SEX DIFFERENCES IN THE PREVALENCE OF HIGH-RISK ORAL AND ANAL HUMAN PAPILLOMAVIRUS INFECTIONS AMONG HETEROSEXUALLY ACTIVE POPULATIONS IN IBADAN, NIGERIA

Imran Morhason-Bello^1,2,3*Yusuf O Bello^2,3,4Deborah Oke^2,3,5Adekunle Daniel^3,6Akinyele Adisa^3,7Adeola Fowotade^3,8Yinan Zheng^10,9Joshua Akinyemi^3,5Isaac Adewole³Miquel A Pavon¹¹Robert Leo Murphy¹⁰Lifang Hou^10,9Suzanna C Francis¹²Deborah Watson-Jones^13,14

• ¹Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ²Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ³HPV Consortium, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ⁴Department of Statistics, Faculty of Science, University of Ibadan, Ibadan, Oyo, Nigeria
• ⁵Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ⁶Department of Otolaryngology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ⁷Department of Oral Pathology, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ⁸Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ⁹Preventive Medicine Department, Cancer Epidemiology and Prevention, Northwestern University, Chicago, Illinois, United States
• ¹⁰Institute for Global Health, Northwestern University, Chicago, Illinois, United States
• ¹¹Infection and Cancer Laboratory, Cancer Epidemiology Research Program, ICO, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
• ¹²International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
• ¹³Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
• ¹⁴Mwanza Intervention Trials Unit, Mwanza, Tanzania

Purpose: To determine sex differences in the prevalence of oral and anal high-risk HPV infections among heterosexually active males and females in Ibadan.Methods: This was a secondary analysis from the Sexual Behavior and HPV Infections in Nigerians in Ibadan (SHINI) study that involved sexually active males and females aged 18-45 years. After a face-to-face interview, samples were collected from the mouth, cervix, vulva, and anus by a sex-matched trained nurse. High-risk HPV (hrHPV) in oral or/and anal sites were primary outcome variables, profiled by Anyplex TM II HPV28 assay. The participants' demographic characteristics, sexual behaviors, and social lifestyle were included as explanatory variables. The chi-square or Fisher exact test was used to investigate the association between the presence of hrHPV and the participants' characteristics. Multivariable logistic regression was conducted to test the association between the sex of participants and each of the primary outcome after adjusting for potential confounders. Statistical significance was set at p <0.05.Results: A total of 625 females including 310 females in general population (FGP) and 315 female sex workers (FSWs) and 316 males were recruited. Oral hrHPV prevalence was higher among FGP and FSWs than among males (10.5% vs. 14.9% vs. 3.6%, p < 0.001), as was anal hrHPV prevalence (39.3% vs. 60.8% vs. 6.7%, p < 0.001). More FGP (7.5%) and FSWs (13.0%) than males (0.9%) had hrHPV at both oral and anal sites (p < 0.001). Males had significantly lower odds of oral hrHPV [adjusted odds ratio (aOR)=0.43, 95% CI: 0.15 -1.24] than FSWs and FGP [aOR = 1.70, 95% CI: 0.62 -4.63]. The odds of anal hrHPV was significantly lower among males [aOR=0.05, 95% CI: 0.03 -0.08] compared to FSWs and FGP [aOR = 0.42, 95% CI: 0.30 -0.58].Oral hrHPV, anal hrHPV, and hrHPV at both sites were more prevalent in females than in males in the heterosexually active population. These findings highlight the importance of developing targeted HPV prevention strategies that account for sex-specific risk factors and the potential biological underpinnings contributing to these disparities.