Abstract
Tobacco use and oral sex (OS) are important risk factors for oral and oropharyngeal Human papillomavirus (HPV) infection. Little is known about the prevalence of OS practice in South Africa. This study aimed to determine the prevalence of OS practice and tobacco use in a South African patient population. This cross-sectional study used a structured questionnaire to collect socio-demographic characteristics, tobacco use, betel nut use and OS practice data from consenting adults (≥18 years; n = 850). Oral sex practices were recorded for patients 18–45 years-old (n = 514). Data analysis included chi-square and multiple logistic regression analyses. Of the study population, 55.2% (n = 468) were female, 88% (n = 748) self-identified as black Africans and 45.1% (n = 383) were unemployed. Furthermore, 19.7% (n = 167), 6.4% (n = 54) and 2.1% (n = 18) were current smokers, snuff users and betel nut users, respectively. Out of the 514 who answered the questionnaire in relation to OS, 22.8% (n = 115) reported to practice it. Oral sex practice in the age group 18–45 years was most common among the self-identified white participants (41.9%); and among tobacco users than among non-tobacco users (30.9% vs. 20.5%; p = 0.022). A multivariable-adjusted regression model showed that white South Africans were more likely to use tobacco than black Africans (OR = 5.25; 95% CI = 2.21–12.47). The practice of OS was more likely among those 18–35 years-old (OR = 1.67; 95% CI = 1.01–2.74), but had no significant association with tobacco use (OR = 1.06; 95% CI = 0.62–1.83). The observed age and ethnic differences in both risk behaviours suggest a need for targeted population intervention in order to reduce the risk for oral HPV infection.
Highlights
The aetiopathogenesis of oropharyngeal squamous cell carcinoma (SCC) has been linked to high-risk human papillomavirus (HPV) infection [1,2,3].While the incidence of SCC of the head and neck is diminishing, that of HPV-related oropharyngeal SCC is increasing [4]. This implies that different aetiologic mechanisms may be at play [5] and support the postulate that HPV-associated SCC is a distinct and separate clinical entity from tobacco and alcohol
Oral sex practice was determined by asking participants whether they were currently engaged in oral sex practice, having their mouth in contact with a partner’s genitalia
A multivariable-adjusted regression model showed that compared to black South Africans, white South Africans were more likely to use tobacco (OR = 5.25; 95% CI = 2.21–12.47) and practice oral sex (OS) (OR = 2.38; 95% CI = 1.06–5.35)
Summary
The aetiopathogenesis of oropharyngeal squamous cell carcinoma (SCC) has been linked to high-risk human papillomavirus (HPV) infection [1,2,3].While the incidence of SCC of the head and neck is diminishing, that of HPV-related oropharyngeal SCC is increasing [4] This implies that different aetiologic mechanisms may be at play [5] and support the postulate that HPV-associated SCC is a distinct and separate clinical entity from tobacco and alcohol-. Earlier oral/oropharyngeal HPV studies were limited by the lack of a standardized meaning for the “oral” vs “oropharyngeal” anatomical compartments. This lead to ambiguity in some reports and care must be taken when interpreting results representative of these two distinct anatomic sites [8,9]. The oropharyngeal site is defined by Paquette and colleagues [9] as “. . .posterior one-third of the tongue, palatine and pharyngeal tonsils, bounded inferiorly by the epiglottis and superiorly by the soft palate.”
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