Oral Human Papillomavirus Prevalence and Genotyping Among a Healthy Adult Population in the US

Abstract

ImportanceIn the US, oropharyngeal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection, is the most frequent HPV-associated cancer, surpassing cervical cancer. However, little is known about oral HPV prevalence and genotype distribution in the general population.ObjectiveTo assess oral HPV prevalence and factors associated with HR and low-risk infection in a general US population.Design, Setting, and ParticipantsPROGRESS (Prevalence of Oral HPV Infection, a Global Assessment) was a cross-sectional observational study conducted between November 2021 and March 2022 in 43 dental offices in the US (24 urban, 13 urban cluster, and 6 rural sites), spanning 21 states. Eligible participants were aged 18 to 60 years, visiting dental clinics for routine dental examination. Dental clinics used targeted sampling to recruit equal distributions of men and women and across age groups.ExposureParticipants provided an oral gargle specimen for HPV DNA and genotyping and completed behavioral questionnaires, and dentists reported oral health status. Detection of HPV DNA and genotyping was performed using the SPF10/DEIA/LiPA25 system at a central laboratory.Main OutcomeOral HPV prevalence.ResultsOf the 3196 participants enrolled, mean (SD) age was 39.6 (12.1) years, and 55.5% were women. Oral HPV prevalence was 6.6% (95% CI, 5.7%-7.4%) for any HPV genotype, and 2.0% (95% CI, 1.5%-2.5%), 0.7% (95% CI, 0.4%-1.0%), and 1.5% (95% CI, 1.1%-1.9%) for HR, HPV-16, and 9-valent-HPV vaccine types, respectively. Among HPV-positive participants, HPV-16 was the most prevalent genotype (12.4% among men and 8.6% among women). Prevalence of HPV was higher in men than women and highest among men aged 51 to 60 years (16.8%, 6.8%, and 2.1% for any HPV, HR HPV, and HPV-16, respectively). Factors associated with HR oral infection included being male (adjusted odds ratio [AOR], 3.1; 95% CI, 1.2-8.5), being aged 51 to 60 years (AOR, 3.3; 95% CI, 1.5-7.3), having 26 or more lifetime male sex partners (AOR, 6.5; 95% CI, 2.3-18.7), and having 6 to 25 lifetime female oral sex partners (AOR, 3.4; 95% CI, 1.3-8.7).Conclusions and RelevanceIn this cross-sectional study, oral HPV burden was highest among older men who may be at higher risk of developing oropharyngeal cancer. In addition to male sex and older age, HR oral HPV infection was also associated with sexual behaviors, including increasing number of male sex partners and female oral sex partners.

Genital and Oral HPV Geno-Prevalence Measured through Urine and Saliva Samples in Young Adults in Italy

“…An oral HPV prevalence of 0.7% has been observed. A substantial variability has been reported ranging from 0.3% in Italy in healthy adults [ 46 ] to more than 10% [ 3 , 45 , 47 , 48 ], with an overall value of 7.7% reported by a meta-analysis conducted in 18 years and older healthy males and females [ 12 ]. This variability has been attributed to differences in the study populations, geographic variations, methods of collection of specimen and HPV detection, and in the investigated HPV genotypes.…”

HPV-associated oropharyngeal cancer: in search of surrogate biomarkers for early lesions

“…Patients with HPV + OPSCC are generally younger than those with HPV(-) OPSCC [ 14 ], although an increase in elderly patients has been reported [ 19 – 21 ]. A recent study on a cohort of over 3000 healthy adults in the United States reported that oral HPV DNA is most prevalent in older males aged 51–60 years [ 22 ]. An earlier study also reported that males aged 60–64 years had higher oral HPV prevalence compared to younger age groups [ 23 ].…”

Surveillance of human papillomavirus through salivary diagnostics - A roadmap to early detection of oropharyngeal cancer in men

“…The PROGRESS (Prevalence of Oral HPV Infection, a Global Assessment) trial examined 3196 healthy adults, aged between 18 and 60 years, who visited dental clinics. The study revealed an oral HPV prevalence of 6.6% with a 2% prevalence for hrHPV [ 62 ]. This translated to 9.1% of men and 4.6% of women having any oral HPV (aHPV) infections.…”