October 16, 2017
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Oral HPV affects 1 in 9 men in US

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The prevalence of oral HPV infection was higher among men than women in the United States, with approximately 11 million men and 3.2 million women affected nationwide, according to recent data published in Annals of Internal Medicine.

“Recent evidence shows that prophylactic HPV vaccination seems to protect against infection with vaccine-covered oral HPV subtypes and thus holds promise for reversing the rising [oropharyngeal squamous cell carcinoma (OPSCC)] incidence among men in the long term; however, the low uptake rate of the vaccine among boys remains a concern. ... Epidemiologic studies on oral HPV infection are needed to guide the design and development of alternative OPSCC prevention strategies targeted toward persons at high risk,” Kalyani Sonawane, PhD, of the department of health services research at the University of Florida, Gainesville, and colleagues wrote.

Researchers sought to determine the population-based prevalence and risk factors of oral HPV infection, and to characterize the concordance of oral and genital HPV infection among men and women in the United States. They evaluated oral rinse, penile swab and vaginal swab specimens from adults aged 18 to 69 years enrolled in the National Health and Nutrition Examination Survey from 2011 to 2014.

Analysis revealed an overall oral HPV infection prevalence of 11.5% (95% CI, 9.8-13.1) in men and 3.2% (CI, 2.7-3.8) in women, which equated to 11 million men and 3.2 million women in the United States. High-risk oral HPV infection (HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73 and 82) was also more common among men (7.3%; 95% CI, 6-8.6) compared with women (1.4%; 95% CI, 1-1.8). Compared with women, men had a 5.4% (CI, 5.1-5.8) greater predicted probability of high-risk oral HPV infection.

The researchers also observed that 1.7 million men and 0.27 million women had oral HPV 16, an oncogenic HPV type known to contribute to increased risk for OPSCC; as a result, oral HPV 16 was six times more common in men (1.8%; 95% CI, 1.3-2.2) than in women (0.3%; 95 % CI, 0.1-0.5).

The prevalence of high-risk HPV infection was 12.7% (95% CI, 7-18.4) among men and 3.6% (95% CI, 1.4-5.9) among women with same-sex partners, and was 22.2% (95% CI, 9.6-34.8) among men with two or more same-sex oral sex partners. Oral HPV prevalence among men with concurrent genital HPV infection was four times greater than among those without it.

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“Our study provides the latest national estimates of oral HPV infection prevalence among men and women in the United States. ... Future research needs to be prioritized to improve targeted prevention and advances in screening and early detection procedures to combat oropharyngeal cancer in this high-risk group,” Sonawane and colleges wrote.

In a related commentary, Patti E. Gravitt, PhD, MS, from George Washington University, Washington, D.C., wrote that further research is necessary to determine the best prevention strategies to target oral HPV infection and associated types of oral cancer. Future study should also specifically work to identify the effectiveness of vaccination in older people, an area that remains unclear.

“Effectiveness will depend on both the population-attributable fraction of prevalent oral HPV at older ages due to recent acquisition and the ability of vaccination to limit or prevent autoinoculation or reactivation,” Gravitt wrote. “Estimation of these variables is critical for responsible, evidence-based policy development and will be best derived from study designs anchored on a conceptual model of the inter- and intraindividual dynamics of HPV infection over the lifespan.” – by Savannah Demko

Disclosures: Gravitt and Sonawane report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.