Partners of patients diagnosed with human papilloma virus (HPV)-positive oropharyngeal cancer (OPC) were no more likely to test positive for oral HPV infection than people in the general population, according to a study published in the April 28 online edition of the Journal of Clinical Oncology. The findings should lessen anxiety that OPC cancer is contagious, at least among long-term partners, and confirms that couples who have been together for several years do not need to change their intimacy or sexual behavior because of the cancer diagnosis.

HPV infection is common among men and women in the U.S., but the overwhelming majority of individuals with the infection will not get cancer. The incidence of HPV-positive head and neck cancers, however, has increased significantly over the past 20 years, particularly among non-Hispanic, white U.S. men.

“Patients with HPV-positive oropharyngeal cancers and their partners often worry about oral HPV transmission and wonder about the cancer risk for their partner. These findings provide assurance that the prevalence of oral HPV infections is not increased among long-term partners and their risk of HPV-OPC remains low,” said lead study author Gypsyamber D’Souza, PhD, MPH, MS, an associate professor of Epidemiology at Johns Hopkins Bloomberg School of Public Health. “Couples who have been together for several years have likely already shared whatever infections they have and no changes in their physical intimacy are needed.”

The study, the Human Oral Papillomavirus Transmission in Partners over Time (HOTSPOT), is the first large one to examine oral HPV infection among patients with HPV-caused oropharyngeal cancer and their partners.

The study included 164 individuals with HPV-OPC and 93 spouses/partners. The OPC patients were predominantly male and partners predominantly female. The median age of OPC patients in this study was 56 years. Oral HPV DNA was collected through a 30-second mouth rinse and gargle at diagnosis and again one year later. The oral rinse samples were tested for 36 different subtypes of HPV, including HPV16, the type responsible for most HPV-OPC cases as well as a variety of other cancers.

HPV DNA was detected in 61 percent of HPV-OPC patients at diagnosis. The prevalence of oncogenic oral HPV among the 87 female partners was 1.2 percent, which is comparable to the prevalence among women in the general population. The prevalence among the small number of male partners assessed in this study was also similar to that among men in the general population. HPV16, the subtype responsible for most cases of HPV-OPC, was detected in 54 percent of HPV-OPC patients but not among the partners.

No oral pre-cancers or cancers were detected in the partners during visual oral exam. However, a history of cervical disease was reported by nine (10.3%) partners, and 2 (11.8%) female cases, and 3 (2.0%) male cases reported a previous partner who developed invasive cervical cancer. This is consistent with research showing that male partners of women with cervical cancer have a two-fold increased risk of tonsillar cancer, and suggests cervical HPV and Pap testing for female partners of HPV-OPC patients is appropriate at the time of diagnosis of HPV-OPC.

While caution with new sexual partners is always appropriate, these findings are reassuring in that they affirm that the risk of HPV-OPC remains low among spouses and long-term partners of people with HPV-OPC.

“Oral human papillomavirus (HPV) infection in HPV-positive oropharyngeal cancer cases and their partners” was written by Gypsyamber DSouza, Neil Gross, Sara Pai, Robert Haddad, Karen Anderson, Shirani Rajan, Jen Gerber, Maura Gillison and Marshall Posner.

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This study was supported by the Johns Hopkins Richard Gelb Cancer Prevention Award (G.D.) and a research grant from the Early Detection Research Network (EDRN) U01CA117374 (K.S.A.). Clinical Trials number: NCT01342978

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Susan Sperry
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Johns Hopkins University Bloomberg School of Public Health