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Sexual Behaviors and Other Risk Factors for Oral Human Papillomavirus Infections in Young Women

Cook, Robert L. MD, MPH*†¶; Thompson, Erika L. MPH, CPH*; Kelso, Natalie E. MSW*; Friary, John MS, MPH*; Hosford, Jennifer MPH†¶; Barkley, Phillip MD†‡; Dodd, Virginia J. PhD, MPH§; Abrahamsen, Martha MPH; Ajinkya, Shaun MPH*; Obesso, Peter Daniel MD; Rashid, Mohammed H. PhD; Giuliano, Anna R. PhD

doi: 10.1097/OLQ.0000000000000159
Original Study

Background Oral human papillomavirus (HPV) is associated with a rising incidence of certain head and neck cancers, and oral sex has been associated with oral HPV. This study sought to identify more specific patterns of oral sexual activity, including self-inoculation, that are associated with oral HPV infections in young women.

Methods A total of 1010 women attending a large university completed a computer-based questionnaire and provided oral specimens that were tested for any oral HPV using a Linear Array assay that detects any HPV as well as 37 HPV genotypes. Twenty-seven women provided additional samples up to 12 months after enrollment. Bivariable and multivariable analyses were conducted to identify oral sexual patterns and other risk factors associated with prevalent oral HPV.

Results Nineteen women had prevalent oral HPV (1.9%), with 10 women (1%) having a type-specific infection. Oral HPV was significantly associated with lifetime coital sex partnership numbers (P = 0.03), lifetime and yearly oral sex partnership numbers (P < 0.01), and hand and/or sex toy transfer from genitals to mouth (P < 0.001). Oral HPV was also associated with greater use of alcohol, cigarettes, marijuana, and sharing of smoking devices, lipstick, or toothbrushes (P < 0.05 for each), with an apparent dose-response for alcohol use and smoking behavior, stratified by number of sexual partners. Of 7 women with prevalent HPV who provided follow-up samples, none had evidence of a persistent type-specific infection.

Conclusions These data provide additional evidence of transmission of oral HPV from oral sexual activity and also suggest possible transmission from self-inoculation or sharing of oral products.

A study of 1010 college women found prevalent oral human papillomavirus (1.9%) to be associated with oral and coital sexual partnerships, self-inoculation behavior, alcohol use, smoking, and sharing of oral devices.

From the *Departments of Epidemiology and †Medicine, ‡Student Healthcare Center, §Department of Community Dentistry & Behavioral Science, and ¶Emerging Pathogens Institute, University of Florida, Gainesville, FL; and ∥Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center, Tampa, FL

Acknowledgments: The HPV Oral Prevalence Investigation study would like to recognize the support of the staff at the University of Florida Student Health Services (Toni Ratliff, Terri Wilkinson, Zenon, Bob, Catherine Seemann), public health students who participated in recruitment and study planning (Shandrika Gordon, Angela DeQuesada, Jason Poling), and Dan’elle C. Smith and the laboratory team at Moffitt.

Conflicts of interest and funding: This work was supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc. Funding was provided to the University of Florida with no specific restrictions. The opinions expressed are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. No recommendations for or against any product provided by Merck are made. Dr Barkley is currently a Merck Employee, but his work on this study and manuscript was completed before being hired by Merck. No other perceived conflicts of interests are declared.

Correspondence: Robert L. Cook, MD, MPH, Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610. E-mail:

Received for publication February 2, 2014, and accepted June 2, 2014.

© Copyright 2014 American Sexually Transmitted Diseases Association