 1.4 million females. Oral HPV 16 was 6-fold higher in men (1.8%) than women (0.3%). Among males and females reporting same-sex partners, the high-risk HPV infection prevalence was 12.7% and 3.6%, respectively. Among males with ≥2 same-sex oral sex partners, high-risk HPV infection prevalence was 22.2%. Oral HPV prevalence was 4 times higher in males with concurrent genital HPV infection (19.3%) than in males without it (4.4%). Compared to females, males had a 5.4% higher predicted probability of infection with high-risk oral HPV. High-risk oral HPV infection had the highest predicted probability among participants who were black, those who smoked >20 cigarettes per day, those who currently used marijuana, and those who reported ≥16 vaginal or oral sex partners in their lifetime.

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