The epidemiology of oral HPV infection among a multinational sample of healthy men

Background: Oral human papillomavirus type-16 (HPV16) infection is a risk factor for oropharyngeal cancer. We examined oral HPV infection among healthy men. Methods: Oral rinse/gargle specimens and questionnaire data were collected from 1,688 healthy men aged 18 to 74 (median 31 years), from the United States, Mexico, and Brazil. HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 and non-carcinogenic HPV types were detected using Roche Linear Array. Results: Oral HPV DNA was detected in 67 of 1680 (4.0%, 95%CI 3.1% to 5.0%) f- globin positive specimens; carcinogenic HPVs were detected in 1.3% (95%CI 0.8% to 2.0%; n=22) and HPV16 was the most commonly detected carcinogenic HPV type (0.6%, 95%CI 0.2% to 1.1%; n=10). The prevalence of oral HPV infection was similar by country except for HPV55, which had notably higher prevalence in Mexico (3.0%) than Brazil (0%) or the US (0.2%). Oral HPV prevalence non-significantly increased over increasing age categories (p for trend 0.096). The strongest predictor of oral HPV was current tobacco use, which increased the odds 2.5-fold (95%CI 1.4-4.4). Oral sexual behaviors were not associated with oral HPV infection. Conclusions: Oral HPV16 infection was rare in healthy men, especially at younger ages, and was positively associated with current tobacco use. Impact: Oral HPV appears to be ~10 fold less prevalent than infection at genital sites in men (4% vs. ~40%, respectively). It remains unclear whether this reflects reduced exposure or if the oral region is more resistant to HPV infection compared to anogenital site