Oral human papillomavirus infection in women with cervical HPV infection: new data from an Italian cohort and a metanalysis of the literature.

A key issue in oral HPV infection is whether it can be associated with a genital HPV infection, or whether it can be considered as an independent event. This analysis evaluated the frequency and type-concordance of oral HPV infection in women with cervical HPV infection by means of: (i) a cross-sectional study on a sample (n=98) of Italian women; and (ii) a literature-based metanalysis, including the experimental study the subject of this Paper and nine other published studies (n=1017), which also examined the influence of oral sampling procedure (oral brushing vs oral rinse) and HIV status on oral HPV detection. The prevalence of oral HPV infection in the Italian study was 14.3% (95% CI: 7.4-21.2); the prevalence of type-concordance was 21.4% (95% CI: 0.0-43.6) and it was only marginally significant (P=0.05). The prevalence of oral HPV infection in the metanalysis was estimated as 18.1% (95% CI: 10.3-25.9); the prevalence of type-concordance was 27.0% (95% CI: 12.3-41.7), and it was statistically significant (P=0.002). The metanalysis also showed that the oral sampling procedure was not a determinant of HPV detection; however, HIV status increased the likelihood of oral HPV infection (HIV-positive vs negative: 27.2%; 95% CI: 22.1-32.2 vs 15.5%; 95% CI: 6.9-24.2) and type-concordance (HIV-positive vs negative: 46.8%; 95% CI: 34.7-58.9 vs 15.6%; 95% CI: 0.8-30.4). Oral HPV infection and type-concordance in women with cervical HPV infection are more prevalent than could be expected by chance; this finding is consistent with the notion of a degree of dependence of the oral site on the cervical site. Furthermore, oral HPV prevalence and type-concordance are influenced by immunity.