Risk of Oral Human Papillomavirus Infection Among Sexually Active Female Adolescents Receiving the Quadrivalent Vaccine

Nicolas F. Schlecht, Martin Masika, Angela Diaz, Anne Nucci-Sack, Anthony Salandy, Sarah Pickering, Howard D. Strickler, Viswanathan Shankar, Robert D. Burk

Research output: Contribution to journalArticle

Abstract

Importance: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and oral HPV infection is associated with increased risk of oropharyngeal cancer. Objective: To describe the risk factors for oral HPV in sexually active female adolescents receiving the quadrivalent vaccine. Design, Setting, and Participants: Longitudinal cohort study involving repeated collection of oral rinse specimens from sexually active female adolescents conducted between October 19, 2007, and March 9, 2017, at a large adolescent health center in New York, New York, that provides free health care, including HPV vaccination. Exposures: Human papillomavirus vaccination and self-reported history of sexual behavior. Main Outcomes and Measures: Prevalence of HPV in the oral cavity. Results: Among the 1259 participants who were included in this study, median age at entry into the study was 18 (range, 13-21) years; 638 (50.7%) were of African American descent, 569 (45.2%) were of Hispanic descent, 43 (3.4%) reported another race/ethnicity, and race/ethnicity was unspecified for 9 (0.7%). The median (mode) age at first sexual activity was 14.8 (14) years, and 1161 (92.2%) reported having had oral sex. Human papillomavirus DNA was detected in baseline oral rinse samples of 78 of the 1259 participants (6.2%; 95% CI, 4.9%-7.6%). There was a significant decrease in oral HPV detection with time (in years) since first engaging in sexual activities, independent of age and concurrent detection of cervical HPV; comparing 4 or more years with 1 year or less, the odds ratio was 0.45 (95% CI, 0.21-0.96). Detection of vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18) was significantly lower among participants who had received at least 1 dose of the quadrivalent HPV vaccine at the time of enrollment compared with those who were unvaccinated (odds ratio, 0.20; 95% CI, 0.04-0.998). Conclusions and Relevance: This study's findings suggest that detection of HPV in the oral cavity is not uncommon in sexually active female adolescents. In addition, HPV vaccination is associated with a significant decrease in detection of HPV vaccine types in the oral cavity.

Original languageEnglish (US)
Pages (from-to)e1914031
JournalJAMA Network Open
Volume2
Issue number10
DOIs
StatePublished - Oct 2 2019

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Papillomavirus Infections
Vaccines
Sexual Behavior
Mouth
Papillomavirus Vaccines
Vaccination
Gammapapillomavirus
Odds Ratio
Oropharyngeal Neoplasms
Human papillomavirus 11
Human papillomavirus 18
Human papillomavirus 16
Sexually Transmitted Diseases
Hispanic Americans
African Americans
Longitudinal Studies
Cohort Studies
Outcome Assessment (Health Care)
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

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Risk of Oral Human Papillomavirus Infection Among Sexually Active Female Adolescents Receiving the Quadrivalent Vaccine. / Schlecht, Nicolas F.; Masika, Martin; Diaz, Angela; Nucci-Sack, Anne; Salandy, Anthony; Pickering, Sarah; Strickler, Howard D.; Shankar, Viswanathan; Burk, Robert D.

In: JAMA Network Open, Vol. 2, No. 10, 02.10.2019, p. e1914031.

