, et al
Risk of oral human papillomavirus infection among sexually active female adolescents receiving the quadrivalent vaccine
JAMA Netw Open
; doi:

Investigators from multiple institutions in New York state conducted a prospective study to assess the prevalence of oral HPV among sexually active female adolescents and evaluate the effect of quadrivalent HPV vaccine on oral HPV. Study participants were sexually active female adolescents, 13–21 years old, receiving care at a large adolescent clinic in New York City. Study participants completed a questionnaire detailing their sexual history, including age at initiation of sexual activity, number of partners, and types of sexual activity. The participants provided an oral rinse sample that was tested for >40 HPV types. Study outcomes included the presence of any type of HPV in oral samples, prevalence of oncogenic HPV types, and prevalence of HPV types included in the quadrivalent vaccine (HPV-6, HPV-11, HPV-16, and HPV-18). A Fisher exact test was used to compare the prevalence of vaccine HPV types among participants who had received ≥1 dose of vaccine to that of those who were unvaccinated; an additional logistic regression analysis was used to adjust for confounders. Regression analysis was also used to assess the association between oral HPV and time since first sexual activity.

Oral rinse samples were collected in 1,259 female adolescents with a median age of 18 years (age range, 13–21 years). Overall, 50.7% of participants were African American and 45.2% were of Hispanic ethnicity. At the time of enrollment, 69.7% reported having ≥3 sexual partners; the median age of first sexual activity among participants was 14.8 years, and 92.2% reported having oral sex. HPV was detected in oral rinse samples from 78 participants (6.2%; 95% CI, 4.9%–7.7%), with an oncogenic HPV type detected in 21 (1.7%; 95% CI, 1.0%–2.5%) and an HPV vaccine type detected in 8 (0.6%; 95% CI, 0.3%–1.3%). The rate of oral HPV decreased with increasing time since first sexual activity (OR, 0.45; 95% CI, 0.21–0.96, when comparing rates of oral HPV in participants who engaged in sex for ≥4 years to those whose first sexual activity was <1 year before testing). At enrollment, 15.3% of participants had not received any doses of the quadrivalent HPV vaccine. Rates of vaccine type HPV were detected in 2 of 192 female adolescents who were not vaccinated versus 1 of 1,067 in those with ≥1 vaccine doses (P=.06). After adjusting for age and years since first sexual activity, receipt of HPV vaccine was independently associated with a decreased risk of vaccine type oral HPV (OR, 0.20; 95% CI, 0.04–1.00).

The authors conclude that oral HPV is not uncommon in sexually active female adolescents and that HPV vaccination reduces detection of vaccine type HPV in oral samples.

Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use...

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