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Transgender Women Have Higher Human Papillomavirus Prevalence Than Men Who Have Sex With Men—Two U.S. Cities, 2012–2014

Singh, Vidisha MSPH*; Gratzer, Beau MPP; Gorbach, Pamina M. MHS, DrPH; Crosby, Richard A. PhD§; Panicker, Gitika PhD; Steinau, Martin PhD; Amiling, Raiza MPH*; Unger, Elizabeth R. PhD, MD; Markowitz, Lauri E. MD*; Meites, Elissa MD, MPH*

doi: 10.1097/OLQ.0000000000001051
Original Studies

Background Human papillomavirus (HPV) prevalence is high among men who have sex with men (MSM), yet little is known about HPV among transgender women (TGW). We assessed HPV prevalence and knowledge among TGW compared with MSM.

Methods We enrolled TGW and MSM aged 18 to 26 years from clinics in Chicago and Los Angeles during 2012 to 2014. Participants self-reported gender identity, HIV status, HPV knowledge, and vaccination status. Self-collected anal and oral specimens were tested for HPV DNA (37 types); serum was tested for HPV antibodies (4 vaccine types). Prevalence among unvaccinated TGW and MSM was compared using prevalence ratios (PRs) and 95% confidence intervals (CIs). Participants without DNA or serologic evidence of HPV were considered naïve.

Results Among 1033 participants, 49 were TGW. Among 44 TGW and 855 MSM who were unvaccinated, any HPV DNA was detected in anal specimens from 39 (88.6%) TGW and 606 (70.9%) MSM (PR, 1.3; 95% CI, 1.1–1.4), and oral specimens from 4 (9.1%) TGW and 81 (9.5%) MSM (PR, 1.0; 95% CI, 0.4–2.5). Antibodies were detected among 37 (84.1%) TGW and 467 (54.6%) MSM (PR, 1.5; 95% CI, 1.3–1.8). Most participants were naïve to 1 or more HPV vaccine type/s, including 29 (65.9%) TGW and 775 (90.6%) MSM (PR, 0.7; 95% CI, 0.6–0.9). Most TGW (55.1%) had never heard of HPV vaccine.

Conclusions Among TGW, HPV prevalence was high and knowledge was low. Most were still naïve to 1 or more HPV vaccine type. Although vaccination ideally occurs prior to exposure, findings support existing national recommendations to vaccinate TGW and MSM, and suggest additional outreach might increase vaccination.

Among 899 unvaccinated 18- to 26-year-olds, anal HPV prevalence was significantly higher among transgender women (88.6%) than cisgender men who have sex with men (70.9%).

From the *Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA

Howard Brown Health, Chicago, IL

Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA

§College of Public Health, University of Kentucky at Lexington, Lexington, KY

Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA

Acknowledgments: Atlanta, GA: Jim Braxton, Rayleen Lewis, William Lonergan, Danielle Miller, Ira Rajbhandari, Akbar Zaidi; Chicago, IL: Michael Maloney, Cody Randel; Lexington, KY: Tom Collins, Adam Parrish; Los Angeles, CA: Robert Bolan, Peter R. Kerndt, Janell Moore.

Conflicts of interest: None declared.

Sources of Funding: Centers for Disease Control and Prevention.

Note: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Correspondence: Elissa Meites, MD, MPH, Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30030. E-mail:

Received for publication February 28, 2019, and accepted July 5, 2019.

© Copyright 2019 American Sexually Transmitted Diseases Association