Oral Human Papillomavirus Infection in Adults Is Associated with Sexual Behavior and HIV Serostatus

Abstract

The prevalence and risk factors for oral human papillomavirus (HPV) infection are unknown, despite evidence for an etiological role for HPV in oral cancers. Oral samples from human immunodeficiency virus (HIV)-seronegative (n=396) and HIV-seropositive (n=190) adults were tested for HPV DNA. High-risk HPV infections were present in 2.1% of tonsil and 6.3% of oral-rinse specimens. The prevalence of oral high-risk HPV infection was greater in HIV-seropositive individuals (13.7% vs. 4.5%; P<.001). In multiple logistic regression, odds of oral HPV infection increased with age, male sex, and herpes simplex virus (HSV)-2 seropositivity in HIV-seronegative individuals and with CD4 cell count <200 cells/mL, HSV-2 seropositivity, oral mucosal abnormalities, and >1 oral sex partner during the previous year (odds ratio, 12.8; 95% confidence interval, 3.1-52.7) among HIV-seropositive individuals. HPV type 16, which is present in most HPV-associated tonsillar cancers, was the most prevalent high-risk oral HPV infection.

Tongue and tonsil carcinoma

“…22 This increase can probably be explained, in part, by a change in sexual behaviors and an increase in the number of sexual partners. Kreimer et al 29 found that the OR of oral HPV infection, detected by isolating HPV DNA from oral rinses among HIV-positive and HIV-negative adults, was higher in participants who reported Ͼ 1 oral sex partner in the previous year (OR ϭ 12.8; 95% CI, 3.1-53). 29 In a study of oral carcinoma risk in relation to sexual history and evidence of HPV infection, other investigators found that the risk of oral carcinoma increased significantly with decreasing age at first intercourse, increasing number of sexual partners, and a history of genital warts.…”

“…Kreimer et al 29 found that the OR of oral HPV infection, detected by isolating HPV DNA from oral rinses among HIV-positive and HIV-negative adults, was higher in participants who reported Ͼ 1 oral sex partner in the previous year (OR ϭ 12.8; 95% CI, 3.1-53). 29 In a study of oral carcinoma risk in relation to sexual history and evidence of HPV infection, other investigators found that the risk of oral carcinoma increased significantly with decreasing age at first intercourse, increasing number of sexual partners, and a history of genital warts. 30 However, these authors used the SEER grouping that comprises SCC of the tongue, gum, floor of mouth, and "other/unspecified part of the mouth, tonsils, or oropharynx."…”

Current topics in the epidemiology of oral cavity and oropharyngeal cancers

“…Analogously, oral HPV infection has recently been associated with sexual behavior, in particular with number of oral sex partners. 90,91 Young age at first intercourse, number of lifetime sexual partners, a history of genital warts, 92 and ever performing oral sex 79 were associated with oral cancer risk in men. Risk among women was associated with number of lifetime sexual partners.…”

Human Papillomaviruses, Herpes Viruses and Oral Neoplasms

“…There is greater likelihood for HIV patients to be infected with more than one of the HPV genotypes (5.8 % compared to 1.5% of immunologically competent individuals) and with a genotype of high oncogenetic risk, such as HPV-16 for example, which is related to tonsillar cancers. Oral warts are rare in immunologically competent individuals, but are a regular finding in HIV patients with HPV (25,42).It is appropriate and advisable to test the levels of the three viruses (HPV, EBV and HSV) in patients with HIV, as well as to monitor their specific manifestations in the oral cavity. …”