title: Concordant Oral-Genital HPV Infection in South Africa Couples: Evidence for Transmission.
abstract: OBJECTIVE
  Cervical cancer is a leading cause of cancer mortality in South Africa. However, little is known about oral human papillomavirus (HPV) infection in high human immunodeficiency virus (HIV) seroprevalence settings.
  
  
  METHODS
  Thirty-four adult heterosexual couples attending an HIV testing center in Soweto, South Africa were enrolled. Each participant provided an oral rinse sample and genital swab, which were tested for 37 types of HPV DNA, and completed a risk behavior survey.
  
  
  RESULTS
  Median age was 31 years and 9% (3/34) of men and 29% (10/34) of women enrolled tested HIV-positive; median CD4 count was 437 cells/mm(3). Oral HPV prevalence was similar in women and men (12 vs. 18%, p = 0.48), and was non-significantly higher in HIV-infected vs. HIV-uninfected (23 vs. 13%, p = 0.34) subjects. Most men (82%) and women (84%) reported ever performing oral sex. Median number of lifetime sexual partners was "2-5" while median number of lifetime oral sex partners was 1. Oncogenic HPV subtypes were detected in 4% of oral, 26% of penile, and 74% of vaginal samples, including HPV16 in 1, 12, and 21% of these samples respectively. Genital HPV prevalence was significantly higher than oral HPV prevalence (75 vs. 15%, p ≤ 0.001). Thirty-five percent of couples (12/34) had at least one type-specific concordant vaginal-penile HPV infection but only one of nine couples with oral HPV had concordant oral-oral infection. However, 67% (4/6) of men and 25% (1/4) of women with oral HPV infection had partners with concordant genital HPV infection. Implications and Impact: Oral-oral HPV concordance between couples is low, but oral-genital and genital-genital HPV concordance is higher, including concordance of male oral HPV infection with their partners' vaginal HPV infection. This data is consistent with possible transmission of vaginal HPV infection to the oral cavity of sexual partners performing oral sex.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh Medical Center , Pittsburgh, PA , USA.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Vogt
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health , Baltimore, MD , USA.
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
authors.affiliation: Perinatal HIV Research Unit, University of Witwatersrand , Johannesburg , South Africa ; Johns Hopkins University School of Medicine , Baltimore, MD , USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
authors.affiliation: Johns Hopkins University School of Medicine , Baltimore, MD , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health , Baltimore, MD , USA.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
keywords: HIV; HPV; South Africa; concordance; genital; oral; oral sex; transmission