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Oral human papillomavirus infection in England and associated risk factors: a case–control study
  1. Vanessa Hearnden1,2,3,
  2. Craig Murdoch2,
  3. Katy D’Apice2,
  4. Susan Duthie4,5,
  5. Nicholas J Hayward5,
  6. Hilary Jane Powers1
  1. 1 Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
  2. 2 School of Clinical Dentistry, University of Sheffield, Sheffield, UK
  3. 3 Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
  4. 4 School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
  5. 5 Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Vanessa Hearnden; v.hearnden{at}


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, UK, between April 2013 and August 2014.

Participants Seven hundred participants, aged 18–60 years, 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.

Trial registration number ID14106.

  • HPV
  • head and neck cancer
  • oncology
  • folate

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  • Contributors The study was conceived and designed by HJP and CM, with contribution by VH. VH took charge of the day-to-day running of the project; recruitment and collection of informed consent was the responsibility of VH and KD; KD and VH ran all clinics, collected and processed oral samples. SD and NJH developed, optimised and ran folate assays for oral buccal and RBC samples. All authors contributed to the manuscript preparation and approved the final version.

  • Funding This study was supported by World Cancer Research Fund (WCRF UK), as part of the World Cancer Research Fund International grant programme (Grant number 2012/587).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study is approved by the NHS Humber Bridge Research Ethics Committee (REC reference 13/YH/0060)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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