Lower Prevalence of Oral HPV Among Vaccinated Female Adolescents

Human papillomavirus (HPV) is the most common sexually transmitted infection in adolescent and young adult women, and is linked to the majority of cervical cancers. Previous research has shown that the HPV vaccine has reduced rates of cervical cancer since its introduction in 2006.

A new study conducted at a large adolescent health clinic in New York City examined the prevalence of oral HPV in sexually active female adolescents receiving the quadrivalent vaccine (4vHPV). The investigators report that detection of HPV in the oral cavity is not uncommon in this population but decreases with age and time since initiation of sexual activity. The study also observed a significant benefit to vaccination, with a lower prevalence of 4vHPV vaccine types. The full results of the research were published in JAMA Network Open.

Experts from the Roswell Park Comprehensive Cancer Center, the Albert Einstein College of Medicine, and the Icahn School of Medicine at Mount Sinai tested for oral HPV DNA in oral rinse samples collected from a prospectively enrolled cohort of patients at a clinic offering free health care and HPV vaccination between October 2007 and March 2017.

A total of 1259 participants were included in the study. The subjects ranged in age from 13-21 years with a median age of 18. Additional information indicates that 638 participants were black, 569 were Hispanic, 43 reported another race/ethnicity, and race/ethnicity was unspecified for 9. Among the participants, the median age for first sexual activity was 14.8 years, and 1161 participants reported having had oral sex.

DNA from collected samples was tested for more than 40 HPV types using a protocol based on the MY09/MY11 polymerase chain reaction platform. HPV DNA was detected in baseline oral rinse samples in 78 of 1259 participants, with a significant decrease in oral HPV detection with time since first engaging in sexual activities. Oncogenic HPV types were detected in 21 participants, 4vHPV vaccine types were detected in 8. The greatest prevalence of oral HPV was detected at age 16 years for all types.

Detection of HPV-6, HPV-11, HPV-16, and HPV-18 was significantly lower among participants who had received at least 1 dose of the quadrivalent HPV vaccine at time of enrollment compared with participants who were unvaccinated. At enrollment, 192 of the 1259 study participants had not received the 4vHPV vaccine.

Study authors assessed associations with sexual activity and other putative risk factors, noting that they “observed no significant associations with giving or receiving oral sex compared with those who reported no oral sex after adjustment for age.”

“In contrast,” authors explained they “observed a significant decrease in oral HPV detection with years since first engaging in sexual activity, comparing participants who engaged in sex 4 or more years versus 1 year or less before testing.”

Authors concluded that their data “do not provide strong support of a sexual transmission model for oral HPV acquisition, although detection was highest soon after initiation of sexual activity.” The presence of cervical HPV was itself significantly associated with detection of oral HPV, “suggesting that the anogenital region may be a source and that transmission could involve digital transfer or autoinoculation.”

Authors continued that “consistent with previous studies, we report that any sexual activity, not just oral sex, may be associated with oral HPV detection. In comparison with previous studies, however, we observed no association between the likelihood of HPV detection in the oral cavity and number of oral sex partners, vaginal sex partners, or both. This may be owing in part to the lack of a reference group of individuals who had not engaged in sexual activity in our study cohort.”