title: Sexual behaviors and other risk factors for oral human papillomavirus infections in young women.
abstract: BACKGROUND
  Oral human papillomavirus (HPV) is associated with a rising incidence of certain head and neck cancers, and oral sex has been associated with oral HPV. This study sought to identify more specific patterns of oral sexual activity, including self-inoculation, that are associated with oral HPV infections in young women.
  
  
  METHODS
  A total of 1010 women attending a large university completed a computer-based questionnaire and provided oral specimens that were tested for any oral HPV using a Linear Array assay that detects any HPV as well as 37 HPV genotypes. Twenty-seven women provided additional samples up to 12 months after enrollment. Bivariable and multivariable analyses were conducted to identify oral sexual patterns and other risk factors associated with prevalent oral HPV.
  
  
  RESULTS
  Nineteen women had prevalent oral HPV (1.9%), with 10 women (1%) having a type-specific infection. Oral HPV was significantly associated with lifetime coital sex partnership numbers (P = 0.03), lifetime and yearly oral sex partnership numbers (P < 0.01), and hand and/or sex toy transfer from genitals to mouth (P < 0.001). Oral HPV was also associated with greater use of alcohol, cigarettes, marijuana, and sharing of smoking devices, lipstick, or toothbrushes (P < 0.05 for each), with an apparent dose-response for alcohol use and smoking behavior, stratified by number of sexual partners. Of 7 women with prevalent HPV who provided follow-up samples, none had evidence of a persistent type-specific infection.
  
  
  CONCLUSIONS
  These data provide additional evidence of transmission of oral HPV from oral sexual activity and also suggest possible transmission from self-inoculation or sharing of oral products.
authors.affiliation: From the *Departments of Epidemiology and †Medicine, ‡Student Healthcare Center, §Department of Community Dentistry & Behavioral Science, and ¶Emerging Pathogens Institute, University of Florida, Gainesville, FL; and ∥Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center, Tampa, FL.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Cook
authors.forename: Erika L
authors.initials: EL
authors.lastname: Thompson
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Kelso
authors.forename: John
authors.initials: J
authors.lastname: Friary
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hosford
authors.forename: Phillip
authors.initials: P
authors.lastname: Barkley
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Dodd
authors.forename: Martha
authors.initials: M
authors.lastname: Abrahamsen
authors.forename: Shaun
authors.initials: S
authors.lastname: Ajinkya
authors.forename: Peter Daniel
authors.initials: PD
authors.lastname: Obesso
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Rashid
authors.forename: Anna R
authors.initials: AR
authors.lastname: Giuliano
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000517:prevention & control / Q000821:virology; D005260:Female; D006258:Head and Neck Neoplasms / Q000517:prevention & control / Q000821:virology; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D008385:Marijuana Smoking / Q000009:adverse effects; D008403:Mass Screening; D009061:Mouth Mucosa / Q000473:pathology* / Q000821:virology; D009910:Oral Hygiene; D030361:Papillomavirus Infections / Q000635:transmission*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D019562:Viral Load; D055815:Young Adult