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Figure 1 depicts a high heterogeneity in the distribution of HPV genotypes in anal sample positive for HPV DNA, with HR-HPV type 33 (31.14% [19 of 61]) the predominant genotype. Along with the HPV-33, HPV-42 (27.8%), HPV-53 (24.6%), HPV-51 (19.7%), HPV-6 and HPV-70 (18.1%) were the 6 most detected genotypes in anal samples. HPV-16 and HPV-18 were detected with a prevalence of 16.4% and 9.8%, respectively. The other high-risk types included in the 9-valent vaccine (Gardasil-9; Merck) were detected at the following prevalence rates: HPV-52, 16.4%; HPV-58, 14.8%; HPV-45, 11.5%; and HPV-31, 9.8%. The HR-HPV types 68 (13.1%), 56 (11.5%), 35, 39 (9.8%), and 59 (3.3%) were also detected. Finally, several low-risk-HPV types were also detected.

Proportions of human papillomavirus (HPV) genotypes identified by molecular biology in 57 anal and 19 oral samples from young men who have sex with men taking preexposure prophylaxis and living in France. Low-risk (LR), high-risk (HR), and possibly oncogenic HPV genotypes are shown, and genotypes included in the 9-valent (Gardasil-9) vaccine are indicated by asterisks.

Proportion of human papillomavirus (HPV) genotypes, by patient age, in 57 anal (A) and 19 oral (B) samples positive for HPV DNA among 61 young men who have sex with men taking preexposure prophylaxis and living in France. Abbreviations: HR, high-risk; LR, low-risk.

Regarding the oral samples, 5 of the 61 MSM included in the study were not able to provide adequate oral rinse samples and were excluded from HPV analyses. One-third of MSM who provided (33.9% [19 of 56]) were positive for HPV DNA in their oral samples and a minority (7.1% [4 of 56]), had multiple HPV genotypes (Table 1). About one-fifth of MSM (19.6% [11 of 56]) had HR-HPV, and oral HPV infections were caused by multiple HR-HPV genotypes in 3 MSM (27.7%).

These findings demonstrate the unsuspected high burden of anal and oral HR-HPV that can be prevented by the 9-valent vaccine, substantiating the national recommendations of HPV prophylactic vaccination in young MSM in France [24]. Finally, anal carriage of HPV and HR-HPV was associated with frequent condomless receptive anal intercourse and a history of anal gonorrhea, indicating possible high-risk sexual behavior. These observations highlight that persistent risky sexual behavior is usual in HIV-uninfected MSM taking PrEP.

A high prevalence of anal HR-HPV (81.9%) was found in the current study. A similar prevalence (70.6%) was previously reported in a short series of 17 HIV-uninfected MSM not taking PrEP and living in Marseille, France [17]. Previous studies assessing the burden of anal HR-HPV in HIV-uninfected MSM worldwide reported prevalence rates ranging from 13.3% to 55.6% [25, 26]. High prevalence of anal HR-HPV detection, similar to those in our study, are mostly reported in HIV-infected MSM [16, 19], who constitute a high-risk population for anal HR-HPV [27, 28].

Concerning HPV genotype distribution, almost 70% of anal HPV and 100% of oral HPV genotypes were targeted by the prophylactic 9-valent HPV vaccine, which is the basis of the rationale for introducing primary prevention against anal and oral cancer in young HIV-uninfected MSM taking PrEP, by using prophylactic vaccination. Unexpectedly, HPV-16 and HPV-18 were, respectively, only the third and sixth most represented genotypes in anal HPV infections among study MSM. Previous studies reported quite different distributions, with HPV-16 the predominant genotype detected in anal and oral samples from HIV-uninfected MSM [17, 34]. Furthermore, the predominance of HR-HPV type 33 in both anal and oral sites of asymptomatic HIV-uninfected MSM has not been previously reported, to our knowledge and may indicate possible regional clusterization in the spreading of particular HR-HPV genotypes within the French MSM community [7].

Our study has some limitations. Because the presence of HPV was assessed using a single anal sample and a single oral sample both take


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