How prevalent is HPV in vaccinated adolescents?

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In adolescents, detection of a cervical human papillomavirus (HPV) infection may signal an increased risk of detection of the virus in the oral cavity, but incidence declines after vaccination. That is one of the key findings of new research on sexually active female adolescents who received the quadrivalent vaccine.

Methods
Published in JAMA Network Open, the conclusion is from a longitudinal cohort study of repeated collection of oral rinse specimens. Researchers took them from sexually active female adolescents from October 19, 2007 to March 9, 2017 at a large adolescent health center in New York, New York that provides free health care, including HPV vaccination. 

The authors aimed to identify risk factors for oral HPV in sexually active female adolescents receiving the quadrivalent vaccine and the main outcome was prevalence of HPV in the oral cavity. Median age of the 1259 participants was 18. Of them, 50.7% were African American, 45.2% were Hispanic, 3.4% reported another race/ethnicity, and race/ethnicity was unspecified in 0.7%). 

The median age at first sexual activity in the cohort was 14.8 years and 92.2% reported having had oral sex. They were followed up every 6 months until age 25 with collection of oral, cervical, and anal samples for HPV testing.

Results
Of the oral rinse samples taken at baseline, 6.2% contained HPV DNA. Detection of oral HPV decreased significantly with time since first sexual activity, independent of age and concurrent detection of cervical HPV. Comparing 4 or more years with 1 year or less, the odds ratio (OR) was 0.45. Of the oral cases of HPV detection, 88% cleared within 12 months. The authors noted, however, that two participants had persistence of oral HPV for more than 1 year, one with HPV-6/11 and the other with HPV-16. Neither had oral or cervical disease.

Detection of HPV-6, HPV-11, HPV-16, and HPV-18 was significantly lower in participants who had received at least one dose of the quadrivalent HPV vaccine at time of enrollment than in those who were unvaccinated (OR 0.20; 95% CI, 0.04-0.998).

Conclusion
“Although our study population had a greater median number of sexual partners and a younger age at sexual initiation compared with previous studies,” the authors concluded, “we observed a significant vaccination benefit reflected by the lower prevalence of 4vHPV vaccine types. Our findings suggest that concurrent detection of an HPV infection in the cervix may be a risk factor for detection of HPV in the oral cavity.”