Oral HPV Infection in Women with HPV-Positive Cervix Is Closely Related to Oral Sex

Abstract

The oral transmission of HPV and, consequently, the risk of oral cancer has increased in the last years. Oral sex has often been implicated among the risk factors for oral HPV infections, however, there is still no consensus on these topics, nor on the relationship between genital and oral HPV infections. The present study aimed to evaluate the coexistence of papilloma virus, at the levels of the oral and genital mucosa, in women with a histologically confirmed HPV lesions (and a positive HPV test) at the genital level and a negative HPV control group. We also evaluated how some risk factors, such as smoking, the number of partners, age, and sexual habits can influence the possible presence of the virus itself in the oropharynx of the same women. In total, 117 unvaccinated women aged between 18 and 52 were enrolled. We found that the prevalence of oral HPV infection was high among the women with concomitant genital HPV infection (22%) compared to the HPV-negative women (0%), and the estimated odds ratio was 17.36 (95% CI: 1.02, 297.04). In none of the women with oral HPV did we find any relevant clinical lesions. The potential risk factors for HPV infections in the oropharynx and genitals were analyzed based on questionnaire responses. A multivariate analysis showed that genital HPV infections were significantly associated with a number of sexual partners > 10 (OR 138.60, 95% CI: 6.04–3181.30, p < 0.001), but the data also referred to having between 3–5 or 6–10 partners as being significant, as were a high level of education (OR 6.24, 95% CI: 1.67–4.23.26 p = 0.003), a frequency of sexual intercourse >10 (OR 91.67 95% CI: 3.20–2623.52, p = 0.004), oral sex (OR 6.16, 95% CI: 1.22–31.19, p = 0.014), and >20 cigarettes/day (OR 6.09 95% CI: 1.21–30.61, p = 0.014). Furthermore, being “separate” and having multiple sexually transmitted diseases were also significantly associated with genital HPV infection. In contrast, oral HPV infections were significantly associated with women aged 36 to 50 years (OR 27.38, 95% CI: 4.37–171.37; p = 0.000202) and oral sex (OR 95.5, 95% CI: 5.13–1782.75, p = 0.001126).Additionally, being separate, being cohabitant, lifetime sexual partners of >10, 3–5 lifetime sexual partners, <20 years of age, >10 sexual intercourse per month, occasional and regular anal sex, >20 cigarettes per day, a history of sexually transmitted disease (herpes and multiple), and having a history of genital warts were significant. Screening and early diagnosis are considered to be practically unfeasible for this category of cancer, given the lack of visible lesions; the 9-valent HPV vaccine remains the only means that could help to successfully counter the growing incidence of oral squamous cell carcinoma.

Analogies between HPV Behavior in Oral and Vaginal Cavity: Narrative Review on the Current Evidence in the Literature

“…Similarly, the majority of female patients have concordant oral and urinary HPV types [ 20 ]. With regard to oral–genital transmission, although HPV is known to have the potential to affect the intimate lives of women and their partners, it has rarely been explored in the literature [ 16 ]. In fact, oral transmission of HPV and, consequently, the risk of oral cancer, increases in women with cervical cancer and their spouses [ 16 ]; this finding suggests a cross-transmission between the mouth and genitals.…”

“…With regard to oral–genital transmission, although HPV is known to have the potential to affect the intimate lives of women and their partners, it has rarely been explored in the literature [ 16 ]. In fact, oral transmission of HPV and, consequently, the risk of oral cancer, increases in women with cervical cancer and their spouses [ 16 ]; this finding suggests a cross-transmission between the mouth and genitals. However, data in this regard are discordant, with only a few studies reporting concordant rates of oral and cervical HPV infection above 65% [ 26 ] ( Figure 1 ).…”

“…Among these, a recent study in Italian women compared the prevalence and concordance of HPV infections between the oropharynx and genital sites, reporting that the prevalence of oral HPV infections was high among women with concomitant genital HPV infections (22%) compared to genital HPV-negative women (0%) [ 26 ]. HPV16 was the most common high-risk genotype at both sites, and there was low concordance between HPV genotypes at the two anatomical sites (kappa = 0.125) [ 16 ]. On the other hand, other studies report that the overall prevalence of oral HPV infections is varied, with values ranging from 0.2% to 20.7%, and rates of concomitant infections with oral and cervical HPV are reported in less than 10% of cases [ 16 ].…”

“…Additionally, it has been observed that certain risk factors, such as smoking, number of partners, age, and sexual habits can impact the potential presence of the virus in the oropharynx of women [ 16 ]. The diagnosis and treatment of oral squamous cell carcinoma (OSCC) have been associated with a significant decrease in the frequency of vaginal and oral sex, regardless of tumor HPV status; a decline in sexual behavior is observed in both HPV-positive and HPV-negative oropharyngeal cancer patients [ 16 ]. The very similar decline in the frequency of sexual behaviors in HPV-positive and HPV-negative patients would suggest that knowledge and concern about the sexual transmission of HPV is not the sole reason behind changes in sexual behavior [ 17 ].…”

“…We also need to deal with the new, emerging evidence that in developed countries, OSCC has become the most frequent HPV-related cancer, surpassing cervical cancer [ 19 ]. Furthermore, it is predicted that by 2030, most squamous cell carcinomas will be HPV-related rather than the non-HPV-related form [ 16 ]. An important aspect to consider in HPV transmission is oral concordance, defined as the simultaneous appearance of the same type of HPV at different anatomical sites [ 20 ].…”