Prevalence of oral and genital HPV-45 and non–vaccine-targeted HPV-35 among U.S. adults.

Abstract

10597 Background: High-risk human papillomavirus (HPV) types 35 and 45 are oncogenic non-16/18 subtypes that contribute measurably to HPV-attributable genital and oropharyngeal cancers. Unlike HPV-45, HPV-35 is not targeted by the current 9-valent vaccine. Although high prevalence of these subtypes has been reported in some global sub-populations, data on their prevalence and distribution in the U.S. adult population remains limited. Methods: We conducted a cross-sectional analysis of adults aged 18-64 years from the National Health and Nutrition Examination Survey (NHANES) cycles 2013-2016. HPV was detected via self-collected oral rinse specimens, vaginal swabs, and penile swabs. HPV vaccination history and sexual behaviors were self-reported. We estimated survey-weighted type-specific HPV prevalence and used survey-weighted Poisson regression to calculate adjusted prevalence ratios (aPRs), accounting for age, sex, race/ethnicity, vaccination status, and number of lifetime sexual partners. Results: Oral HPV prevalence was low overall, with HPV-16 remaining the most frequently detected type (0.87%). Genital HPV showed a broader distribution of oncogenic types. Among men, penile HPV-35 (1.93%, 95% CI 1.27-2.60%) and HPV-45 (1.94%, 95% CI 1.37-2.50%) were less prevalent than HPV-16 (3.97%, 95% CI 3.13-4.80%) and slightly more prevalent than HPV-18 (1.71%, 95% CI 1.20-2.22%), though confidence intervals overlapped. Among women, vaginal HPV-35 (1.40%, 95% CI 0.95-1.85%) and HPV-45 (1.71%, 95% CI 1.21-2.21%) were also less common than HPV-16 (2.95%, 95% CI 2.14-3.77%) and comparable to HPV-18 (1.26%, 95% CI 0.88-1.65%), again with overlapping confidence intervals. While there were extremely low rates of dual oral-genital infections, males exhibited slightly higher, though non-significant, dual infection prevalences for HPV-35 (0.03% vs. 0%), HPV-45 (0.21% vs 0.07%), and HPV-16 (0.17% vs. 0.11%) compared to females. Non-Hispanic Black participants had a significantly higher genital prevalence of both HPV-35 (aPR 2.75, 95% CI 1.71-4.42) and HPV-45 (aPR 2.08, 95% CI 1.13-3.85) compared with Non-Hispanic White participants. Prevalence was higher among males than females for both types, although these differences did not reach statistical significance. Conclusions: In this nationally representative sample of U.S. adults, we found that HPV-35, a high-risk type not included in the current 9-valent vaccine, showed genital prevalence comparable to vaccine-covered types and marked racial disparities. These findings highlight the importance of continued HPV surveillance and targeted prevention strategies. Additionally, future studies should investigate these subtypes in HPV-associated malignancies.