Research output: Contribution to journalArticle

Schlecht, Nicolas F. ; Masika, Martin ; Diaz, Angela ; Nucci-Sack, Anne ; Salandy, Anthony ; Pickering, Sarah ; Strickler, Howard D. ; Shankar, Viswanathan ; Burk, Robert D. / Risk of Oral Human Papillomavirus Infection Among Sexually Active Female Adolescents Receiving the Quadrivalent Vaccine. In: JAMA Network Open. 2019 ; Vol. 2, No. 10. pp. e1914031.
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abstract = "Importance: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and oral HPV infection is associated with increased risk of oropharyngeal cancer. Objective: To describe the risk factors for oral HPV in sexually active female adolescents receiving the quadrivalent vaccine. Design, Setting, and Participants: Longitudinal cohort study involving repeated collection of oral rinse specimens from sexually active female adolescents conducted between October 19, 2007, and March 9, 2017, at a large adolescent health center in New York, New York, that provides free health care, including HPV vaccination. Exposures: Human papillomavirus vaccination and self-reported history of sexual behavior. Main Outcomes and Measures: Prevalence of HPV in the oral cavity. Results: Among the 1259 participants who were included in this study, median age at entry into the study was 18 (range, 13-21) years; 638 (50.7{\%}) were of African American descent, 569 (45.2{\%}) were of Hispanic descent, 43 (3.4{\%}) reported another race/ethnicity, and race/ethnicity was unspecified for 9 (0.7{\%}). The median (mode) age at first sexual activity was 14.8 (14) years, and 1161 (92.2{\%}) reported having had oral sex. Human papillomavirus DNA was detected in baseline oral rinse samples of 78 of the 1259 participants (6.2{\%}; 95{\%} CI, 4.9{\%}-7.6{\%}). There was a significant decrease in oral HPV detection with time (in years) since first engaging in sexual activities, independent of age and concurrent detection of cervical HPV; comparing 4 or more years with 1 year or less, the odds ratio was 0.45 (95{\%} CI, 0.21-0.96). Detection of vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18) was significantly lower among participants who had received at least 1 dose of the quadrivalent HPV vaccine at the time of enrollment compared with those who were unvaccinated (odds ratio, 0.20; 95{\%} CI, 0.04-0.998). Conclusions and Relevance: This study's findings suggest that detection of HPV in the oral cavity is not uncommon in sexually active female adolescents. In addition, HPV vaccination is associated with a significant decrease in detection of HPV vaccine types in the oral cavity.",
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AU - Nucci-Sack, Anne

AU - Salandy, Anthony

AU - Pickering, Sarah

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AU - Shankar, Viswanathan

AU - Burk, Robert D.

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N2 - Importance: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and oral HPV infection is associated with increased risk of oropharyngeal cancer. Objective: To describe the risk factors for oral HPV in sexually active female adolescents receiving the quadrivalent vaccine. Design, Setting, and Participants: Longitudinal cohort study involving repeated collection of oral rinse specimens from sexually active female adolescents conducted between October 19, 2007, and March 9, 2017, at a large adolescent health center in New York, New York, that provides free health care, including HPV vaccination. Exposures: Human papillomavirus vaccination and self-reported history of sexual behavior. Main Outcomes and Measures: Prevalence of HPV in the oral cavity. Results: Among the 1259 participants who were included in this study, median age at entry into the study was 18 (range, 13-21) years; 638 (50.7%) were of African American descent, 569 (45.2%) were of Hispanic descent, 43 (3.4%) reported another race/ethnicity, and race/ethnicity was unspecified for 9 (0.7%). The median (mode) age at first sexual activity was 14.8 (14) years, and 1161 (92.2%) reported having had oral sex. Human papillomavirus DNA was detected in baseline oral rinse samples of 78 of the 1259 participants (6.2%; 95% CI, 4.9%-7.6%). There was a significant decrease in oral HPV detection with time (in years) since first engaging in sexual activities, independent of age and concurrent detection of cervical HPV; comparing 4 or more years with 1 year or less, the odds ratio was 0.45 (95% CI, 0.21-0.96). Detection of vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18) was significantly lower among participants who had received at least 1 dose of the quadrivalent HPV vaccine at the time of enrollment compared with those who were unvaccinated (odds ratio, 0.20; 95% CI, 0.04-0.998). Conclusions and Relevance: This study's findings suggest that detection of HPV in the oral cavity is not uncommon in sexually active female adolescents. In addition, HPV vaccination is associated with a significant decrease in detection of HPV vaccine types in the oral cavity.

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