Incidence and clinical management of oral human papillomavirus infection in men: a series of key short messages

Abstract

Oral human papillomavirus (HPV) infections are less prevalent than genital and anal infections. However, the incidence of oropharyngeal squamous cell carcinomas has increased significantly over the last 2 decades in several countries. At least 90% of these cancers are associated with oncogenic type HPV16. Oral HPV infections are notably more frequent in men than in women, and the incidence of HPV-positive oropharyngeal squamous cell carcinomas has increased, predominantly among mid-adult men. Nevertheless, little is known about the progression of oral HPV infection to cancer, and it remains unclear which medical interventions should be applied to modify the natural history of the disease. This narrative review aimed at non-experts in HPV infection provides an update on oral HPV infection and its clinical management in men. Furthermore, using the cervix as a reference anatomical site, the lessons learned from investigations on cervical HPV infection are also addressed.

Keywords::

• clinical management
• human papillomavirus
• men
• oral infection
• oropharyngeal squamous cell carcinomas

Acknowledgements

We are grateful to Thomas O’Boyle for proofreading manuscript.

Financial & competing interests disclosure

This work was supported by Lluita contra la SIDA Foundation. B. CLOTET has received honoraria for speaking and participating on advisory boards from Abbott, Bristol-Myers Squibb, Boehringer-Ingelheim, Gilead Sciences, GlaxoSmithKline, Pfizer, Merck, Janssen-Tibotec and Siemens. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Human papillomavirus (HPV) infection is one of the commonest sexually transmitted viral infections. Although HPV infection is usually harmless and clears spontaneously, it is causally linked to squamous cell carcinoma at various sites (cervix, anus, vulva, penis and oropharynx), thus making it a major public health problem.

• Little is known about the natural history of oral HPV infection. It is less prevalent than HPV infection at other sites, such as the cervix and the anus, and is more prevalent in men than in women, and in HIV-infected individuals than in the general population.

• HPV16 is the most prevalent high-risk oncogenic genotype. At least 90% of oropharyngeal squamous cell carcinomas are associated with this type.

• The incidence of oropharyngeal squamous cell carcinoma has increased significantly over the last two decades in several countries, predominantly among mid-adult men. Consequently, the clinical impact of this disease in men in the near future (2020) gives cause for concern. It has been suggested that the incidence of HPV-associated oropharyngeal cancer might exceed that of HPV-associated cervical cancer by the end of this decade.

• It remains unclear which medical interventions should be applied to modify the natural history of oral HPV infection (from infection to oropharyngeal cancer). In fact, screening for oral HPV infection using only a molecular marker is uninformative (although it could prove useful for performing a close follow-up of oral HPV-infected patients), and screening for oral HPV-associated cytological lesions seems impractical.

• In this scenario, vaccination against HPV can be an effective medical intervention for primary prevention of oral infection. However, clinical research programs on vaccination aimed at preventing oral HPV infection are urgently needed to consolidate the role of vaccination in primary prevention. Likewise, until evidence on the efficacy of the HPV vaccine becomes available, the frequency of oral HPV infection and oropharyngeal cancer could be reduced with parallel promotion of education programs (for both clinicians and the public), periodic and systematic visual examination, and laryngoscopy (at-risk patients).