Oropharyngeal cancers associated with oral human papillomavirus (oHPV) are becoming more common. Understanding factors associated with oHPV among African men, including those living in settings where broader contextual factors shape how HPV-associated cancers are prioritized, may help predict future cancer risk and inform screening interventions.
Methods
From 2014 to 2018, a cross-sectional study of the prevalence of oHPV was conducted among men who have sex with men (MSM) in Abuja and Lagos, Nigeria. Participants completed HIV testing and behavioral questionnaires before providing oral gargle samples. Gargle samples were genotyped for oHPV and oral high-risk HPV (oHR-HPV16/18/31/33/35/39/45/51/52/56/58/59/68). Multivariable logistic regression estimated the adjusted odds ratio (aOR) and 95% confidence intervals (CIs).
Results
Among 584 men, median age was 24 years (interquartile range: 22–28) and 69% were living with HIV. The prevalence of oHPV, oHR-HPV and HPV16 was 16.6% (95% CI: 13.7–19.9), 5.7% (95% CI: 3.9–7.8), and 1.2% (95% CI: 0.5–2.5), respectively. Living with HIV was positively associated with oHPV (aOR: 1.97, 95% CI: 1.14–3.41) and trended similarly for oHR-HPV (aOR: 2.30, 95% CI: 0.93–5.66). Oral HPV was associated with having insertive anal sex (aOR: 1.85, 95% CI: 1.06–3.24) as compared to both insertive and receptive. Oral HPV was associated with having sex with women over 5 years ago (aOR: 3.13, 95% CI: 1.28–7.67) but not in the past 5 years (aOR: 1.70, 95% CI: 0.91–3.18) as compared to no sex with women. Oral HR-HPV was independently associated with insertive anal sex (aOR: 2.59, 95% CI: 1.11–6.08).
Conclusions
Living with HIV was significantly associated with oHPV prevalence, though oHR-HPV prevalence was lower than expected. Longitudinal studies are needed to define risk pathways for oropharyngeal cancer, particularly in settings where social and structural contexts may affect access to appropriate care.
LechnerMJonesOSBreezeCE, et al.Gender-neutral HPV vaccination in the UK, rising male oropharyngeal cancer rates, and lack of HPV awareness. Lancet Infect Dis2019; 19(2): 131–132. https://doi.org/10.1016/S1473-3099(18)30802-8
2.
Bandala-JacquesASaldanhaIJD’SouzaG. Oropharyngeal cancer risk groups in the United States: a meta-analysis and SEER analysis. BMC Cancer2025; 25(1): 1441. https://doi.org/10.1186/s12885-025-14904-4
3.
FarsiNJEl-ZeinMGaiedH, et al.Sexual behaviours and head and neck cancer: a systematic review and meta-analysis. Cancer Epidemiol2015; 39(6): 1036–1046. https://doi.org/10.1016/j.canep.2015.08.010
4.
SaraiyaMUngerERThompsonTD, et al.US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst2015; 107(6): djv086. https://doi.org/10.1093/jnci/djv086
5.
HabbousSChuKPLauH, et al.Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centres using multiple imputation. CMAJ (Can Med Assoc J)2017; 189(32): E1030–E1040. https://doi.org/10.1503/cmaj.161379
6.
LuYXieZLuoG, et al.Global burden of oropharyngeal cancer attributable to human papillomavirus by anatomical subsite and geographic region. Cancer Epidemiol2022; 78: 102140. https://doi.org/10.1016/j.canep.2022.102140
7.
OkerosiSMokohLWRubagumyaF, et al.Human papillomavirus-associated head and neck malignancies in Sub-Saharan Africa: a systematic review. JCO Glob Oncol2023; 9: e2200259. https://doi.org/10.1200/GO.22.00259
8.
Della PollaGMiraglia Del GiudiceGPostiglioneM, et al.Prevalence of oral human papillomavirus infection in African countries: a systematic review and meta-analysis. Pathog Glob Health2025; 119(7): 259–271. https://doi.org/10.1080/20477724.2025.2529822
9.
