Oral High-Risk Human Papillomavirus Infection Among Women Reporting Same-Sex Sexual Contact: A Propensity Score–Matched Analysis of the National Health and Nutrition Examination Survey 2009–2016

PURPOSE: To compare the prevalence of oral high-risk human papillomavirus (HR-HPV) infection between women reporting any lifetime sexual contact with a female partner (WSW) and women reporting exclusively male partners (WSM) in a nationally representative U.S. sample, and to assess how much of the difference is explained by lifetime partner count. METHODS: Cross-sectional analysis of women aged 18-69 in the National Health and Nutrition Examination Survey 2009-2016 with evaluated oral HPV genotyping and sexual behavior data. Survey-weighted prevalence was estimated in the full sample. WSW were matched 1:2 to WSM by propensity score on age, smoking, race/ethnicity, and poverty income ratio. Logistic regression in the matched sample additionally adjusted for lifetime partner count (≥10, and four categories). RESULTS: Of 7,943 women, 751 were WSW; 724 (96.4%) of them also reported male partners. Weighted oral HR-HPV prevalence was 2.84% (95% CI 1.57-4.69%) among WSW and 1.04% (0.78-1.35%) among WSM. After matching, WSW had higher odds of infection (OR 2.05, 95% CI 1.15-3.64). WSW reported more lifetime partners (median 12 vs 5), including more male partners (median 10 vs 5). Adjustment for partner count attenuated the association below statistical significance (≥10 partners: OR 1.46, 0.79-2.72). CONCLUSIONS: WSW, nearly all of whom also reported male partners, had higher odds of oral HR-HPV infection than demographically matched WSM; lifetime partner count explained part of this difference. A history of female partners should not be taken to imply lower oral HPV risk, and HPV vaccination should be offered according to current recommendations.