Oral human papillomavirus infection and its risk factors among 5,410 healthy adults in China, 2009-2011

Background: Despite the established link between oral human papillomavirus (HPV) infection and a subset of oropharyngeal squamous cell carcinoma (OSCC), little is known about the epidemiology of oral HPV infection among healthy adults in China.

Methods: Oral swab specimens and questionnaires were collected from 5,410 individuals (ages 25-65 years). HPV DNA in oral exfoliated cells was tested by general primer-mediated (SPF1/GP6+) PCR and sequencing. Univariate and multivariate analyses were performed to assess the associations between exposure factors and oral infection.

Results: Alpha mucosal HPV types were detected in 0.67% [95% confidence interval (CI), 0.47%-0.93%] of 5,351 β-globin-positive specimens, and cutaneous HPV in 5.46% (95% CI, 4.86%-6.10%). HPV 16 and 3 were the most prevalent types of α mucosal (0.43%; 95% CI, 0.27%-0.64%) and cutaneous HPV (4.17%; 95% CI, 3.65%-4.74%), respectively. The prevalence of α mucosal HPV decreased with increasing age (25-65 years) from 0.93% to 0.36% (Ptrend = 0.033), and was associated with self-reported history of oral disease [adjusted odds ratio (OR), 4.78; 95% CI, 1.07-21.41]. In 1,614 heterosexual couples, cutaneous HPV in one partner was found to increase the other partner's risk of cutaneous HPV infection (adjusted OR, 2.33; 95% CI, 1.22-4.48).

Conclusions: Oral HPV infection, particularly with α mucosal types, is rare among healthy adults in China. A younger age and a history of oral disease imply higher risk of α mucosal HPV infection.

Impact: This study addresses the paucity of epidemiological data on oral HPV infection among healthy population in China.