Recurrence of HPV Types Found in Vaccine High Among Men with High-Risk Sexual Behavior

A study in the Journal of Infectious Diseases found that men with high-risk sexual behavior and a history of the human papillomavirus (HPV) are at an increased risk for the recurrence of the viral infection, particularly for the HPV types found in the newly approved nonavalent HPV vaccine (ie, HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58). A higher number of new sexual partners, as well as lifetime sexual partners, may drive this risk in these patients.

“In the current analysis, higher numbers of new male sexual partners were consistently associated with higher recurrence of incident infections in both type-specific (HPV 16) and grouped analyses,” according to the study investigators led by Anna R. Giuliano, PhD, director of the Center for Infection Research in Cancer at the Moffitt Cancer Center. “Other high-risk sexual behaviors (number of new female partners and frequency of sexual intercourse) were also associated with higher recurrence of prevalent HPV 6, 16, and 31 infections. Recurrence significantly differed by smoking and alcohol use only for HPV types 16, 52, and 58.”

A total of 1537 healthy men from the United States, Brazil, and Mexico, who had genital DNA samples available for analysis were included in this study. Participants who had incident HPV infections (n = 635), prevalent infections (n = 641), and both incident and prevalent infections of ≥1 of the 9 vaccine HPV types (n = 261) were enrolled. Investigators followed men every 6 months during a total median follow-up period of 3.7 years. The investigators analyzed factors associated with type-specific HPV recurrence, which consisted of a recurring infection following a ≥12-month infection-free period. The types of HPV assessed in this analysis included HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58, all of which are found in the nonavalent HPV vaccine.

The HPV 45 type had the highest recurrence among men with a prior persistent infection (36.8%), with HPV 52 being the second-most frequent infection type in this subset of patients (32.4%). Prior prevalent infections and prior incident infections recurred in 31% and 20% of patients in this study, respectively. The frequency of sexual intercourse with female sexual partners as well as new sexual partners (either male or female) drove the recurrence risk of HPV 6, 16, 31, and 58 infections.

Having ≥2 new female sexual partners in the previous 6-12 months was significantly associated with HPV 6 infection recurrence in men with initial prevalent infections (P = .0007). In addition, there was an association between the recurrence of HPV 16 and a high frequency of sexual intercourse with female sexual partners (>30 times) in the previous 6 to 12 months (P = .045). In addition, recurrence of the HPV 31 was higher among men reporting a new female sexual partner vs men without a new sexual partner in these time periods (P = .032). Incident infection recurrence was higher in men with greater lifetime male sexual partners (P = .012) and new male partners (P = .011).

The logistic regression analysis showed that >12 lifetime male sexual partners (adjusted odds ratio [aOR] = 2.40, 95% CI 1.19-4.84) and ≥2 new male sexual partners (aOR 2.35, 95% CI 1.16-4.74) was associated with a higher chance of recurrence.

Limitations of the analysis include the relatively small sample size of individual HPV type recurrences as well as the lack of data regarding HPV status before the study.

“To prevent these infections, gender-neutral HPV vaccine policies that target adolescent males and females are needed to protect against the initial HPV infection, recurrent infections, and importantly the prevalence of disease-causing HPV types circulating in the overall community,” according to the investigators.