Date of Award

Spring 5-2019

Degree Name

Master of Science (MS)

Advisor(s)

STACIA DESANTIS, Ph.D

Second Advisor

GEORGE DELCLOS, M.D., M.P.H., Ph.D.

Abstract

Human papillomavirus (HPV) is a common sexually transmitted disease which infects various sites in the body including the genitals, oral cavity, and anal regions. Very little research has assessed the prevalence of concurrent and concordant high risk (HR) HPV oral and genital infections in the general United States population despite the fact that HR HPV oral pharyngeal cancers are on the rise in the US, particularly in men. To further our understanding of HR HPV concurrent and concordant infections we aim to estimate the prevalence of HR HPV concurrent and concordant infections in the U.S. population, and for men and women separately. The next aim is to determine via Monte Carlo simulations, whether HR HPV concurrent and concordant infections happen more than expected by chance, given the population marginal rates of oral and genital infections. Lastly, we characterize predictors of HR HPV concurrent and concordant infections. We use the cross-sectional National Health and Nutrition Examination Survey (NHANES). Participants included women from NHANES 2009-2014 and men from NHANES 2013-2014 who had valid HPV test results. Concurrent infections were identified in 116 (2.5%) individuals in the combined population (65 (4.0%) men and 51 (.76%) women). Simulations showed that the observed prevalence of concurrent infections exceeded the expected prevalence for the combined population, men, and women (1.13%, 4.0%, and .76%, respectively). Similarly, we identified concordant infections in 59 (.99%) of individuals (29 (1.5%) men and 30 (.47%) women). Simulations showed that the observed prevalence of concordant infections exceeded the expected prevalence for the combined population, men, and women (.15%, .26%, and .05% respectively). Our multivariable analysis for men showed marital status, lifetime number of sexual partners, lifetime number of oral sex partners, recent number of oral sex partners, marijuana use, and sexual orientation were all positively associated with HR HPV concurrent infection, and lifetime number of sex partners, recent number of sex partners, and sexual orientation were positively associated with HR concordant infections. Our multivariable analysis for womenshowednopredictorswereassociatedwithHRHPVconcurrentinfections, and cigarette use was positively associated with HR HPV concordant infections. Importantly, our analyses show that HR HPV infections between the oral and genital sites are not independent of one another. We further highlight several factors that are important predictors of HR HPV concurrent and concordant infections. These analyses show the importance of the HPV vaccine and suggest its continued recommendation, perhaps more adamantly in boys and men than previously suggested.

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