Barrier Use during Oro-Genital Sex and Oral Human Papillomavirus Prevalence: Analysis of NHANES 2009-2014.

Objectives:  The incidence of Human Papillomavirus (HPV) types 16 and 18 positive oropharyngeal squamous cell carcinomas is increasing. Oral HPV infection is acquired through oro-genital contact. We examined the association between barrier use during oro-genital sex and oral HPV 16/18 prevalence in HPV unvaccinated individuals.

Methods:  A cross-sectional analysis of individuals aged 18-59 years with a history of oro-genital sex was conducted using National Health and Nutrition Assessment Survey (NHANES) from 2009 to 2014. Multivariable logistic regression models were adjusted for gender, total number of oro-genital sex partners, smoking status, and alcohol consumption. Using NHANES sample weights, analysis was weighted for national representation.

Results:  Sample of 4,357 individuals represented 68,680,333 individuals nationally. 6.6% reported always or usually using a barrier during oro-genital sex, and 1.3% were positive for oral HPV 16/18 infection. In the adjusted analysis, barrier users were less likely to be oral HPV 16/18 positive, as compared to those who did not report using a barrier (RR: 0.21; 95% CI: 0.04-0.97; p < 0.05).

Conclusion:  Using barrier during oro-genital sex might help to reduce oral HPV 16/18 prevalence. Hence, the use of a barrier should be promoted not only during vaginal but also during oro-genital sex. This finding is particularly important among HPV unvaccinated individuals.