No Apparent Increase in Risk of Oral HPV Infection in Sexual Partners of HPV-Positive Patients With Oropharyngeal Cancer
In a study reported in the Journal of Clinical Oncology, D’Souza et al found that while human papillomavirus (HPV)-positive patients with oropharyngeal cancer had high prevelances of oncogenic oral HPV DNA and oral HPV16 DNA, their sexual partners did not appear to have increased risk of oncogenic oral HPV infection.
Study Details
This prospective study involved 164 HPV-positive patients with oropharyngeal cancer and 93 partners identified by patients as individuals with whom they had been sexually active for ≥ 2 years. Patients were enrolled between October 2009 and May 2013 at four head and neck cancer clinics. Oral rinse samples from patients and partners were evaluated for 36 types of HPV DNA using PGMY 09/11 primers and line-blot hybridization and for HPV16 copy number using quantitative polymerase chain reaction. Oral HPV prevalence was compared with infection rates among persons aged 45 to 65 years using National Health and Nutrition Examination Survey (NHANES) 2009 to 2010 data.
Patients had a median age of 56 years, 90% were men, 97% had performed oral sex with ≥ 1 partner in their lifetime, and 51% were never-smokers. Disease stage was IV in 80%, III in 14.5%, II in 4%, and I in 1%, and 91% of stage IV cases were N2M0. All patients had oncogenic HPV detected in their tumor by in situ hybridization (71%) or p16 (29%) detection, and most (67%) had documented tumor HPV and p16 positivity.
Partners had a median age of 53 years, 94% were women, 98% had performed oral sex, 57% were never-smokers, and 100% were married or living as married. The 71 patients without enrolled partners had partners who were not available or not interested in participating in the study. Patients with and without enrolled partners were similar in most demographics, tobacco and alcohol use, and lifetime sexual behaviors, but those without enrolled partners were less likely to be married (52% vs 100%, P < .001) and more likely to report multiple oral sexual partners in the past year (16% vs 6%, P < .001).
Prevalence Rates
Patients had a high prevalence of oncogenic oral HPV DNA (61%) and oral HPV16 DNA (54%). However, female partners had an oncogenic oral HPV prevalence similar to that in the general population of the same age (1.2% vs 1.3%). No oncogenic oral HPV infections were found in the six male partners in the study.
Cancer Histories
No precancers or cancers were found in partners in oral cancer screening examinations. One partner (1%) and one female patient (6%) had documented history of invasive cervical cancer, and eight partners (9%) and one female patient (6%) reported a history of cervical dysplasia (one confirmed by medical records and others by self-report). Additional self-reported cancer history included a diagnosis of prostate cancer by 4% of male patients and history of breast cancer by 18% of female patients and 5% of female partners.
In reports that could not be confirmed, patients claimed a history of HPV-positive invasive cervical cancer in 2% of partners, oropharyngeal cancer in 1%, and anal cancer in 1%. One partner reported the death of a former husband from oropharyngeal cancer before meeting her current partner, who also developed HPV-positive oropharyngeal cancer.
The investigators concluded, “This study demonstrates that oncogenic oral HPV DNA detection is common among patients with HPV-[positive oropharyngeal cancer] but not among their partners. This is the first study to our knowledge to explore oral HPV prevalence and cancer history in partners of patients…and suggests that cancer risk in these partners remains low. Partners may have been repeatedly exposed to oral HPV during the many years it presumably took for … oral HPV infections to progress to cancer. Therefore, the low oral HPV prevalence detected in partners is notable and suggests that most partners have cleared any oral HPV infections that they may have acquired. This is consistent with initial research that suggested most individuals are able to clear oral HPV infections within 1 or 2 years.”
Gypsyamber D’Souza, PhD, of Johns Hopkins Bloomberg School of Public Health, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Johns Hopkins Richard Gelb Cancer Prevention Award and a grant from the Early Detection Research Network. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
