Influence of Oral Sex and Oral Cancer Information on Young Adults' Oral Sexual-Risk Cognitions and Likelihood of HPV Vaccination
Stock, Michelle L., Peterson, Laurel M., Houlihan, Amy E., Walsh, Laura A., The Journal of Sex Research
Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. It is estimated that at least 50% of sexually active men and women will be infected at some point (Centers for Disease Control and Prevention [CDC], 2011), and the prevalence of HPV infection is highest among women ages 20 to 24 (Dunne et al., 2007). HPV is transmitted through vaginal, anal, and oral sex. Although most people infected with HPV will not develop symptoms, certain types (6 and 11) can cause genital warts, and high-risk types (16 and 18) are associated with multiple forms of cancer (CDC, 2011; Chaturvedi, 2010).
HPV, Oral Cancer, and Oral Sex
HPV-16 and HPV-18 account for approximately 70% of cervical cancer cases (Bosch & de Sanjose, 2003). Because these types of HPV have most commonly been associated with cervical cancer, many people are unaware of the link between these strains of HPV and other cancers. Recent medical research has revealed that oral HPV infection also causes oropharyngeal (tonsillar and tongue, "oral") cancers (D'Souza et al., 2007; Heck et al., 2010; Kreimer, Clifford, Boyle, & Franceschi, 2005; Psyrri, Prezas, & Burtness, 2008), even among those without a history of tobacco or alcohol use (Gillison et al., 2008; Psyrri & DiMaio, 2008). In 2010, there were approximately 37,000 new cases of oral cancers in the United States (National Cancer Institute, 2011). It is estimated that HPV-16 is a factor in up to 86.7% of HPV-positive cancers in the oropharynx, which is a higher percentage of HPV-16-associated cancers than cancers of the cervix (Kreimer et al., 2005). Some researchers have estimated that 12% to 63% of oropharyngeal cancers may be attributable to HPV infection (Chaturvedi, 2010). The incidence of HPV-associated oral cancers has risen over the past few decades, whereas the incidence of cervical cancer and oral cancers associated with tobacco/alcohol use has declined (Chaturvedi, 2010; Palefsky, 2010; Psyrri et al., 2008). HPV-positive diagnoses are the fastest growing group of the oral cancers among Americans under 50 years of age (Oral Cancer Foundation, 2011). The HPV virus, which is associated with HPV-positive oral cancers, is most likely transmitted via sexual behaviors--in particular, oral sex (D'Souza et al., 2007; Gillison et al., 2008). Engaging in oral sex, especially with more or casual oral sex partners and with infrequent condom use, is associated with oral cancer risk (D'Souza et al., 2007; Gillison et al., 2008; Heck et al., 2010).
Oral Sex and HPV Knowledge among Youth
Although getting an STI via oral versus vaginal sex is less likely, the increasing reports of oral HPV infections, cancers, sexual behaviors, and the low levels of condom use during oral sex increase the importance of studying this behavior. Approximately 65% to 850 of 18- to 24-year-olds report engaging in oral sex behaviors (Higgins, Trussell, Moore, & Davidson, 2010; Mosher, Chandra, & Jones, 2005). The majority of adolescents and young adults who give or receive oral sex do not use protection (Prinstein, Meade, & Cohen, 2003; Stone, Hatherall, Ingham, & McEachran, 2006). For example, only 5% of college students report using condoms mostly or always in the last 30 days during oral sex (American College Health Association, 2010).
Most young adults are unaware that STIs can be transmitted via oral sex (Stone et al., 2006). Many students lack knowledge regarding HPV transmission, prevalence, and the link between HPV and cancer (Baer, Allen, & Braun, 2000; Sandfort & Pleasant, 2009). In addition, the majority of public and media focus has been directed toward women due to HPV's link to cervical cancer. Given that the majority of young adults engage in oral sex without protection and are unaware of the health risks due to oral sex, researchers have called for focusing more educational efforts on the health consequences of oral sex (Brady & Halpern-Felsher, 2007; Halpern-Felsher, 2008; Stone et al. …