Title: A CLINICIAN’S DILEMMA: WHAT SHOULD BE COMMUNICATED TO WOMEN
WITH ONCOGENIC GENITAL HPV AND THEIR PARTNERS REGARDING THE RISK
OF ORAL VIRAL TRANSMISSION?
Version: 4 Date: 14 Aug 2022
Reviewer's report:
This is an interesting opinion piece.   Since there is no method section outlining how the literature
search was performed it is difficult to judge the reliability and validity of the information
obtained in the author’s literature search.  The abstract summarizes the paper.  Without more
information I find the last sentence, line 51 to 54, difficult to understand more information should
be provided to clarify it.  The last words on line 54 tell us that this document is aimed at the
gynecologist.   It is important to remember that gynecologists are not the only one who provide
care to women.   In fact, several health care professionals offer primary care to this population
including family physicians, nurse practitioners,  nurse clinicians as well as pediatricians who
offer care to adolescents.  All these groups of practitioners should be included in any document
discussing the nature of the education to be provided to women about HPV.  Furthermore,
education should be done with men as well and very few gynecologists see men while primary
care health care givers do.
In the introduction we are presented with knowledge known to date.   As this is not a research
paper it does not have a research question, however lines 77 to 79, does present us with the
equivalent.  It states: “Are gynecologist sufficiently aware and knowledgeable regarding not
only cervical, vaginal, vulvar, anal, and penile, but also oropharyngeal HPV-mediated cancers?
Should they address the issue of orogenital HPV transmission and, if yes, how?”  In line with
my previous comment the sentence should start with “health care practitioners”.   On line 86,
I would suggest changing “convincing rationale” to evidence.    “Convincing rationale” may
include non-evidence-based data as well as subjective interpretation of data and expert opinion.
In line 95, it is stated  “currently standardized counseling”.   Does this exist, if so, a reference
should be given and it should be explained.
The “Epidemiological background of oropharyngeal infection” section presents us with some of
the evidence related to this subject.  The first sentence should have references, line 99 and 100.
In line 129 and 130 we are presented with a list of viral types, this is followed by a comment
in parentheses (genetically related to HPV 16).   Does this refer to types 18, 31,33,35, 52, 58 or
simply to 58?  The sentence needs to be rewritten to clarify what is meant here.   The sentence
on line 138 and 139 needs a reference.  In the sentence at the end of this section, line 140 –
143, a reference is made to the study entitled, “HPV Infection in Men Study”.   In this type of
paper more information should be provided about the population included in this study.   Was
the sample only assigned men at birth who have sex  with assigned females at birth, or did it
also include assigned men at birth who have sex with other assigned men at birth, or some other
combination, this needs to be clarified.  One cannot assume that all the readers will be familiar
with the specifics of this study.
In the section “Dynamics of oropharyngeal HPV transmission” there are typos in line 161, an “s”
should be added to “lead” and the “s” should be removed at the end of “rate”.    In the sentence,
on line 171 and 172, the authors mentioned a statistic for prevalence of high-risk HPV infection
in “same-sex oral sex partners”.   To better understand this statistic, we should be provided by
one for assigned males at birth having oral sex with assigned females at birth.   Also note that
this is the first and only mention of same sex partners, making this a heterosexist manuscript.
Furthermore, this article is aimed at gynecologist which, as highlighted previously, is elitist and
excludes several other health care practitioners.   However, even gynecologist will see assigned
females at birth who have sex with other assigned female at birth, so the article should be more
inclusive of these populations.
In the section “Screening, early diagnosis, and prevention of oropharyngeal cancers” a change
has been made in the sentence on line 219-220.   Please clarify that the “shared clinical decision-
making” relates to all adults aged 27 to 45 years or exclusively women.   The elitist nature of
this manuscript is continued in the sentence on line “239 to 241” where it is suggested that “oral
heath care specialists and otolaryngologists” also educate patients about vaccination.   Since the
manuscript does not mention other health care practitioners who care for women, at the very
least they should be included here.
The rest of the document presents some interesting information and counseling suggestions.
In my opinion this manuscript needs major rewrites to make it more inclusive of other health
care practitioners offering  care to women and less heterosexist in nature.  This would make if
more valuable.