By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: The prevalence of human papillomavirus infections and their sequelae remain high, although this is a problem that is preventable with available vaccines.
SOURCES: Tota JE, Giuliano AR, Goldstone SE, et al. Anogenital human papillomavirus (HPV) infection, seroprevalence, and risk factors for HPV seropositivity among sexually active men enrolled in a global HPV vaccine trial. Clin Infect Dis 2022;74:1247-1256.
Berenson AB, Hirth JM, Chang M. Prevalence of oral human papillomavirus infection: Impact of sex, race/ethnicity, and vaccination status. Clin Infect Dis 2022;74:1230-1236.
Tota and colleagues examined the prevalence of human papillomavirus (HPV) infection in sexually active human immunodeficiency virus (HIV)-negative men at the time of their enrollment in a global trial of a quadrivalent HPV vaccine. The following HPV types were included in the test system: HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 — the last five of which are in the 9-valent vaccine but are absent from the quadrivalent product.
The deoxyribonucleic acid (DNA) of one or more of these HPV types was detected in 455/3,463 (13.1%) heterosexual men (HM) and in 228/602 (37.9%) men who have sex with men (MSM). The seroprevalence (a measure of total exposure in this unvaccinated population) was 8.1% in HM from Europe and 29.9% in MSM from North America or Europe. The overall seropositivity risk was higher in MSM, with an adjusted odds ratio of 3.0 (95% confidence interval [CI], 2.4 to 6.4). Most HM and MSM were seronegative for all vaccine types, indicating continued risk. Multivariate analysis failed to identify independent risk factors for HPV DNA positivity in HM, but among MSM these were less frequent condom use, a greater number of receptive anal partners, and younger age at sexual debut.
Berenson and colleagues studied the prevalence of vaccine-type HPV DNA in the oropharynx of 9,437 individuals 18-59 years of age who were able to report their HPV vaccination status. The prevalence of oral HPV infection was 6.9% (95% CI, 6.1% to 7.9%) and was 3.5 times higher in males than in females, regardless of vaccination status. When the analysis was restricted to HPV included in available vaccines, HPV types in the quadrivalent vaccine and 9-valent vaccines were identified 5.5-5.6 times more frequently in males than females.
COMMENTARY
Of the 69,000 new diagnoses of HPV-related cancers in men in the world in 2018, 34,000 were oropharyngeal, 18,000 were penile, and 9,900 were anal. The frequency of oropharyngeal cancer is increasing at a rapid pace in the United States and occurs as much as five times more frequently in males than in females.
Evidence clearly indicates that many of these malignancies are potentially preventable with the use of available HPV vaccines. Although the uptake of such vaccination is increasing, vaccination of males remains limited. In their study of oropharyngeal cancers, the investigators concluded that the observation that males were more likely than females to be HPV positive, regardless of vaccination history, is most consistent with a lower frequency of males being vaccinated prior to their initiation of oral sex. Clearly, all the data point to the importance of vaccination and with improved targeting of males at a young age.
The prevalence of human papillomavirus infections and their sequelae remain high, although this is a problem that is preventable with available vaccines.
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