MumenaCHUwamunguSKjellerG, et al.Oral human papillomavirus infections in Zambian rural and urban residents-a community cross-sectional study. BMC Oral Health2024; 24(1): 1540. https://doi.org/10.1186/s12903-024-05312-4
10.
Morhason-BelloIOBaisleyKPavonMA, et al.Prevalence and concordance of penile, anal, and oral human papillomavirus infections among sexually active heterosexual men in Ibadan, Nigeria. Cancer Causes Control2025; 36(1): 51–66. https://doi.org/10.1007/s10552-024-01920-1
11.
AlemanyLFelsherMGiulianoAR, et al.Oral human papillomavirus (HPV) prevalence and genotyping among healthy adult populations in the United States and Europe: results from the PROGRESS (PRevalence of oral hpv infection, a global aSSessment) study. eClinicalMedicine2025; 79: 103018. https://doi.org/10.1016/j.eclinm.2024.103018
12.
MaltsevaMKlasenCWuerdemannN, et al.Detection and natural history of HPV infection of oral cavity and tonsils - a systematic literature review. BMC Cancer2025; 25(1): 1405. https://doi.org/10.1186/s12885-025-14547-5
13.
KingEMOomeerSGilsonR, et al.Oral human papillomavirus infection in men who have sex with men: a systematic review and meta-analysis. PLoS One2016; 11(7): e0157976. https://doi.org/10.1371/journal.pone.0157976
14.
MistryHBLebeloRLMatshonyongeF, et al.Oral and oropharyngeal high-risk HPV prevalence, HIV status, and risk behaviours in a cohort of South African men who have sex with men. AIMS Public Health2022; 9(1): 129–141. https://doi.org/10.3934/publichealth.2022010
15.
YayaIBoyerVEhlanPA, et al.Heterogeneity in the prevalence of high-risk human papillomavirus infection in human immunodeficiency virus-negative and human immunodeficiency virus-positive men who have sex with men in West Africa. Clin Infect Dis Off Publ Infect Dis Soc Am2021; 73(12): 2184–2192. https://doi.org/10.1093/cid/ciab157
16.
NowakRGGravittPEHeX, et al.Prevalence of anal high-risk human papillomavirus infections among HIV-positive and HIV-negative men who have sex with men in Nigeria. Sex Transm Dis2016; 43(4): 243–248. https://doi.org/10.1097/OLQ.0000000000000431
17.
RobbinsSJDaudaWKokoghoA, et al.Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria. PLoS One2020; 15(9): e0238745. https://doi.org/10.1371/journal.pone.0238745
18.
Rodriguez-HartCBradleyCGermanD, et al.“Building that strong energy”: an exploration of stigma coping strategies among sexual and gender minorities in Nigeria. Stigma Health2023; 8(2): 223–231. https://doi.org/10.1037/sah0000319
19.
KokoghoAAmusuSBaralSD, et al.Disclosure of same-sex sexual practices to family and healthcare providers by men who have sex with men and transgender women in Nigeria. Arch Sex Behav2021; 50(4): 1665–1676. https://doi.org/10.1007/s10508-020-01644-8
20.
VolpiCRChamaJBlancoN, et al.“Does human papillomavirus (HPV) cause cancer?” - a cross-sectional study of HPV awareness among sexual minority men in Nigeria. Sex Health2025; 22: SH24250. https://doi.org/10.1071/SH24250
21.
SchwartzSRNowakRGOrazulikeI, et al.The immediate eff ect of the same-sex marriage prohibition act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort. The Lancet HIV2015; 2(7): e299–e306. https://doi.org/10.1016/S2352-3018(15)00078-8
22.
CharuratMEEmmanuelBAkoloC, et al.Uptake of treatment as prevention for HIV and continuum of care among HIV-positive men who have sex with men in Nigeria. J Acquir Immune Defic Syndr2015; 68: S114–S123. https://doi.org/10.1097/QAI.0000000000000439
23.
