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Not Too Surprising: Oral Sex Linked to Oral HPV Infections

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A study published in the Journal of Infectious Diseases suggests oral sex and deep kissing are risks for acquiring oral HPV infections.

Gypsyamber D’Souza, Ph.D., and colleagues previously demonstrated that oral sex is a risk for cancers of the oropharynx (tongue, soft palate, and tonsils). The American Cancer Society estimates there are about 34,000 cases of oropharyngeal cancer each year in the U.S. Heavy tobacco and alcohol use is strongly linked to these diseases, but “high risk” HPV plays a role with half or more of oropharyngeal cancers.

Does this mean that sexual behaviors are a risk for acquiring oral HPV infections? To examine the potential link, the investigators collected demographic and sexual behavior information from two cohorts: Patients with no history of cancer who were part of a control group in head and neck cancer research, and college-age men. Oral samples were collected and tested for HPV DNA.

Oral HPV prevalence was low in both groups, 4.8% in the control and 2.9% in the young men, respectively. With the controls, the risk of oral HPV infection was greater as the number of lifetime oral and vaginal sex partners increased (10 or more oral sex partners or 25 or more vaginal sex partners). 

Among the young men, the risks were elevated as the number of oral sex and open-mouth kissing partners increased (vaginal sex was not a risk for oral HPV in this group). Oral HPV was detected most often among those who, in the last 12 months, had six or more oral sex or open-mouth kissing partners. In a subset of men with no reported history of oral sex, higher rates of oral HPV infection were found among those with 10 or more lifetime or five or more recent deep-kissing partners.

The investigators conclude that oral sexual behaviors associated with oropharyngeal cancers are also linked with oral HPV infections, and that deep kissing is also a risk.

Studies such as this inevitably lead some partners of those diagnosed with genital HPV to wonder if it’s safe to engage in oral sex. It should be pointed out that the vast majority of cases of HPV don’t lead to cancer. Cancers of the oropharynx–while they occur more often than cervical cancer–are still not common and don’t develop quickly, usually taking 10 years or longer.

There are few guidelines regarding oral sex and HPV, apart from common sense precautions of abstaining while skin lesions related to the virus are present (including cervical cell changes detected on Pap tests). The effectiveness of latex barriers (condoms, dental dams, and even household plastic wrap) in reducing oral HPV transmission hasn’t been studied, but some experts say they have value in protecting against other STIs when performing oral sex and may also reduce the risk of acquiring HPV.

References
G D’Souza, Y Agrawal, J Halpern, S Bodison, M Gillison. Oral Sexual Behaviors Associated with Prevalent Oral Human Papillomavirus Infection. Journal of Infectious Diseases, 2009. 199 (9): 1263-69.
G D’Souza, A Kreimer,R Viscidi, M Pawlita, C Fakhry, Wayne M. Koch, W Westra, M Gillison. Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer. New England Journal of Medicine, 2007.
Cervical Intraepithelial Neoplasia. www.clinicaltrials.gov (study NCT00303823) http://clinicaltrials.gov/ct2/show/study/NCT00303823

 

HIV Risk Greater among Gay Men with Anal HPV

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Investigators at the University of California, San Francisco say anal HPV infection increases the risk of HIV acquisition among men who have sex with men (MSM).

The Centers for Disease Control and Prevention says having a sexually transmitted infection (STI) increases susceptibility to HIV 3-5 fold: Breaks in the skin caused by ulcerations from genital herpes and syphilis, for example, make it easier for fluids containing HIV to enter the system. Other STIs, such as chlamydia and gonorrhea, leave skin intact but provoke a response from the immune system that boosts the types of cells that HIV targets.

While the STI/HIV co-infection link is well established, little is known about the specific role HPV may play in increasing HIV susceptibility. To examine the potential HPV/HIV relationship, Peter V. Chin-Hong, MD, from the University of California, San Francisco, and colleagues recruited 1409 HIV-negative MSM who reported having insertive or receptive anal sex over the last year. Subjects were tested for anal HPV (57% had anal HPV detected at baseline), and also tested for HIV at baseline and six month intervals. 

Over 12 to 48 months of follow-up, 51 participants tested positive for HIV, and 81% of them also were positive for anal HPV. Men with more than one type of HPV detected were at greatest risk of acquiring HIV. The authors said that while it isn’t clear exactly how HPV elevates the risk for HIV, the connection may be similar to that observed with other STIs; that is, greater concentration of susceptible immune cells in the affected area, and small skin lesions that allow HIV easier access.

Reference
P Chin-Hong, M Husnik, R Cranston, G Colfax, S Buchbinder, M Da Costa, T Darragh, D Jones, F Judson, B Koblin, K Mayer, J Palefsky. Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS, 2009. 23(9),1135–42.

 

Smoking Hampers HPV Clearance in Adolescents

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Adolescent females who smoke have a more difficult time clearing abnormal cervical cell changes, a recent study finds.

Evidence that links smoking with HPV persistence and increased cervical cancer risk has been mounting for years. According to the American Cancer Society, women who smoke double their risk of developing the disease. While the interaction between puffing and HPV/cancer isn’t totally understood, experts believe smoking may diminish immune cells that are critical in clearing the virus. Young woman smoking

The stack of evidence that implicates smoking just got a bit higher. From 2004 through 2006, investigators at the Lehigh Valley Hospital in Allentown, PA followed 125 female patients at the between the ages of 12-22 years who had dysplasia (abnormal cervical cell changes most often due to “high risk” HPV types, especially in younger women). Information was collected on patient race, history of smoking, number of sex partners, contraception type and use.

Dysplasia cleared naturally with most cases (57.6%), and the only variable associated with persistent abnormalities was smoking, which the investigators say places “smokers at increased risk of advanced [cervical] diseases.”

Go to www.smokefree.gov for resources and tools on stopping smoking. This service of the National Cancer Institute also offers expert help and support through phone and text messages.

Reference
C. Chen, F. Campbell, J. Patruno, S. Kimmel, R. Boulay, C. Meyers, M. Martino. Factors associated with regression of cervical dysplasia in adolescents: A retrospective study. Journal of Clinical Oncology, 2009. 27 (15S); 5582.

 


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