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Oral human papillomavirus infection in England and associated risk factors: a case control study.

Hearnden, Vanessa; Murdoch, Craig; D'Apice, Katy; Duthie, Susan; Hayward, Nicholas J; Powers, Hilary Jane


Vanessa Hearnden

Craig Murdoch

Katy D'Apice

Nicholas J Hayward

Hilary Jane Powers


Objectives - This study was conducted to determine the prevalence of and associated risk factors for infection with oral high-risk human papillomavirus (HR-HPV) in adult participants within England, and to explore any association with oral mucosal buccal epithelial cell and whole blood folate concentration. Design - This was an observational study to determine oral HR-HPV prevalence in the study population. A case-control study was performed to explore the association between infection and folate status. Setting - This study was conducted in Sheffield, United Kingdom between April 2013 and August 2014. Participants - Seven hundred participants, aged 18-60 yr, were recruited from university students (n=179), university and hospital staff (n=163), dental hospital patients (n=13), Sexual Health Sheffield patients (n=122) and the general public (n=223). Interventions - Participants completed a lifestyle and sexual behaviour questionnaire, provided an oral rinse and gargle sample for the detection of oral HR-HPV and an oral mucosal buccal epithelial cell sample for the measurement of oral mucosal buccal epithelial cell folate. A blood sample was collected for measurement of whole blood folate concentration. Outcome measures - The prevalence of oral HR-HPV infection in the study population was the primary outcome measure. Secondary outcome measures included associations between risk factors, folate status and infection. Results - The prevalence of oral HR-HPV infection in this cohort was 2.2% (15/680) with 0.7% (5/680) positive for HPV16 or HPV18. Twenty samples were excluded due to insufficient material for HPV detection. Participants with oral HR-HPV infection were more likely to be a former smoker, and have a greater number of sexual and oral sexual partners. Folate status was not linked to likelihood of HPV infection. Conclusions - The prevalence of oral infection with HR-HPV in adult men and women in Sheffield in the north of England was low. Smoking and sexual behaviour were associated with HR-HPV positivity.


HEARNDEN, V., MURDOCH, C., D'APICE, K., DUTHIE, S., HAYWARD, N.J. and POWERS, H.J. 2018. Oral human papillomavirus infection in England and associated risk factors: a case control study. BMJ open [online], 8(8), article number 022497. Available from:

Journal Article Type Article
Acceptance Date Jul 6, 2018
Online Publication Date Aug 19, 2018
Publication Date Aug 31, 2018
Deposit Date Aug 20, 2018
Publicly Available Date Aug 20, 2018
Journal BMJ open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 8
Article Number 022497
Keywords HPV; Head and neck cancer; Oncology; Folate
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