title: Epidemiology of Human Papillomavirus Detected in the Oral Cavity and Fingernails of Mid-Adult Women.
abstract: BACKGROUND
  Oral and fingernail human papillomavirus (HPV) detection may be associated with HPV-related carcinoma risk at these nongenital sites and foster transmission to the genitals. We describe the epidemiology of oral and fingernail HPV among mid-adult women.
  
  
  METHODS
  Between 2011 and 2012, 409 women aged 30 to 50 years were followed up for 6 months. Women completed health and behavior surveys and provided self-collected oral, fingernail, and vaginal specimens at enrollment and exit for type-specific HPV DNA testing. Concordance of type-specific HPV detection across anatomical sites was described with κ statistics. Using generalized estimating equations or exact logistic regression, we measured the univariate associations of various risk factors with type-specific oral and fingernail HPV detection.
  
  
  RESULTS
  Prevalence of detecting HPV in the oral cavity (2.4%) and fingernails (3.8%) was low compared with the vagina (33.1%). Concordance across anatomical sites was poor (κ < 0.20 for all comparisons). However, concurrent vaginal infection with the same HPV type (odds ratio [OR], 101.0; 95% confidence interval [CI], 31.4-748.6) and vaginal HPV viral load (OR per 1 log10 viral load increase, 2.2; 95% CI, 1.5-5.5) were each associated with fingernail HPV detection. Abnormal Papanicolaou history (OR, 11.1; 95% CI, 2.8-infinity), lifetime number of male vaginal sex partners at least 10 (OR vs. 0-3 partners, 5.0; 95% CI, 1.2-infinity), and lifetime number of open-mouth kissing partners at least 16 (OR vs. 0-15 partners, infinity; 95% CI, 2.6-infinity, by exact logistic regression) were each associated with oral HPV detection.
  
  
  CONCLUSIONS
  Although our findings support HPV DNA deposition or autoinoculation between anatomical sites in mid-adult women, the rarity of HPV in the oral cavity and fingernails suggests that oral/fingernail HPV does not account for a significant fraction of HPV in genital sites.
authors.affiliation: From the Departments of *Epidemiology and †Biostatistics, University of Washington, Seattle, WA; ‡FIDALAB, Seattle, WA; §Fred Hutchinson Cancer Research Center, Seattle, WA; and Departments of ¶Pathology and ∥Global Health, University of Washington, Seattle, WA.
authors.forename: Tsung-chieh Jane
authors.initials: TC
authors.lastname: Fu
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Feng
authors.forename: Ayaka
authors.initials: A
authors.lastname: Hulbert
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Hawes
authors.forename: Long Fu
authors.initials: LF
authors.lastname: Xi
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Stern
authors.forename: Laura A
authors.initials: LA
authors.lastname: Koutsky
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Winer
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D015151:Immunoblotting; D008137:Longitudinal Studies; D008875:Middle Aged; D009055:Mouth / Q000821:virology*; D009262:Nails / Q000821:virology*; D030361:Papillomavirus Infections / Q000635:transmission*; D015995:Prevalence; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D014481:United States; D014621:Vagina / Q000821:virology*; D014626:Vaginal Smears / Q000379:methods*; D019562:Viral Load; D016387:Women's Health
chemical_list: D004279:DNA, Viral