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Oral Human Papillomavirus in Women With High-Grade Cervical Intraepithelial Neoplasia

Woelber, Linn MD1; Breuer, Julia MD1; Meyer, Thomas PhD2; Vettorazzi, Eik3; Prieske, Katharina MD1; Bohlmann, Inga MD1; Busch, Chia-Jung MD4; Teudt, Ingo MD5,6; Brummer, Oliver MD7,8; Mueller, Volkmar MD1; Schmalfeldt, Barbara MD1; Grimm, Donata MD1

Journal of Lower Genital Tract Disease: July 2017 - Volume 21 - Issue 3 - p 177–183
doi: 10.1097/LGT.0000000000000313
Original Research Articles: Cervix and HPV

Objective This study was designed to investigate the co-prevalence of cervical and oropharyngeal human papillomavirus (HPV) infection in patients with HPV-related high-grade disease of the uterine cervix (high-grade squamous intraepithelial lesion [HSIL]).

Materials and Methods In a prospective cohort study, women with abnormal cervical cytology admitted to our colposcopy units received HPV testing of the uterine cervix and the oropharynx via smear. From a subset of patients, oral lavage was collected to compare detection rates of HPV DNA between lavage and swab. Patients with confirmed high-risk HPV (HR-HPV)–positive HSIL of the cervix were further investigated. Sexual behavior and lifestyle factors were documented with a standardized questionnaire.

Results Two hundred thirty-five women were included in the study. Of the 235 women, 135 (57.5%) were cervically HR-HPV positive with histologically confirmed high-grade cervical intraepithelial lesion (median [range] age = 30 [21–45] years). Of these, only 6 (4.4%) also had a positive oral specimen. In 3 (50%) of the 6 cases, the same HPV type was detected in oral and cervical samples (HPV 16, 35, and 45). Oral HPV detection was not higher when combining swab and lavage compared with swab alone. A relation between sexual behavior and oral HPV detection could not be demonstrated.

Conclusions Oral HPV prevalence in women with cervical HPV infection and HSIL is low. Simultaneous testing of oropharyngeal and cervical HPV infection does not seem promising as future screening strategy.

Women with human papillomavirus–positive high-grade cervical intraepithelial lesion show a low prevalence of oropharyngeal human papillomavirus. No relation to sexual behavior can be shown.Supplemental digital content is available in the text.

1Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany; 2Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany; 3Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 4Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Germany; 5Department of Otolaryngology, Head and Neck Surgery, Asklepios Klinik Hamburg Altona, Germany; 6HNO-in-Altona, Private Otorhinolaryngology Praxis, Hamburg, Germany; 7Tagesklinik Altonaer Strasse, Private Gynaecology Praxis, Hamburg, Germany; and 8Department of Gynaecology and Gynaecologic Oncology, Medical Center Asklepios Altona, Hamburg, Germany

Correspondence to: Donata Grimm, MD, Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. E-mail:

This work was supported by Greiner Bio-One GmbH (Frickenhausen, Germany). Human papillomavirus polymerase chain reaction test were provided at no costs without restriction to the study protocol.

L.W. received study support from MSD, GSK, Medac oncology, and Vaccibody and honoraria/travel support from Roche, Medac, Jenapharm, MSD. T.M. received honoraria from Roche, Cepheid. K.P. received honoraria from Astra Zeneca. C.J.B. received honoraria from BMS. I.T. received study support from Asklepios Klinik Hamburg Altona. O.B. received study support from Asklepios Klinik Hamburg Altona and honoraria from Roche, MSD. B.S. received honoraria from Roche, Astra Zeneca. D.G. received honoraria from Roche, ESOP.

All authors disclose any financial and personal relationships that could inappropriately influence (bias) the work. The authors have declared they have no conflicts of interest.

L.W. and J.B. contributed equally.

Ethical approval was obtained from the local ethical board (reference number PV438).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Copyright © 2017 by the American Society for Colposcopy and Cervical Pathology