Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014

Ann Intern Med. 2017 Nov 21;167(10):714-724. doi: 10.7326/M17-1363. Epub 2017 Oct 17.


Background: The burden of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men, yet empirical evidence regarding the difference in prevalence of oral HPV infection between men and women is limited. Concordance of oral and genital HPV infection among men is unknown.

Objective: To determine the prevalence of oral HPV infection, as well as the concordance of oral and genital HPV infection, among U.S. men and women.

Design: Nationally representative survey.

Setting: Civilian noninstitutionalized population.

Participants: Adults aged 18 to 69 years from NHANES (National Health and Nutrition Examination Survey), 2011 to 2014.

Measurements: Oral rinse, penile swab, and vaginal swab specimens were evaluated by polymerase chain reaction followed by type-specific hybridization.

Results: The overall prevalence of oral HPV infection was 11.5% (95% CI, 9.8% to 13.1%) in men and 3.2% (CI, 2.7% to 3.8%) 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% [CI, 6.0% to 8.6%]) than women (1.4% [CI, 1.0% to 1.8%]). Oral HPV 16 was 6 times more common in men (1.8% [CI, 1.3% to 2.2%]) than women (0.3% [CI, 0.1% to 0.5%]) (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% (CI, 7.0% to 18.4%) and 3.6% (CI, 1.4% to 5.9%), respectively. Among men who reported having 2 or more same-sex oral sex partners, the prevalence of high-risk HPV infection was 22.2% (CI, 9.6% to 34.8%). Oral HPV prevalence among men with concurrent genital HPV infection was 4-fold greater (19.3%) than among those without it (4.4%). Men had 5.4% (CI, 5.1% to 5.8%) 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.

Limitation: Sexual behaviors were self-reported.

Conclusion: Oral HPV infection is common among U.S. men. This study's findings provide several policy implications to guide future OPSCC prevention efforts to combat this disease.

Primary funding source: National Cancer Institute.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Genital Diseases, Female / epidemiology*
  • Genital Diseases, Female / ethnology
  • Genital Diseases, Male / epidemiology*
  • Genital Diseases, Male / ethnology
  • Homosexuality
  • Humans
  • Male
  • Middle Aged
  • Mouth Diseases / epidemiology*
  • Mouth Diseases / ethnology
  • Mouth Diseases / virology
  • Nutrition Surveys
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / ethnology
  • Pharyngeal Diseases / epidemiology*
  • Pharyngeal Diseases / etiology
  • Pharyngeal Diseases / virology
  • Prevalence
  • Risk Factors
  • Sex Distribution
  • Sexual Behavior
  • Young Adult