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Gender Differences in Sexual Biomarkers and Behaviors Associated With Human Papillomavirus-16, −18, and −33 Seroprevalence

Kreimer, Aimee R. PhD*†; Alberg, Anthony J. PhD*; Viscidi, Rapheal MD; Gillison, Maura L. MD, PhD

Sexually Transmitted Diseases: April 2004 - Volume 31 - Issue 4 - p 247-256
doi: 10.1097/01.OLQ.0000118425.49522.2C

Background The elevated risk for incident head and neck cancer among human papillomavirus (HPV)-16-seropositive individuals has substantiated a role for HPV in the etiology of head and neck cancers. The relationship between HPV seroreactivity and prevalent oral HPV infection in men and women without cancer has yet to be investigated.

Goal The goal of this study was to evaluate a possible association between oral HPV infection and HPV seroreactivity after adjustment for gender, sexual behaviors, and sexually transmitted disease.

Study Design A cross-sectional study of factors associated with HPV-16, −18, and −33 seroreactivity was performed in a population of 586 men and women with and without HIV infection. Antibodies in sera were measured by use of a virus-like protein (VLP)-based enzyme-linked immunosorbent assay. Exfoliated cells from the tonsillar and oral mucosa were analyzed for the presence of 38 mucosal HPV types by polymerase chain reaction.

Results Women had significantly greater seroreactivity for all HPV types investigated when compared with men (odds ratio, 4.3; 95% confidence interval, 3.0–6.0). Seroprevalence was greatest in men and women aged 35 to 45 years. Tonsillar HPV infection, oral sex with men, and HIV infection were independently associated with HPV seroreactivity in men after adjustment for age and number of sexual partners. In women, HSV-2 seropositivity and a history of sexually transmitted diseases were similarly important. Oral and tonsillar HPV infection were not associated with HPV seroreactivity in women.

Conclusion HPV seropositivity is associated with sexually transmitted diseases among women and possibly mucosal HPV exposures in men. Tonsillar HPV infection could impact seroprevalence, particularly in men.

HPV-16, −18, and −33 seroprevalence were significantly higher in women than men. HPV seropositivity was associated with sexually transmitted diseases among women and possibly mucosal HPV exposures in men.

*Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, NIH, DHHS, Bethesda, Maryland; the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; and the §Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland

This work was supported by grants from the NIDCR (DE13121) and the State of Maryland Cigarette Restitution Fund (MLG). AJA is a recipient of a K07 award (CA73790) from the National Cancer Institute. RV is supported by a grant from the National Institutes of Health (AI-42058). The authors thank the laboratories of Thomas Quinn for performing HIV serologic analysis and Jonathan Zenilman for performing HSV-2 analysis. Maura Gillison is a Damon Runyon-Lilly Clinical Investigator supported (in part) by the Damon Runyon Cancer Research Foundation. The authors also thank Elizabeth Garrett, PhD, from the Department of Biostatistics at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins for guidance with statistical analysis.

Correspondence: Maura L. Gillison, MD, PhD, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, G91, Cancer Research Building, 1650 Orleans Street, Baltimore, MD 21231. E-mail:

Received for publication September 15, 2003,

revised November 26, 2003, and accepted December 11, 2003.

© Copyright 2004 American Sexually Transmitted Diseases Association