HPV Oral Infection Rates 'Lower Than Previously Thought'

Peter Russell

August 21, 2018

The prevalence of oral infection with high-risk human papillomavirus (HR-HPV) was lower than expected in a sample of adults in Sheffield, a study found.

The research, led by the University of Sheffield, found strong evidence that smoking, having more sexual partners, and oral sex were risk factors for oral HPV infection, which can lead to oropharyngeal (throat) cancer.

Increasing Rates of Throat Cancer

Rates of oropharyngeal cancer are increasing worldwide and have been linked to oral infection rates with HR-HPV. However, there is a lack of evidence about how common HR-HPV oral infection is in the UK. One trial in Scotland reported infection rates of 3.7% in dental patients aged 16 to 69. Another study in London, which involved HIV-negative men who have sex with men, reported a prevalence of 5.9%.

To try to establish a consensus, researchers recruited 700 men and women aged 18 to 60 from Sheffield. The cohort consisted of university students, university and hospital staff, dental patients, sexual health clinic patients and members of the general public.

Participants were asked lifestyle questions relating to their sexual history, and tobacco and alcohol use. Cell samples were collected from the mouths of the volunteers.

The study, published in BMJ Open , found that the rate of oral HR-HPV infection in the group was 2.2%, with 0.7% testing positive for HPV16 or HPV18.

Smoking and Multiple Sexual Partners Were Risk Factors

Former smokers and those with more than six sexual partners were significantly more likely to test positive for HR-HPV compared to those who had never smoked or had fewer sexual partners, researchers said.

Also, participants who reported having oral sex with between 6 and 10 partners were at a higher risk of infection than those who had fewer oral sex partners.

Co-author Vanessa Hearnden, a lecturer in biomaterials and tissue engineering at the University of Sheffield, said there were likely reasons why their study found a lower prevalence of oral HR-HPV infection. "Our cohort was probably slightly younger than some of the other cohorts because we recruited through university mailing lists as well as in the general public, and we do know there is a slightly higher risk in older individuals." Also, the proportion of smokers was lower than in other published research, she said.

HPV Vaccine

A vaccine that protects against HPV is to be given to adolescent boys in England, Scotland and Wales, it was announced last month. The current HPV vaccine administered to girls aged 12 to 13 through the NHS is protective against four HPV strains (16, 18, 6 and 11).

Dr Hearnden told Medscape News UK that including boys would bring several benefits. "The HPV vaccine programme in boys will allow us to protect boys against contracting HPV in the future.

"Men are also at risk of developing penile cancer and anal cancer from HPV as well because the same virus can lead to cancers in those sites too. And it will also provide further herd immunity for the girls against cervical cancer.

"So, if you protect both males and females, then there's less chance of transmission between males and females, so it should also bring down the rates of female HPV infection."

Future vaccines could protect against more strains of HPV than is currently the case. "I think the data from our study shows that it's really worth considering the vaccines which have a wider coverage to try to prevent against more of these high-risk strains that we know are capable of causing cancer," said Dr Hearnden. "They're not seen much in the cancer cases that we see at the moment but that's not to say that we won't in the future."

Oral human papillomavirus infection in England and associated risk factors: a case–control study, BMJ Open. Paper.

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