Among women with human papillomavirus (HPV) infection, vaginal and oral dual-site infections were low, 4%, and dual site infections of identical HPV strains were even more rare at 1%, researchers reported.
Additionally, having a new sexual partner in the last year increased the risk of developing an HPV infection in both vaginal and oral locations, regardless of HPV serotype, and having more than two oral sex partners in the past year increased the risk of developing HPV infections in both areas with the same serotype, Ryan K. Orosco, MD, of the University of California San Diego, and colleagues, reported in JAMA Otolaryngology -- Head & Neck Surgery.
Dual-site infections, with concordant as well as discordant serotypes, were most common among young, low-income women, they also found.
"Discussion of condom use or other barrier method protection during sexual contact for otolaryngologic patients with known oral or cervical HPV is therefore of paramount importance," Jonathan M. Bock, MD, of Medical College of Wisconsin, wrote in an accompanying editorial. "These are not conversations that are part of otolaryngologic residency training or traditional practice."
"Most important, the ability of HPV vaccines to eradicate the disease burden of HPV infection cannot be overstated," Bock wrote. "Both [oropharyngeal squamous cell carcinoma] and [recurrent respiratory papilloma] are potentially preventable diseases."
The study, he added, "endorses the role of physicians and otolaryngologist in advocating for HPV vaccine administration in all patients, both male and female."
That view was also expressed by Peter D. Constantino, MD, of Northwell Health's New York Head & Neck Institute in New York City, in an email to MedPage Today.
"All children, male and female, should be vaccinated," wrote Constantino, who was not involved with the study.
Orosco's group analyzed the National Health and Nutrition Examination Survey (NHANES) data collected across 3 months in 2015. As part of the survey, a mobile examination center was sent to aid in the collection of oral samples and vaginal swabs. In total, 3,463 women, ages 18 to 69, were tested for the 37 known strains of HPV.
No data regarding patient history of oropharyngeal and cervical cancers were captured.
About half the women were either married or cohabitating; 40% were single and had never been married. Median household income was $35,000 to $45,000. The racial/ethnic demographic was 39% white, 23% black, 16% Mexican American, 11% Hispanic, and the rest identified as "other." Some 90% said they identified as heterosexual.
The average age of sexual debut was 17, with sexual experience reported by 95% of women, and 78% said they had experienced oral sex. The median number of lifetime partners was four for sexual encounters, and two for oral sex.
Among women in the sample, 89% reported no history of sexually transmitted infection, but 11% said they had been diagnosed with either genital herpes, gonorrhea, chlamydia, or genital warts. And at the time of the survey, 45% patients tested positive for vaginal HPV, and 4% for oral HPV.
Dual infection, HPV in both locations but not the same serotype, was observed in 3%. Concordant infection, HPV of the same serotype in both locations, was observed in 1%. According to the authors, only 7% of the women who had a vaginal infection had a dual infection, but 76% of those with oral infection had dual infection.
A multivariate analysis revealed that marital status, education level, and cigarette use did not predict infections, however, age and the income to poverty ratio did. For behavioral characteristics, only oral sexual history was associated with increased rates of dual or concordant infection.
Compared with women who were younger than 20, women ages 30 to 39 and 40 to 49 were less likely to have a dual infection (odds ratio 0.30, 95% CI 0.11-0.83, P=0.02, and OR 0.37, 95% CI 0.15-0.89, P=0.03, respectively).
Compared with an income to poverty ratio of less than 1, women who had a ratio of 2-3 (OR 0.29, 95% CI 0.12-0.69, P=0.01), and women who had an income to poverty ratio greater than 3 (OR 0.25, 95% CI, 0.10-0.59, P=0.002) were less likely to have a dual infection.
Women who had a new sexual partner within the last year were more likely to have a dual infection (OR 2.28, 95% CI, 1.03-5.02, P=0.04).
Similar patterns were seen for concordant infections.
The authors suggested that, in light of the fact that no screening protocol for OPSCC currently exists, women who have high-risk vaginal infections or positive pap smear results should undergo screening.
Limitations included the lack of longitudinal data in NHANES, and the fact that many survey participants chose not to answer sexual history questions or undergo HPV testing, potentially introducing a selection bias.
None of the authors reported any relevant financial relationships with industry.
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