Abstract
PurposeThis study explores whether gender, age and race differences in oral sexual behavior account for the demographic distribution of oral human papillomavirus infection (HPV) and HPV-positive oropharyngeal cancer (HPV-OSCC)MethodsThis analysis included 2,116 men and 2,140 women from NHANES (2009–10) who answered a behavioral questionnaire and provided an oral-rinse sample for HPV detection. Weighted prevalence estimates and prevalence ratios (PR) were calculated for sexual behaviors and oral HPV infection by gender, age-cohort (20–29, 30–44, 45–59, 60–69), and race, and contrasted with incidence rate ratios (IRR) of OSCC from SEER 2009. Multivariate logistic regression was used to evaluate predictors of oral sexual behavior and oral HPV16 infection.ResultsDifferences in oral sexual behavior were observed by gender, age-cohort and race. Most men (85.4%) and women (83.2%) had ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence than women (each p<0.001). 60–69 year olds (yo) were less likely than 45–59 or 30–44 (yo) to have performed oral sex (72.7%, 84.8%, and 90.3%, p<0.001), although oral HPV16 prevalence was similar. Prevalence ratios (PR) of ever oral sex in men vs. women (PR = 1.03), and 45–59 vs. 30–44 year-old men (PR = 0.96) were modest relative to ratios for oral HPV16 infection (PRs = 1.3–6.8) and OSCC (IRR = 4.7–8.1). In multivariate analysis, gender, age-cohort, and race were significant predictors of oral sexual behavior. Oral sexual behavior was the primary predictor of oral HPV16 infection; once this behavior was adjusted for, age-cohort and race were no longer associated with oral HPV16.ConclusionThere are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups.
Highlights
In recent decades sexual behaviors have changed; the age of sexual initiation has decreased, and the lifetime number of sexual partners has increased. [6,7,8,9,10,11,12] In addition, ever having performed oral sex varies with age and may differ by race, [12] with oral sex being more prevalent among whites (,75%) than blacks (,62%) or Hispanics (,63%). [13,14] Interestingly, the increase in HPVOSCC incidence in the U.S is observed among men and whites, but not among women or blacks
Similar to the differences seen in Human papillomavirus (HPV)-oropharyngeal squamous cell cancers (OSCCs) rates, oral HPV prevalence in the general population varies by gender, age, and race
Differences in Behavior by Race Given the observed differences in prevalence of oral HPV16 infection and incidence of HPV-OSCC among racial groups in the U.S, we evaluated the prevalence of sexual risk factors by race/ethnicity
Summary
Human papillomavirus (HPV), a sexually transmitted infection, causes a subset of oropharyngeal squamous cell cancers (OSCCs). [1] From 1973 to 2004, the incidence of HPV-positive OSCC (HPV-OSCC) in the United States (U.S.) rose steadily, while the incidence of HPV-negative OSCC (HPVn-OSCC) decreased. [2,3] The decline in HPVn-OSCC has largely been attributed to the success of anti-smoking campaigns. [4] By contrast, the recent rise in HPV-OSCC has been speculated to be a result of the sexual revolution coupled with the maturation of the so-called ‘‘baby boom’’ generation [2,5].In recent decades sexual behaviors have changed; the age of sexual initiation has decreased, and the lifetime number of sexual partners has increased. [6,7,8,9,10,11,12] In addition, ever having performed oral sex varies with age and may differ by race, [12] with oral sex being more prevalent among whites (,75%) than blacks (,62%) or Hispanics (,63%). [13,14] Interestingly, the increase in HPVOSCC incidence in the U.S is observed among men and whites, but not among women or blacks. [2] individuals with HPV-OSCC have a distinct demographic profile, tending to be male, younger, and of higher socioeconomic status than those with HPVn-OSCC. [1,15,16,17,18] Studies consistently report that a significantly higher proportion of white (21–64%) than black (0–35%) OSCC cases are HPV-positive. [15,16,17,18,19] The lower proportion of HPV-OSCC among blacks might be explained by a higher incidence of HPVn-OSCC and/or lower rates of HPVOSCC among blacks than whites [16,19,20,21].Similar to the differences seen in HPV-OSCC rates, oral HPV prevalence in the general population varies by gender, age, and race. [22] Presently, it is unclear whether differences in sexual behavior of men, younger age cohorts, and whites, explain the higher oral HPV infection and HPV-OSCC rates in these groups. [15,16,17,18,19] The lower proportion of HPV-OSCC among blacks might be explained by a higher incidence of HPVn-OSCC and/or lower rates of HPVOSCC among blacks than whites [16,19,20,21]. Similar to the differences seen in HPV-OSCC rates, oral HPV prevalence in the general population varies by gender, age, and race. [22] Presently, it is unclear whether differences in sexual behavior of men, younger age cohorts, and whites, explain the higher oral HPV infection and HPV-OSCC rates in these groups. We examined differences in sexual behaviors by gender, age-cohort, and race in a nationally representative sample, to explore whether the observed epidemiologic differences in oral HPV infection and OSCC rates reflect differences in sexual behaviors across these groups
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
