Prevention of oral human papillomavirus infection

摘要

To the Editor: Dr Schlecht's Editorial adds context to the report on the epidemiology of oral human papillomavirus (HPV) infection based on the National Health and Nutrition Examination Survey (NHANES). However, the subtitle undercuts some reassuring observations, such as the relatively low prevalence of oral HPV infection (6.9%) compared with anogenital infection and the 1 % prevalence of oral HPV-16, the main type associated with oropharyngeal squamous cell carcinoma.The suggestion that barrier protection would prevent oral HPV is unsupported. Orogenital exposure was not independently associated with oral HPV in the NHANES sample,and other transmission mechanisms are likely to contribute to oral HPV infection, such as autoinoculation from genital infection and indirect exposure to genital secretions during other sexual practices. Condoms reduce HPV transmission to women by vaginal intercourse, but even a modest lapse in consistent use ablates the protective effect. It is difficult enough to influence sexually active persons to adopt evidence-based prevention strategies, and promoting strategies with inherently low acceptability and little likelihood of success risks undermining those efforts. There are cogent arguments for barriers for oral sex in some settings, but clinicians should not tell their patients it would reduce their risk of oral HPV or throat cancer.