Epidemiology of human papillomavirus Beyond cervical infection

Human papillomavirus (HPV) vaccines and topics concerning cervical infection prevention have been studied extensively. Although it remains important to study how cervical cancer prevention could be optimised, the current focus of HPV research may be broadened to topics of HPV epidemiology beyond the cervix. This thesis focuses on the epidemiology of HPV, more specifically on the epidemiology of HPV at anatomical locations other than the cervix.
We conducted the first global systematic review on male genital type-specific HPV prevalence, where no systematic difference was observed between men with different sexual preference. Additionally, risk-factors for anogenital HPV and seropositivity were assessed for men who have sex with men (MSM). Receptive anal intercourse (RAI) was the most important risk factor for both anal HPV as seropositivity, suggesting a site-specific humoral immune response.
Analyses for extragenital HPV were done too. Type-specific concurrent HPV detection was common for females, but not for MSM. In our risk factor analysis among females with genital HPV, RAI was not associated with additional anal HPV. This is suggestive for autoinoculation.
Oropharyngeal cancer (OPC) can be caused by HPV. Distinction between HPV-driven and non-HPV-driven OPC may be made with the HPV-16 E6 biomarker. The diagnostic accuracy of HPV-16 E6 serology was good, and was consistently high across key patient characteristics, like sex and age.
Finally, the vaccine effectiveness (VE) of the bivalent HPV vaccine was assessed and its impact on genital HPV. The protection of the vaccine goes beyond targeted genotypes, and beyond vaccinated populations.