Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov 21;167(10):714-724.
doi: 10.7326/M17-1363. Epub 2017 Oct 17.

Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014

Kalyani Sonawane  1 , Ryan Suk  1 , Elizabeth Y Chiao  1 , Jagpreet Chhatwal  1 , Peihua Qiu  1 , Timothy Wilkin  1 , Alan G Nyitray  1 , Andrew G Sikora  1 , Ashish A Deshmukh  1
Affiliations

Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014

Kalyani Sonawane et al. Ann Intern Med. .

Abstract

Background: The burden of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men, yet empirical evidence regarding the difference in prevalence of oral HPV infection between men and women is limited. Concordance of oral and genital HPV infection among men is unknown.

Objective: To determine the prevalence of oral HPV infection, as well as the concordance of oral and genital HPV infection, among U.S. men and women.

Design: Nationally representative survey.

Setting: Civilian noninstitutionalized population.

Participants: Adults aged 18 to 69 years from NHANES (National Health and Nutrition Examination Survey), 2011 to 2014.

Measurements: Oral rinse, penile swab, and vaginal swab specimens were evaluated by polymerase chain reaction followed by type-specific hybridization.

Results: The overall prevalence of oral HPV infection was 11.5% (95% CI, 9.8% to 13.1%) in men and 3.2% (CI, 2.7% to 3.8%) in women (equating to 11 million men and 3.2 million women nationwide). High-risk oral HPV infection was more prevalent among men (7.3% [CI, 6.0% to 8.6%]) than women (1.4% [CI, 1.0% to 1.8%]). Oral HPV 16 was 6 times more common in men (1.8% [CI, 1.3% to 2.2%]) than women (0.3% [CI, 0.1% to 0.5%]) (1.7 million men vs. 0.27 million women). Among men and women who reported having same-sex partners, the prevalence of high-risk HPV infection was 12.7% (CI, 7.0% to 18.4%) and 3.6% (CI, 1.4% to 5.9%), respectively. Among men who reported having 2 or more same-sex oral sex partners, the prevalence of high-risk HPV infection was 22.2% (CI, 9.6% to 34.8%). Oral HPV prevalence among men with concurrent genital HPV infection was 4-fold greater (19.3%) than among those without it (4.4%). Men had 5.4% (CI, 5.1% to 5.8%) greater predicted probability of high-risk oral HPV infection than women. The predicted probability of high-risk oral HPV infection was greatest among black participants, those who smoked more than 20 cigarettes daily, current marijuana users, and those who reported 16 or more lifetime vaginal or oral sex partners.

Limitation: Sexual behaviors were self-reported.

Conclusion: Oral HPV infection is common among U.S. men. This study's findings provide several policy implications to guide future OPSCC prevention efforts to combat this disease.

Primary funding source: National Cancer Institute.

PubMed Disclaimer

Conflict of interest statement

Potential conflict of interest disclosures: Dr. Wilkin has received grant support paid to Weill Cornell Medicine from Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline/Viiv Healthcare. Dr. Wilkin has served as an ad hoc consultant to GlaxoSmithKline/ViiV Healthcare. Dr. Sikora receives unrestricted research funding from Advaxis in support of an investigator-initiated trial of a therapeutic vaccine for HPV-related head and neck cancer. Dr. Chhatwal received grant support from Gilead and consulting fee from Gilead and Merck on unrelated projects.

Figures

Figure 1.
Figure 1.. Type-specific prevalence of oral HPV infection among men and women, NHANES 2011–2014.
(A) The weighted prevalence (and 95% CI) of high-risk type-specific oral HPV infection among men and women. (B) The weighted prevalence (and 95% CI) of Low-risk type-specific oral HPV infection among men and women.
Figure 2.
Figure 2.. Prevalence by age and race of overall and high-risk oral HPV infection among individuals with or without concurrent genital HPV infection, NHANES 2013–2014.
Prevalence of (A) overall and (B) high-risk oral HPV infection among men and women with or without concurrent genital HPV infection. Prevalence of (C) overall and (D) high-risk oral HPV infection by age among men and women with or without concurrent genital HPV infection. Prevalence of (E) overall and (F) high-risk oral HPV infection by race among men and women with or without concurrent genital HPV infection. * P-value for trend
Figure 3.
Figure 3.. Prevalence by sexual behavior of overall and high-risk oral HPV infection among individuals with or without concurrent genital HPV infection, NHANES 2013–2014.
Prevalence of (A) overall and (B) high-risk oral HPV infection by lifetime number of any sex partners among men and women with or without concurrent genital HPV infection. Prevalence of (C) overall and (D) high-risk oral HPV infection by lifetime number of oral sex partners among men and women with or without concurrent genital HPV infection. Prevalence of (E) overall and (F) high-risk oral HPV infection by lifetime number of vaginal sex partners among men and women with or without concurrent genital HPV infection. * P-value for trend
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Giuliano AR, Nyitray AG, Kreimer AR, Pierce Campbell CM, Goodman MT, Sudenga SL, et al. EUROGIN 2014 roadmap: differences in human papillomavirus infection natural history, transmission and human papillomavirus-related cancer incidence by gender and anatomic site of infection. Int J Cancer. 2015;136(12):2752–60. - PMC - PubMed
    1. Viens LJ, Henley SJ, Watson M, Markowitz LE, Thomas CC, Thompson TD, et al. Human Papillomavirus-Associated Cancers - United States, 2008–2012. MMWR Morb Mortal Wkly Rep 2016;65(26):661–6. - PubMed
    1. Mourad M, Jetmore T, Jategaonkar AA, Moubayed S, Moshier E, Urken ML. Epidemiological Trends of Head and Neck Cancer in the United States: A SEER Population Study. J Oral Maxillofac Surg 2017. - PMC - PubMed
    1. Gillison ML, Chaturvedi AK, Anderson WF, Fakhry C. Epidemiology of Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma. J Clin Oncol 2015;33(29):3235–42. - PMC - PubMed
    1. Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011;29(32):4294–301. - PMC - PubMed

MeSH terms