Download PDF
Laryngorhinootologie 2020; 99(09): 647-657
DOI: 10.1055/a-1097-1525
CME-Fortbildung

High-Risk-HPV-Infektionen im Kopf-Hals-Bereich – Welche Bedeutung hat das Sexualverhalten?

Sexual Behavior and High-Risk HPV Infection in the Head and Neck
Veronika Innerhofer
,
Barbara Kofler
,
Herbert Riechelmann
› Further Information
Also available at
    Permissions and Reprints

Der Anstieg an Nachweisraten HPV-positiver Oropharynxkarzinome in den letzten 20 Jahren wurde insbesondere mit einer erhöhten Zahl an Oralsexpartnern in Zusammenhang gebracht. In der Regel verläuft eine HPV-Infektion nur über einige Monate und ohne Symptome. Eine Viruspersistenz ist onkogen und wird durch Rauchen begünstigt, weshalb die Kombination von Rauchen und Oralsex mit ≥ 5 Partnern einen besonderen Risikofaktor darstellt.

Abstract

In the second half of the 20th century, the sexual revolution went hand in hand with changes in common sexual practices. At the turn of the millennium, an increase in the detection rate of HPV-positive oropharyngeal carcinomas (OPC) in the USA was observed for the first time. An increase in the OPC was also observed in Europe. It was shown that this increase was due to HPV-positive OPC. However, the detection rate of the HPV-positive OPC has national and regional differences. Within Europe, the highest detection rate is in Northern Europe (56,5 %), followed by Central Europe (37,6 %). An association between patients with OPC and ≥ 6 sexual partners (OR = 1,25) and ≥ 4 oral sex partners (OR = 2,25) has been described. An HPV infection is usually asymptomatic and eliminated by the immune system within a few months. The persistence of the virus is oncogene. Smoking favors virus persistence, which is why the combination of smoking and oral sex with ≥ 5 partners is a particular risk factor. It was also examined whether partners from patients with cervical cancer have an increased oropharyngeal HPV infection rate. There was no definite declaration on this, but further investigations are required. Oral condoms or dental dams are suitable for the prevention of an oral HPV infection. The studies regarding the effectiveness of HPV vaccination for the prevention of an OPC are poor. Authors described a significantly lower detection rate of oral HPV infection in vaccinated people than in non-vaccinated people (0,11 % vs. 1,61 %; p = 0,008).

Schlüsselwörter

Oropharynxkarzinom - Rachenkrebs - HPV - Humanes Papillomavirus - Impfung

Key words

oropharyngeal carcinoma - oropharyngeal cancer - HPV - human papilloma virus - vaccination


