Predictors of high-risk and low-risk oral HPV infection in the United States

Laryngoscope. 2016 Jun;126(6):1365-72. doi: 10.1002/lary.25822. Epub 2015 Dec 28.

Abstract

Objectives/hypothesis: Determine predictors of high-risk and low-risk oral HPV infection in the United States.

Study design: Retrospective analyses of National Health and Nutrition Examination Survey cross-sectional data of U.S. population from 2009 to 2012.

Methods: Database queried for subjects aged 18 to 69 with oral rinse human papillomavirus (HPV) DNA data. Logistic regression identified factors associated with high-risk and low-risk infection. Covariates included age, gender, ethnicity, income-to-poverty (IP) ratio, sexual orientation, human immunodeficiency virus infection, other sexually transmitted infections, lifetime sexual partners, and lifetime oral sex partners.

Results: In total, 9,256 subjects were identified with mean age of 42.1 years. Oral HPV infection was present in 8.1% (N = 747); 55.7% were high-risk and 55.3% were low-risk types, including 11% with both. Oral infection had a negative association with female gender (odds ratio [OR] 0.3, P < 0.001), IP ratio ≥ 3 (OR 0.7, P = 0.02), and one lifetime oral sex partner (OR 0.7, P = 0.03). Increasing oral sex behavior (6-21+ lifetime partners) was positively associated with oral HPV (OR 1.4-3.0, P = 0.03). Low-risk infection had negative associations with female gender (OR 0.4, P < 0.001) and non-Hispanic white ethnicity (OR 0.6, P = 0.02), IP ratio ≥ 3 (OR 0.6, P = 0.01), and positive association with > 20 sexual partners (all sex OR 1.7, P = 0.04; oral sex OR 1.9, P = 0.02). Predictors of high-risk HPV infection included male gender and increasing oral sex partners.

Conclusion: Increasing oral sex partners is positively associated with oral HPV infection; female sex and higher socioeconomic class are negatively associated. The risk-factor profiles for high-risk and low-risk HPV types are distinct, with similar trends related to sexual behaviors.

Level of evidence: 4. Laryngoscope, 126:1365-1372, 2016.

Keywords: Human papillomavirus (HPV); NHANES; oral; oral sex; oropharynx; smoking.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Odds Ratio
  • Papillomaviridae*
  • Papillomavirus Infections / epidemiology
  • Papillomavirus Infections / etiology*
  • Papillomavirus Infections / virology
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Sexual Behavior / statistics & numerical data
  • Sexual Partners
  • United States / epidemiology
  • Young Adult