Incidence and clearance of oral and cervicogenital HPV infection: longitudinal analysis of the MHOC cohort study

Abstract

Objectives: The Michigan HPV and Oropharyngeal Cancer study aimed to evaluate patterns of oral and cervicogenital human papillomavirus (HPV) infection prevalence, incidence, and clearance as well as their relationship to sexual behaviours.

Design: Cohort SETTING: General public in and around Ann Arbor, Michigan.

Participants: 394 college-age and older-adult participants of both sexes provided oral samples, and 325 completed at least 2 visits. 130 who provided a cervicogenital samples, and 127 completed at least 2 visits.

Outcomes: Incidence and clearance rates as well as HRs for oral and cervicogenital HPV.

Results: Oral HPV infections were transient, with only 16% of genotypes persisting to the next visit. The mean time to clearance of a genotype was 46 days (95% CI 37 to 58). In contrast, cervicogenital infections were more persistent, with 56% of genotypes persisting to the next visit. The mean time to clearance of a genotype was 87 days (95% CI 74 to 102). HPV vaccination was associated with reduced incidence of cervicogenital HPV infection (HR 0.63; 95% CI 0.47 to 0.83) but not oral HPV infection. Incidence of oral HPV infection was associated with 2+ recent deep kissing partners (HR 2.00; 95% CI 1.13 to 3.56). Incidence of both oral (HR: 1.70; 95% CI 1.08 to 2.68) and cervicogenital (HR 2.46; 95% CI 1.69 to 3.59) was associated with 2+ recent sexual partners.

Conclusions: Detection of oral HPV was highly transient, but incidence was associated with recent deep kissing and sexual partners. Detection of cervicogenital HPV was more persistent, and incidence was positively associated with recent sexual partners and negatively associated with HPV vaccination.

Keywords: epidemiology; gynaecology; otolaryngology; public health; sexual medicine.

Figure 1

Participants transition between human papillomavirus (HPV) negative and positive states, and we observe these states at fixed time points. The multistate transition model estimates the underlying instantaneous infection and clearance rates that best explain the observed data when they are combined to estimate probabilities of being in each state at each visit.

Figure 2

Alluvial plots of the longitudinal (A) oral and (B) cervicogenital human papillomavirus (HPV) status of participants in the Michigan HPV and Oropharyngeal Cancer study (data collected in Ann Arbor, Michigan, USA, 2015–2017). Note that the cervicogenital testing was rolled out later than oral testing, so that the majority of ‘invalid/not tested’ participants in (B) represent individuals who participated in several study visits prior to the enrolling in the cervicogenital substudy.