Publication History

Article published online:
26 August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Bänziger PP, Beljan M, Eder FX. et al Sexuelle Revolution? Zur Sexualitätsgeschichte seit den 1960er Jahren im deutschsprachigen Raum. Bielefeld: Transcript; 2015: 7-23
    CrossrefGoogle Scholar
  • 2 Willimas ME. The Sexual Revolution. San Diego, CA: Greenhaven; 2002: 240
    Google Scholar
  • 3 Twenge JM, Sherman RA, Wells BE. Declines in Sexual Frequency among American Adults, 1989–2014. Arch Sex Behav 2017; 46: 2389-2401 . doi:10.1007/s10508-017-0953-1
    CrossrefPubMedGoogle Scholar
  • 4 Wellings K, Palmer MJ, Machiyama K. et al Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal). BMJ 2019; 365: l1525 . doi:10.1136/bmj.l1525
    CrossrefPubMedGoogle Scholar
  • 5 Haversath J, Garttner KM, Kliem S. et al Sexual Behavior in Germany. Dtsch Arztebl Int 2017; 114: 545-550 . doi:10.3238/arztebl.2017.0545
    PubMedGoogle Scholar
  • 6 Wittekindt C, Wagner S, Bushnak A. et al Increasing Incidence rates of Oropharyngeal Squamous Cell Carcinoma in Germany and Significance of Disease Burden Attributed to Human Papillomavirus. Cancer Prev Res (Phila) 2019; 12: 375-382 . doi:10.1158/1940-6207.CAPR-19-0098
    CrossrefPubMedGoogle Scholar
  • 7 Chaturvedi AK, Engels EA, Pfeiffer RM. et al Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011; 29: 4294-4301 . doi:10.1200/JCO.2011.36.4596
    CrossrefPubMedGoogle Scholar
  • 8 Klussmann JP, Weissenborn SJ, Wieland U. et al Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas. Cancer 2001; 92: 2875-2884 . doi:10.1002/1097-0142(20011201)92:11<2875::aid-cncr10130>3.0.co;2-7
    CrossrefPubMedGoogle Scholar
  • 9 Ndiaye C, Mena M, Alemany L. et al HPV DNA, E6 / E7 mRNA, and p16INK4a detection in head and neck cancers: a systematic review and meta-analysis. Lancet Oncol 2014; 15: 1319-1331 . doi:10.1016/S1470-2045(14)70471-1
    CrossrefPubMedGoogle Scholar
  • 10 Satterwhite CL, Kamb ML, Metcalf C. et al Changes in sexual behavior and STD prevalence among heterosexual STD clinic attendees: 1993–1995 versus 1999–2000. Sexually transmitted diseases 2007; 34: 815-819 . doi:10.1097/OLQ.0b013e31805c751d
    CrossrefPubMedGoogle Scholar
  • 11 D’Souza G, Kreimer AR, Viscidi R. et al Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007; 356: 1944-1956 . doi:10.1056/NEJMoa065497
    CrossrefPubMedGoogle Scholar
  • 12 Farsi NJ, El-Zein M, Gaied H. et al Sexual behaviours and head and neck cancer: A systematic review and meta-analysis. Cancer epidemiology 2015; 39: 1036-1046 . doi:10.1016/j.canep.2015.08.010
    CrossrefPubMedGoogle Scholar
  • 13 Schnelle C, Whiteman DC, Porceddu SV. et al Past sexual behaviors and risks of oropharyngeal squamous cell carcinoma: a case-case comparison. Int J Cancer 2017; 140: 1027-1034 . doi:10.1002/ijc.30519
    CrossrefPubMedGoogle Scholar
  • 14 Hong A, Lee CS, Jones D. et al Rising prevalence of human papillomavirus-related oropharyngeal cancer in Australia over the last 2 decades. Head Neck 2016; 38: 743-750 . doi:10.1002/hed.23942
    CrossrefPubMedGoogle Scholar
  • 15 Heck JE, Berthiller J, Vaccarella S. et al Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Int J Epidemiol 2010; 39: 166-181 . doi:10.1093/ije/dyp350
    CrossrefPubMedGoogle Scholar
  • 16 Taberna M, Inglehart RC, Pickard RK. et al Significant changes in sexual behavior after a diagnosis of human papillomavirus-positive and human papillomavirus-negative oral cancer. Cancer 2017; 123: 1156-1165 . doi:10.1002/cncr.30564
    CrossrefPubMedGoogle Scholar
  • 17 Eggersmann TK, Sharaf K, Baumeister P. et al Prevalence of oral HPV infection in cervical HPV positive women and their sexual partners. Arch Gynecol Obstet 2019; 299: 1659-1665 . doi:10.1007/s00404-019-05135-7
    CrossrefPubMedGoogle Scholar
  • 18 Uken RB, Brummer O, von Schubert-Bayer C. et al Oral HPV prevalence in women positive for cervical HPV infection and their sexual partners: a German screening study. Eur Arch Oto-Rhino-Laryngol 2016; 273: 1933-1942 . doi:10.1007/s00405-016-3953-1
    CrossrefPubMedGoogle Scholar
  • 19 D’Souza G, Gross ND, Pai SI. et al Oral human papillomavirus (HPV) infection in HPV-positive patients with oropharyngeal cancer and their partners. J Clin Oncol 2014; 32: 2408-2415 . doi:10.1200/JCO.2014.55.1341
