Abstract
BackgroundHuman papillomaviruses (HPV) are causally associated with ano-genital and a subset of head and neck cancers. Rising incidence of HPV+ anal cancers and head and neck cancers have now been demonstrated in the developed world over the last decade. The majority of published data on HPV prevalence at the anal and oro-pharyngeal sites are from studies of higher-risk populations. There is a paucity of data on the prevalence of HPV at non-cervical sites in lower risk, non-HIV+ women and this study was designed to provide initial pilot data on a population of women recalled for colposcopy as part of the UK cervical screening programme.Methods100 non-HIV+ women with abnormal cervical cytology, attending clinic for colposcopic examination were recruited. Swabs from the oro-pharyngeal, anal and cervical sites were taken and DNA extracted. HPV detection and genotyping were performed using a standardised, commercially available PCR-line blot assay, which is used to genotype 37 HPV subtypes known to infect the ano-genital and oro-pharyngeal areas. Strict sampling and laboratory precautions were taken to prevent cross-contamination.ResultsThere was a very high prevalence of HPV infection at all three sites: 96.0%, 91.4% and 92.4% at the cervix, anus and oro-pharynx, respectively. Multiple HPV subtype infections were dominant at all 3 mucosal sites. At least one or more HR genotype was present at both the cervix/anus in 39/52 (75.0%) patients; both the cervix/oro-pharynx in 48/56 (85.7%) patients; and both the anus/oro-pharynx in 39/52 (75.0%) patients. HPV 16 infection was highly dominant across all mucosal sites, with over a 2-fold increase over the next most prevalent subtype (HPV 31).ConclusionsWomen with abnormal smears have widespread infection with high-risk HPV at the cervical, anal and oro-pharyngeal mucosal sites and may represent a higher risk population for HPV disease in the future.
Highlights
Human papillomaviruses (HPV) are causally associated with ano-genital and a subset of head and neck cancers
Anal cancer is the most strongly associated with HPV (~90%), yet much less is known of the natural history of anal compared to cervical infection
Patients were tested for the prevalence of HPV infection at two other main mucosal sites, which are clinically relevant to the increasing rates of anal and head and neck cancers observed today
Summary
Human papillomaviruses (HPV) are causally associated with ano-genital and a subset of head and neck cancers. Rising incidence of HPV+ anal cancers and head and neck cancers have been demonstrated in the developed world over the last decade. The majority of published data on HPV prevalence at the anal and oropharyngeal sites are from studies of higher-risk populations. Human papillomavirus (HPV) is associated with 99.7% of cervical cancer cases [1] and implicated in the pathogenesis of other ano-genital malignancies such as anal, vulvar, penile and head and neck cancers. HPV prevalence data from either the anal or oral site in men who have sex with men (MSM) and high-risk women such as sex workers or HIV+ women have been published. Little is known of the prevalence in women from the general population from these non-cervical sites, and to our knowledge, no reports of concurrent infection rates at three different mucosal sites in women have been published
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