NowakRGAmbulosNPSchumakerLM, et al.Genotyping of high-risk anal human papillomavirus (HPV): ion torrent-next generation sequencing vs. linear array. Virol J2017; 14(1): 112. https://doi.org/10.1186/s12985-017-0771-z
24.
Nampota-NkombaNMohantyKAdebiyiR, et al.Penile human papillomavirus prevalence in circumcised sexual minority men with and without HIV. AIDS2025; 39(10): 1431–1440. https://doi.org/10.1097/QAD.0000000000004209
25.
OliverSEGorbachPMGratzerB, et al.Risk factors for oral human papillomavirus infection among young men who have sex with Men-2 cities, United States, 2012-2014. Sex Transm Dis2018; 45(10): 660–665. https://doi.org/10.1097/OLQ.0000000000000845
26.
ReadTRHHockingJSVodstrcilLA, et al.Oral human papillomavirus in men having sex with men: risk-factors and sampling. PLoS One2012; 7(11): e49324. https://doi.org/10.1371/journal.pone.0049324
27.
KingEMGilsonRBeddowsS, et al.Oral human papillomavirus (HPV) infection in men who have sex with men: prevalence and lack of anogenital concordance. Sex Transm Infect2015; 91(4): 284–286. https://doi.org/10.1136/sextrans-2014-051955
28.
MooijSHBootHJSpeksnijderAGCL, et al.Oral human papillomavirus infection in HIV-negative and HIV-infected MSM. AIDS2013; 27(13): 2117–2128. https://doi.org/10.1097/QAD.0b013e328362395c
29.
CarnallaMRojas-MartínezRBarrientos-GutiérrezT, et al.Prevalence and development of a risk score for oral human papillomavirus infection in men who have sex with men in Mexico. J Oral Pathol Med2023; 52(8): 751–757. https://doi.org/10.1111/jop.13474
30.
HerreroRCastellsaguéXPawlitaM, et al.Human papillomavirus and oral cancer: the international agency for research on cancer multicenter study. J Natl Cancer Inst2003; 95(23): 1772–1783. https://doi.org/10.1093/jnci/djg107
31.
GiulianoARFelsherMWaterboerT, et al.Oral human papillomavirus prevalence and genotyping among a healthy adult population in the US. JAMA Otolaryngol Head Neck Surg2023; 149(9): 783–795. https://doi.org/10.1001/jamaoto.2023.1573
32.
AlessandriniJCoxJde PokomandyA, et al.Prevalence of oral human papillomavirus infection among urban gay, bisexual, and other men who have sex with men in Canada, 2017-2019. J Infect Dis2024; 230(5): e1039–e1048. https://doi.org/10.1093/infdis/jiae345
33.
KreimerARPierce CampbellCMLinHY, et al.Incidence and clearance of oral human papillomavirus infection in men: the HIM cohort study. Lancet (London, England)2013; 382(9895): 877–887. https://doi.org/10.1016/S0140-6736(13)60809-0
34.
BeachlerDCSugarEAMargolickJB, et al.Risk factors for acquisition and clearance of oral human papillomavirus infection among HIV-Infected and HIV-uninfected adults. Am J Epidemiol2015; 181(1): 40–53. https://doi.org/10.1093/aje/kwu247
35.
EzechiOAkinsoluFSalakoA, et al.High-risk human papillomavirus infection among Nigerian women: a systematic review and meta-analysis. J Int Med Res2023; 51(7): 3000605231182884. https://doi.org/10.1177/03000605231182884
36.
MeitesEGorbachPMGratzerB, et al.Monitoring for human papillomavirus vaccine impact among gay, bisexual, and other men who have sex with men-united states, 2012-2014. J Infect Dis2016; 214(5): 689–696. https://doi.org/10.1093/infdis/jiw232
37.
JohnsMMPingelEEisenbergA, et al.Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. Am J Mens Health2012; 6(6): 505–518. https://doi.org/10.1177/1557988312455214