    CrossrefPubMedGoogle Scholar
  • 20 Tam S, Fu S, Xu L. et al The epidemiology of oral human papillomavirus infection in healthy populations: A systematic review and meta-analysis. Oral Oncol 2018; 82: 91-99 . doi:10.1016/j.oraloncology.2018.04.005
    CrossrefPubMedGoogle Scholar
  • 21 Stanley MA, Sterling JC. Host responses to infection with human papillomavirus. Curr Probl Dermatol 2014; 45: 58-74 . doi:10.1159/000355964
    CrossrefPubMedGoogle Scholar
  • 22 Schiffman M, Castle PE, Jeronimo J. et al Human papillomavirus and cervical cancer. Lancet 2007; 370: 890-907 . doi:10.1016/S0140-6736(07)61416-0
    CrossrefPubMedGoogle Scholar
  • 23 Haukioja A, Tervahartiala T, Sorsa T. et al Persistent Oral Human Papillomavirus (HPV) Infection is Associated with Low Salivary Levels of Matrix Metalloproteinase 8 (MMP-8). J Clin Virol 2017; 97: 4-9 . doi:10.1016/j.jcv.2017.10.011
    CrossrefPubMedGoogle Scholar
  • 24 Centers for Disease Control and Prevention (CDC). STD Risk and Oral Sex – CDC Fact Sheet. Im Internet (zuletzt abgerufen am 04.05.2020): www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm
    PubMedGoogle Scholar
  • 25 Gupta A, Perkins RB, Ortega G. et al Barrier use during oro-genital sex and oral Human Papillomavirus prevalence: Analysis of NHANES 2009-2014. Oral Dis 2019; 25: 609-616 . doi:10.1111/odi.12997
    CrossrefPubMedGoogle Scholar
  • 26 Lehtinen M, Dillner J. Clinical trials of human papillomavirus vaccines and beyond. Nat Rev Clin Oncol 2013; 10: 400-410 . doi:10.1038/nrclinonc.2013.84
    CrossrefPubMedGoogle Scholar
  • 27 European Medicines Agency (EMA). Gardasil Produktinformation. Im Internet (zuletzt abgerufen am 04.05.2020): www.ema.europa.eu/en/documents/product-information/gardasil-9-epar-product-information_de.pdf
    PubMedGoogle Scholar
  • 28 Suzich JA, Ghim SJ, Palmer-Hill FJ. et al Systemic immunization with papillomavirus L1 protein completely prevents the development of viral mucosal papillomas. Proc Natl Acad Sci U S A 1995; 92: 11553-11557 . doi:10.1073/pnas.92.25.11553
    CrossrefPubMedGoogle Scholar
  • 29 Chaturvedi AK, Graubard BI, Broutian T. et al Effect of Prophylactic Human Papillomavirus (HPV) Vaccination on Oral HPV Infections Among Young Adults in the United States. J Clin Oncol 2018; 36: 262-267 . doi:10.1200/JCO.2017.75.0141
    CrossrefPubMedGoogle Scholar
  • 30 Herrero R, Quint W, Hildesheim A. et al Reduced prevalence of oral human papillomavirus (HPV) 4 years after bivalent HPV vaccination in a randomized clinical trial in Costa Rica. PloS one 2013; 8: e68329 . doi:10.1371/journal.pone.0068329
    CrossrefPubMedGoogle Scholar
  • 31 Mehanna H, Bryant TS, Babrah J. et al Human Papillomavirus (HPV) Vaccine Effectiveness and Potential Herd Immunity for Reducing Oncogenic Oropharyngeal HPV-16 Prevalence in the United Kingdom: A Cross-sectional Study. Clin Infect Dis 2019; 69: 1296-1302 . doi:10.1093/cid/ciy1081
    CrossrefPubMedGoogle Scholar
  • 32 IARC. In Primary End-points for Prophylactic HPV Vaccine Trials. Lyon (FR): 2014
    PubMedGoogle Scholar
  • 33 Wurdemann N, Wagner S, Sharma SJ. et al Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma. Front Oncol 2017; 7: 129 . doi:10.3389/fonc.2017.00129
    CrossrefPubMedGoogle Scholar
  • 34 Klussmann JP, Gultekin E, Weissenborn SJ. et al Expression of p16 protein identifies a distinct entity of tonsillar carcinomas associated with human papillomavirus. Am J Pathol 2003; 162: 747-753 . doi:10.1016/S0002-9440(10)63871-0
    CrossrefPubMedGoogle Scholar
  • 35 Prigge ES, Arbyn M, von Knebel-Doeberitz M. et al Diagnostic accuracy of p16(INK4a) immunohistochemistry in oropharyngeal squamous cell carcinomas: A systematic review and meta-analysis. Int J Cancer 2017; 140: 1186-1198 . doi:10.1002/ijc.30516
    CrossrefPubMedGoogle Scholar
  • 36 Kofler B, Borena W, Manzl C. et al Sensitivity of tumor surface brushings to detect human papilloma virus DNA in head and neck cancer. Oral oncology 2017; 67: 103-108 . doi:10.1016/j.oraloncology.2017.02.013
    CrossrefPubMedGoogle Scholar
  • 37 Gipson BJ, Robbins HA, Fakhry C. et al Sensitivity and specificity of oral HPV detection for HPV-positive head and neck cancer. Oral oncology 2018; 77: 52-56 . doi:10.1016/j.oraloncology.2017.12.008
    CrossrefPubMedGoogle Scholar