title: Cervical, anal and oral HPV in an adolescent inner-city health clinic providing free vaccinations.
abstract: OBJECTIVE
  Published human papillomavirus (HPV) vaccine trials indicate efficacy is strongest for those naive to the vaccine-types. However, few high-risk young women have been followed and cervical HPV has been the predominant outcome measure.
  
  
  METHODS
  We collected cervical and anal swabs, as well as oral rinse specimens from 645 sexually active inner-city young females attending a large adolescent health-clinic in New York City that offers free care and HPV vaccination. Specimens were tested for HPV-DNA using a MY09/MY11-PCR system. Type-specific prevalence of HPV at each anatomic site was compared for individuals by vaccination dose using generalized estimating equation logistic regression models.
  
  
  RESULTS
  The majority of subjects reported being of non-Caucasian (92%) and/or Hispanic ethnicity (61%). Median age was 18 years (range:14-20). All had practiced vaginal sex, a third (33%) practiced anal sex, and most (77%) had also engaged in oral sex. At enrollment, 21% had not received the vaccine and 51% had received three doses. Prevalent HPV infection at enrollment was detected in 54% of cervical, 42% of anal and 20% of oral specimens, with vaccine types present in 7%, 6% and 1% of specimens, respectively. Comparing prevalence for vaccine types, the detection of HPV in the cervix of vaccinated compared to unvaccinated adolescents was significantly reduced: HPV6/11 (odds ratio [OR] = 0.19, 95%CI:0.06-0.75), HPV16 (OR = 0.31, 95%CI:0.11-0.88) and HPV18 (OR = 0.14, 95%CI:0.03-0.75). For anal HPV, the risk of detecting vaccine types HPV6/11 (OR = 0.27, 95%CI:0.10-0.72) and HPV18(OR = 0.12, 95%CI:0.01-1.16) were significantly reduced for vaccinated adolescents however, the risk for HPV16 was not significantly decreased (OR = 0.63, 95%CI:0.18-2.20).
  
  
  CONCLUSIONS
  HPV Prevalence is extremely high in inner-city female adolescents. Administration of the HPV vaccine reduced the risk for cervical HPV; however continued follow-up is required to assess the protection for HPV at all sites in young women with high exposure.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America. nicolas.schlecht@einstein.yu.edu
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schlecht
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.forename: Anne
authors.initials: A
authors.lastname: Nucci-Sack
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Shankar
authors.forename: Ken
authors.initials: K
authors.lastname: Peake
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lorde-Rollins
authors.forename: Richard
authors.initials: R
authors.lastname: Porter
authors.forename: Lourdes Oriana
authors.initials: LO
authors.lastname: Linares
authors.forename: Mary
authors.initials: M
authors.lastname: Rojas
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Angela
authors.initials: A
authors.lastname: Diaz
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000821:virology*; D002584:Cervix Uteri / Q000821:virology*; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D006801:Humans; D009055:Mouth / Q000821:virology*; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000453:epidemiology*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D015995:Prevalence; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines