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Human papillomavirus (HPV) vaccination and oropharyngeal HPV in ethnically diverse, sexually active adolescents: community-based cross-sectional study
  1. Sarah Kerry-Barnard1,
  2. Simon Beddows2,
  3. Fiona Reid3,
  4. Nicholas Beckley-Hoelscher3,
  5. Kate Soldan2,
  6. Kavita Panwar2,
  7. Cangul Seran2,
  8. Charlotte Fleming4,
  9. Agata Lesniewska1,
  10. Tim Planche5,
  11. Jonathan Williamson1,
  12. Phillip Hay6,
  13. Pippa Oakeshott1
  1. 1Population Health Research Institute, St George's University of London, London, UK
  2. 2National Infection Service, Public Health England, London, UK
  3. 3School of Population Health and Environmental Sciences, King's College London, London, UK
  4. 4Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Public Health, London, UK
  5. 5Infection and Immunity, St George's University of London, London, UK
  6. 6Burrell Street Sexual Health Clinic, Guys and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Professor Pippa Oakeshott, Population Health Research Institute, University of London Saint George's, London SW17 ORE, UK; oakeshot{at}


Objectives Oropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-associated cancer in the UK, but little is known about the prevalence of oropharyngeal HPV in sexually active teenagers. We investigated reported HPV vaccination coverage (in females) and prevalence of oropharyngeal HPV in sexually active students attending six technical colleges in London, UK.

Methods In 2017, we obtained mouthwash samples and questionnaires from male and female students taking part in the ‘Test n Treat’ chlamydia screening trial. Samples were subjected to HPV genotyping.

Results Of 232 participants approached, 202 (87%) provided a mouthwash sample and questionnaire. Participants’ median age was 17 years and 47% were male. Most (73%) were from black and minority ethnic groups, 64% gave a history of oral sex, 52% reported having a new sexual partner in the past 6 months, 33% smoked cigarettes, 5.9% had concurrent genitourinary Chlamydia trachomatis infection and 1.5% Neisseria gonorrhoeae and 5.0% were gay or bisexual. Only 47% (50/107) of females reported being vaccinated against HPV 16/18, of whom 74% had received ≥2 injections. HPV genotyping showed three mouthwash samples (1.5%, 95% CI 0.3% to 4.3%) were positive for possible high-risk human papillomavirus (HR-HPV), one (0.5%, 0.0% to 2.7%) for low-risk HPV 6/11, but none (0.0%, 0.0% to 1.8%) for HR-HPV. Four samples (2.0%, 0.5% to 5.0%) were positive for HPV16 using a HPV16 type-specific quantitative PCR, but these were at a very low copy number and considered essentially negative.

Conclusions Despite the high prevalence of oral sex and genitourinary chlamydia and low prevalence of HPV vaccination, the prevalence of oropharyngeal HR-HPV in these adolescents was negligible.

  • HPV
  • vaccination
  • oral sex
  • adolescent

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  • Handling editor Anna Maria Geretti

  • Contributors PH, SKB, SB, FR, TP, CF and PO designed the study. KP, CS and AL did the laboratory testing. JW assisted with data collection. SB, SKB, NB-H and FR conducted the analysis. SKB wrote the first draft and all authors contributed to the preparation of the manuscript.

  • Funding The BMA Foundation for Medical Research TP Gunton Award funded the HPV study. The Wellcome Trust Institution Strategic Support Fund grant number 204809/Z/16/Z funded the chlamydia/gonorrhoea tests in oropharyngeal samples. The Test n Treat study was funded by the NIHR under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1014-35007). FR is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funding body had no role in the design of the study, the collection, analysis or interpretation of the data or the writeup of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by Bromley REC reference 15/LO/1929.

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

  • Data availability statement All data relevant to the study are included in the article.

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