Oral HPV infection is common among Men

Oct 17, 2017

According to the Annals of Internal Medicine's report (Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014), published in October 17, 2017, oral HPV infection is common among U.S. men.
Human papillomavirus (HPV) infection causes cancer at several anatomical sites, including the oropharynx, anus, and penis in men and the oropharynx, anus, cervix, vagina, and vulva in women. Between 2008 and 2012, an average of 38 793 cases of HPV-related cancer were diagnosed annually in the United States, 23 000 (59%) in women and 15 793 (41%) in men. Among these cases, the most common cancer was oropharyngeal squamous cell carcinoma (OPSCC), of which there were 3100 cases in women and 12 638 in men.

The incidence of HPV-related OPSCC among women generally plateaued (with a statistically insignificant increase of 0.57% per year) from 2002 to 2012. In contrast, the incidence among men (7.8 per 100 000) has increased dramatically (2.89% per year) and has already surpassed the incidence of cervical cancer in women (7.4 per 100 000). The increase in annual incidence was particularly high in men aged 50 to 59 years: 7.75% from 2002 to 2004 and 2.44% from 2004 to 2010. These incidence trends are projected to continue and not reverse until after 2060, making OPSCC a significant public health concern.

Recent evidence shows that prophylactic HPV vaccination seems to protect against infection with vaccine-covered oral HPV subtypes and thus holds promise for reversing the rising OPSCC incidence among men in the long term; however, the low uptake rate of the vaccine among boys remains a concern. Furthermore, the great majority of persons at risk for OPSCC are older than 26 years and do not qualify for HPV vaccination or may already have been exposed to HPV. For this reason, epidemiologic studies on oral HPV infection are needed to guide the design and development of alternative OPSCC prevention strategies targeted toward persons at high risk. Examining the relationship between HPV infections occurring at different anatomical sites also is crucial to understanding HPV transmission dynamics. Therefore, our objective was twofold: to estimate the population-based prevalence and risk factors of oral HPV infection by sex and sexual orientation and to characterize the concordance of oral and genital HPV infection from the NHANES (National Health and Nutrition Examination Survey).


The overall prevalence of oral HPV infection was 11.5% in men and 3.2% in women (equating to 11 million men and 3.2 million women nationwide). High-risk oral HPV infection was more prevalent among men (7.3%) than women (1.4%). Oral HPV 16 was 6 times more common in men (1.8%) than women (0.3%) (1.7 million men vs. 0.27 million women). Among men and women who reported having same-sex partners, the prevalence of high-risk HPV infection was 12.7% and 3.6%, respectively. Among men who reported having 2 or more same-sex oral sex partners, the prevalence of high-risk HPV infection was 22.2%. Oral HPV prevalence among men with concurrent genital HPV infection was fourfold greater (19.3%) than among those without it (4.4%). Men had 5.4% greater predicted probability of high-risk oral HPV infection than women. The predicted probability of high-risk oral HPV infection was greatest among black participants, those who smoked more than 20 cigarettes daily, current marijuana users, and those who reported 16 or more lifetime vaginal or oral sex partners.