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Male Circumcision and STI Prevention: More Good News

Summary and Comment |
March 25, 2009

Male Circumcision and STI Prevention: More Good News

  1. Larry M. Baddour, MD

Add protection against HSV-2 and HPV infections to the list of circumcision’s benefits.

  1. Larry M. Baddour, MD

Although we have strong evidence that male circumcision reduces the incidence of HIV infection in high-risk men, its benefits regarding other sexually transmitted infections (STIs) have remained unclear. To examine this wider issue, researchers examined data obtained in Uganda during two earlier trials of male circumcision for preventing HIV infection. A total of 5534 uncircumcised males aged 15 to 49 were involved.

Of 3393 participants who were HIV and herpes simplex virus type 2 (HSV-2) seronegative at enrollment, 1684 were randomized to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision 24 months later (control group). Serial screening (physical examination, an interview, and testing for HSV-2 and HIV infection and syphilis), conducted at baseline, was repeated for both groups at 6, 12, and 24 months. A subset of study participants also underwent screening for human papillomavirus (HPV) infection at baseline and at 24 months.

At 24 months, the cumulative probability of HSV-2 infection was lower for the intervention group than for the control group (7.8% vs. 10.3%; adjusted hazard ratio, 0.72; 95% confidence interval, 0.56–0.92). In addition, the prevalence of high-risk HPV genotypes was lower in the intervention group than in the control group (18.0% vs. 27.9%; adjusted risk ratio, 0.65; 95% CI, 0.46–0.90). However, no significant between-group difference in syphilis incidence was demonstrated (adjusted HR, 1.10; 95% CI, 0.75–1.65).

Comment

Studies conducted in Africa have shown that male circumcision decreases the rates of several STIs in men and in their female partners. Such benefits should guide public health policy for neonatal, adolescent, and adult male circumcision programs in areas such as Uganda, where prevalence of HIV infection is high. Whether circumcision confers similar benefits in other settings is unclear.

Citation(s):

Reader Comments (3)

Alexis Bartley

I'm curious if sexual activity was studied in these groups as well- as in, were the males who had the intervention as sexually active as they were before their surgery. Were there any cultural ramifications of the procedure which may have impacted their sexual activity? Was time given for the intervention group to heal from their surgery? Etc...

Competing interests: None declared

James T Thomas

Rates of STI's are lower in Europe than in the USA. Rates of circumcision in Europe are close to zero. In the USA it is around 70%. What does that tell you? The conclusions drawn from these Randomised Control Trial's should not be applied to the USA.

Rates of condom use in the USA are already very low. we know from the Sorrells study (2007) that circumcision reduces sensitivity. This means that condom use will be lower among circumcised men. And so circumcision probably increases risk of STI infection. This could explain why the USA has higher rates of STI's than Europe. the best way to tackle STI's is to step up safe sex education and promote condom use.

Neonatal circumcision is an infringement of bodily integrity. Neonatal circumcision carries risks. It may have a psychological impact, and it may disrupt breast-feeding and the mother-son bond.

The foreskin has a function. The gliding action of the skin makes sex and masturbation easier. The book/study by O Hara et al shows this very clearly.

Medicaid funding should be stopped to this damaging procedure as soon as possible.

Competing interests: None declared

marcella m alsan

My understanding is that there was no evidence that circumcision reduced HIV transmission to women. Is that correct? In other words, circumcised or uncircumcised, a man who is HIV positive presents the same risk of transmission to their female partner. please let me know if I am mistaken. Thank you.

Competing interests: None declared

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