Open Access Highly Accessed Research article

Prevalence of human papillomavirus infection in the oropharynx and urine among sexually active men: a comparative study of infection by papillomavirus and other organisms, including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp

Kazufumi Nakashima1, Kazuyoshi Shigehara12*, Shohei Kawaguchi1, Akira Wakatsuki3, Yoshitomo Kobori4, Kazuyoshi Nakashima5, Yasunori Ishii6, Masayoshi Shimamura2, Toshiyuki Sasagawa7, Yasuhide Kitagawa1, Atsushi Mizokami1 and Mikio Namiki1

Author Affiliations

1 Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa 920-8641, Japan

2 Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan

3 Wakatsuki Clinic, Osaka City, Osaka, Japan

4 Department of Urology, Dokkyo Medical School, Koshigaya Hospital, Koshigaya, Saitama, Japan

5 Nakashima Clinic, Kanazawa, Ishikawa, Japan

6 Ishii Clinic, Saitama City, Saitama, Japan

7 Department of Obstetrics & Gynecology, Kanazawa Medical School, Kahoku-gun, Ishikawa, Japan

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BMC Infectious Diseases 2014, 14:43  doi:10.1186/1471-2334-14-43

Published: 27 January 2014



Oropharyngeal squamous cell carcinoma (OSCC) has shown a gradual increase in male predominance due to the increasing incidence of human papillomavirus (HPV)-associated OSCC. However, the mode of HPV transmission to the oral cavity is poorly understood, and little is known about the epidemiology of oral HPV infection in men. The prevalence rates of HPV, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp. were compared in the oropharynx (oral cavity) and urine of male Japanese patients attending a sexually transmitted disease clinic.


The study population consisted of 213 men aged 16 – 70 years old (mean: 34.4 years old). Oropharyngeal gargles and urine were collected, and sedimented cells were preserved in liquid-based cytology solution. After DNA extraction, β-globin and infectious organisms were analyzed by a PCR-based method. The HPV genotype was determined by HPV GenoArray test.


β-Globin was positive in 100% and 97.7% of oral and urine samples, respectively. HPV detection rates were 18.8% and 22.1% in oral and urine samples, respectively, suggesting that the prevalence of HPV infection in the oral cavity was similar to that in the urinary tract. N. gonorrhoeae was more prevalent in oral (15.6%) than urine samples (9.1%), whereas C. trachomatis was detected more frequently in urine (15.9%) than oral samples (4.2%). The detection rates of M. genitalium, M. hominis, and Ureaplasma spp. were 5.2%, 10.3%, and 16.0% in oral samples, and 7.7%, 6.3%, and 19.2% in urine, respectively. There were no significant differences in the detection rates of Mycoplasma spp. and Ureaplasma spp. between anatomical locations. The distribution of HPV types were similar in oral and urine samples, and HPV16 was the most common type. The majority of men with HPV infection in both the oral cavity and urine had concordant oral and urinary HPV infection. The presence of urinary HPV infection was an independent risk factor of oral HPV infection, with an odds ratio of 3.39 (95% CI: 1.49 – 7.71), whereas oral gonococcal infection was inversely correlated with oral HPV infection (odds ratio: 0.096; 95% CI: 0.01 – 0.77).


Oral HPV infection commonly occurs in sexually active men, and is significantly correlated with urinary HPV infection.

Human papillomavirus; Oral infection; Mycoplasma; Ureaplasma; Liquid-based cytology