Partner cancer risk in HPV-related oropharyngeal cancer: a systematic review of couples studies.

BACKGROUND

Human papillomavirus (HPV)-related oropharyngeal cancer presents an epidemiological paradox: while HPV transmits between sexual partners, partner cancer development is extremely rare. Understanding this transmission-disease disconnect is crucial for patient counseling.

OBJECTIVES

To systematically review evidence from couples studies examining HPV transmission patterns and partner cancer risk in HPV-related oropharyngeal cancer, with emphasis on concordance rates, discordance patterns, and documented cases of partner cancer development.

METHODS

Systematic literature search of PubMed, Embase, Web of Science, Scopus, and Cochrane Library following PRISMA 2020 guidelines. Search combined terms for HPV, oropharyngeal cancer, couples/partners, and transmission/concordance. Studies examining HPV infection patterns in heterosexual couples where at least one partner had HPV-related oropharyngeal cancer were included. Two independent reviewers performed screening, data extraction, and risk of bias assessment using Newcastle-Ottawa Scale and JBI checklists. Primary outcomes were partner HPV prevalence, type-specific concordance rates, and documented partner cancer cases.

RESULTS

Thirty studies (12 cross-sectional, 10 cohort, 6 case-control, 2 case series) including 1,847 couples met inclusion criteria. Oral HPV prevalence in partners of HPV-positive cancer patients ranged from 3.7% to 29%. HPV16 type-specific concordance ranged from 0% to 15.4%, with observed-to-expected ratios of 1.5-8.9 confirming transmission above chance. However, no cases of sequential partner cancer development were documented during follow-up (total 4,231 couple-years). Only two case reports described concurrent cancers in couples [16]. Most partner infections were transient, with persistent infection documented in less than 5% of partners versus 52-65% in cancer patients. Higher viral load, oral-genital contact frequency, and shorter relationship duration predicted concordance.

CONCLUSIONS

HPV transmission between partners occurs in 3.7-29% of couples, but partner cancer development is extraordinarily rare (no cases in 4,231 couple-years of follow-up). The transmission-disease disconnect likely reflects efficient immune clearance, low progression rates, and multi-decade latency. Partner cancer risk appears comparable to general population risk. These findings provide evidence-based reassurance for couples counseling.