Men face substantial lifelong risk of oral HPV infection

Abstract

Men remain at risk of acquiring an oral human papillomavirus (HPV) infection throughout their lifetime, suggesting a benefit of HPV vaccination in men regardless of age according to a study published in Nature Microbiology.¹

It is well known that oral HPV infections, particularly those with high-risk genotypes, cause oropharyngeal cancer, with HPV-16 found in approximately 90% of all oropharyngeal cancer cases in men in the United States.

Less known is the natural history of oral HPV infection. The current study fills that gap by providing information on rates of newly acquired oral HPV infections and associated risk factors for acquiring HPV infections in a multinational cohort of more than 3000 men from the United States, Brazil, and Mexico who were followed for a median of 57 months.

The study found that the incident rate of any new oral oncogenic HPV infection was 2.4 per 1000 person-months, with men in the United States having a higher incidence (3.5 per 1000 person-months) than men in Brazil and Mexico (2.1 per 1000 person-months for both).

The highest incidence rate of any new oncogenic HPV infection by age was in the youngest cohort (18–24 years) at 2.9 per 1000 person-months, which was followed by 2.2 per 1000 person-months for those 25–32 or 33–41 years old and 2.5 per 1000 person-months for those 42 years old or older.

These incidence rates stayed constant over time, whether for any oncogenic HPV infection or by HPV genotype.

By country, men in the United States had a higher risk of acquiring any oncogenic HPV infection or an HPV-16 infection compared to those in Mexico. No difference was found between men in Brazil and men in Mexico.

Risk factors associated with a higher risk of HPV infection included higher education (13–15 years), alcohol consumption (>60 alcoholic beverages in the past month), having only male sexual partners, a history of three or more female sexual partners, and more frequent performance of oral sex (at least seven times in the past 6 months). Men with one or more lost teeth due to oral disease also had a marginally elevated risk.

In all countries, no association was found between the risk of acquiring a new oral HPV infection and age, indicating that men may remain susceptible throughout their lifetime.

Zachary S. Zumsteg, MD, associate professor of the Department of Radiation Oncology at the Cedars–Sinai Samuel Oschin Comprehensive Cancer Institute, who specializes in head and neck cancers, says that the study provides strong evidence that men continue to be at risk of acquiring an oral HPV infection throughout life.

“One of the most surprising findings of this study is that the likelihood of acquiring an oral HPV infection was similar across age groups among the men enrolled in the study,” he says.

He notes that a prior cross-sectional study using data from the 2009–2010 National Health and Nutrition Examination Survey showed that age accounted for a substantial variation in the incidence of oral HPV infection, with two separate peaks occurring among those aged 30–34 years and those aged 60–64 years.²

Dr Zumsteg says that the study findings have potential implications for HPV vaccination. “There could still be a benefit to receiving HPV vaccination for unvaccinated men in middle and older age groups,” he says.

The lead author of the study, Anna Giuliano, PhD, founding director of the Center for Immunization and Infection Research in Cancer at the Moffitt Cancer Center, said in a press release that “our study underscores the importance of continued vigilance against oral HPV infections.”³

“The consistent rate of HPV acquisition across ages and the significant regional variations call for tailored vaccination strategies and greater awareness to help prevent HPV-related oropharyngeal cancers,” she said.³