Association between different types of oral sexual behaviors and oral HPV in college women: Are all oral sexual behaviors equal?

Introduction: Oral human papillomavirus (oHPV) is globally linked to head and neck cancer, typically of the oropharynx. Studies suggest a relationship between oral sexual behavior (OSB) and oHPV, but it is not clear which types of OSB increase risk. It is important to understand associations of OSB to oHPV in order to determine transmission risk and tailor prevention strategies.

Methods: We enrolled 1,030 women from a university campus to provide an oral rinse specimen and complete a questionnaire on OSB, including kissing, oral-penile, -scrotal, -anal, -vaginal contact and oral self-inoculation, a novel concept. Specimens were tested for any HPV, including 20 subtypes. Exact methods were used in bivariate and logistic regression analyses, adjusted for smoking and alcohol use.

Results: The sample was 50% White, with a mean age of 22. OSB was reported by 5.3-77.5% for specific acts. Oral sexual activities that can lead to self-inoculation were reported by 15.7% (10.7% by hand; 7.5% by sex-toy). oHPV was detected in 1.8%. Number of lifetime partners of kissing, oral-penile contact, and self-inoculation were associated with oHPV infection in bivariate analyses. Multivariable analysis indicated a significant association between oHPV and oral self-inoculation (OR=3.7, 95% CI= 1.4-9.6).

Conclusion: Prevalence of oHPV was consistent with previous research. Behaviors that could result in self-inoculation were important predictors. Although HPV vaccination could prevent cancer-associated oHPV, research indicates that less than 1/3 of young women complete the series. Therefore, patient education regarding potential risk of oHPV via self-inoculation may decrease oHPV incidence and associated risk of oropharyngeal cancer.