What Is Oral HPV? The STI Is On The Rise Among American Men, And Here's Why

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You may know that human papillomavirus (HPV) is common among sexually active men and women. However, now a new study has found that oral HPV,  is on the rise among American men. The form of HPV, which is found in the mouth and throat — and many have received from oral sex — can lead to head and neck, cancers.

The study analyzed adults aged 18 to 69 years from NHANES (National Health and Nutritional Examination Survey, 2011 to 2014), who were given a physical examination, including laboratory tests for 37 HPV types, followed by an interview. The findings were published on Oct. 17 in the journal Annals of Internal Medicine. In the U.S., 11 million men have oral HPV versus 3.2 million women. In other words, that's 11.5 percent of men versus 3.2 percent of women, meaning that's almost four times as many men who are affected with it. Suffice it to say, that is a lot.

In case you're not familiar with HPV, it's contracted a variety of ways — and not even necessarily through sex acts themselves. Though most sexually active people have HPV at some point, Dr. Michael Krychman, MD, OB/GYN, sexual medicine gynecologist and the executive director of the Southern California Center for Sexual Health and Survivorship Medicine and co-author of The Sexual Spark: 20 Essential Exercises to Reignite the Passion, tells Bustle, it may not be from sex itself. "HPV is spread through close contact of genital skin. Plus, it's important to note that in most cases, an HPV infection is typically removed and/or cleared by the body. However, other HPV infections are chronic and can lead to health complications." The latter is what people need to watch out for, such as with oral HPV-related effects. "There are many types of HPV, some more high-risk than others at increasing your chance of getting cervical, oral, or anal cancers," Sherry Ross, MD, OB/GYN, and women's health expert, tells Bustle.

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The Centers for Disease Control and Prevention (CDC) says that there are over 100 types of HPV. Overall, HPV is so popular, in fact, that it's the most common STI in the United States. The CDC states that nearly 80 million people — about one in four — are currently infected with HPV in the U.S. However, nine types are the high-risk ones Ross indicates above, and those in particular are the ones to monitor.

"One suspects that the HPV persists longer (means doesn't clear easily) among men and that might be causing increased prevalence," Ashish A. Deshmukh, senior author of the study and an assistant professor at the University of Florida's College of Public Health and Health Professions, said in an email, reported CNN. "It is also possible that men acquire oral HPV more readily than women. Further research is needed to understand the reason behind this." As for the study participants, about 11.5 percent had had an oral HPV infection.    

Oral HPV And Cancer

Between 2008 and 2012 in the U.S., annually, there was an average of 38,793 cases of HPV-related cancer, 59 percent in women and 41 percent in men, according to CNN. But as far as oropharyngeal squamous cell carcinoma, a type of head and neck cancer, more men were diagnosed per year than women — 12,638 versus 3,100, respectively. This makes it the most common among HPV-related cancers — more men get this type of HPV-related cancer compared to women who get cervical cancer from HPV, 7.8 per 100,000 men compared to 7.4 per 100,000 women.

"One of the problems with this particular STI is that most people are unaware that they carry HPV, especially men."

But why? The study found that certain factors could make oral HPV more common in men, such as men with genital HPV infections, men who have had multiple sex partners, and men who reported having sex with men. Cigarette and marijuana use were factors, too. "Our study is also first to show that oral HPV infection prevalence was higher among Black men compared to White men (three percent greater risk), those men who smoked more than 20 cigarettes daily compared to never smokers (10 percent greater risk), current marijuana users (six percent greater risk), and men who have had more than 16 lifetime sexual partners (almost 20 percent greater risk)," Deshmukh told CNN.

The most prevalent type of high-risk HPV is HPV 16, the one that contributes to head and neck cancers. This was six times higher among men, 1.8 percent, than women, 0.3 percent, and most common in men 50 to 69 years old, the researchers said. "The rates of oropharyngeal cancer among men have risen more than 300 percent in the past 40 years making oropharyngeal cancer most common HPV-related cancer in the United States," Deshmukh told CNN. "In contrast, the rates of oropharyngeal cancer among women have declined."

Can Oral HPV Be Prevented?

While there is a vaccine for HPV, Gardasil 9, which protects against the nine most common types of HPV, including HPV 16, it's not foolproof. Plus, the CDC recommends it for certain age groups only: from adolescents, 11 and 12, up to 21-year-olds for men and 26-year-olds for women. Some doctors will give their patients the vaccine anyway, even if they are outside these age parameters, but it is a case-by-case basis.

For instance, Dr. Ross had a patient in her early 40s who wanted the vaccine. "I supported her decision to get the HPV vaccination even though she is in her 40s and it's not completely supported by the medical community," says Dr. Ross. "One of the problems with this particular STI is that most people are unaware that they carry HPV, especially men. Unfortunately, men do not have an equivalent to the Pap smear, which allows detection of HPV. Unless men have warts or a history of warts, they have no way of detecting this epidemic virus. Even a condom does not provide complete protection against HPV since the virus may live at the base of the penis or in other exposed areas, thereby allowing it to pass to their partner during sexual intercourse."

Even if more men received the HPV vaccine, "it will need at least 20-30 years to reverse the rising rates of oropharyngeal cancer among U.S. men because majority of men at risk for this cancer are already older than vaccine eligibility age," Deshmukh said. "We have methods to screen for cervical cancer; however, we still don't have ways to detect oropharyngeal precancer."

How To Talk About Your Sexual Health With Your Partner

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So if not everyone is getting vaccinated, and even if they were, it's not a 100 percent guarantee that they will not get HPV, how can it be prevented? Safe sex. "It's always important to discuss your past sexual history with a potential partner," Dr. Krychman says. "There is no stigma about this, as you want to protect yourself from the STI as well as the potential far-reaching complications. Open, frank discussions protect both you and your partner. Caring about your health and the health of your partner's is paramount for a healthy, productive, and intimate relationship."

Dr. Ross agrees with Dr. Krychman about being open with your partner about your sexual health — and the sooner, the better. "I advocate talking to a new partner before you get intimate," she says. "I'd suggest having this conversation before you have a couple of drinks and before you've strewn your clothes around the room. Have it on a date or during dinner if you feel the relationship is heading towards sexual intimacy. Make it part of your dating routine to bring up the subject of STIs. As unromantic as it may seem, make it a priority even before kissing. Honesty is the best policy, especially in the bedroom."

While no HPV prevention is foolproof, all anyone can do is take as many safe-sex precautions as possible, as well as have regular check-ups with their doctors so that they can stay on top of their health.