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Home HPV and Men HPV and Men Male Circumcision for HPV Prevention

Male Circumcision for HPV Prevention

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A review of recent studies finds more evidence of the value of male circumcision in reducing the risks for acquiring a number of viral sexually transmitted infections.

Circumcision, a surgical procedure where the foreskin of the penis is removed, is often done for religious or cultural reasons. The practice is not without controversy: Commonly done on infants and boys, opponents point to discomfort, particularly if local analgesia is not used, questions about sexual enjoyment, and use of parental consent for this elective procedure on an infant among reasons for not routinely performing the procedure.

Numerous studies do indicate that circumcision offers health benefits, especially in making a man less likely to contract HIV. Recently, evidence in this regard is mounting. The January 2010 issue of the Archives of Pediatric and Adolescent Medicine features a review of three randomized trials conducted in Africa since 2005 that looked at the impact of circumcision on STI acquisition. The review authors, Aaron Tobian, MD, PhD; Ronald Gray, MD, MS; Thomas Quinn, MD, MS, all of Johns Hopkins University, report that data from the trials shows circumcision greatly reduced heterosexual acquisition of several viral infections: HIV fell by 50-60%; HSV-2 (usually associated with genital herpes) by 28%-34%; and HPV by 32%-35%.

In the studies reviewed, the impact of circumcision on bacterial STIs (such as syphilis, chlamydia, and gonorrhea) in men was unclear, but female partners of circumcised men were much less likely to have bacterial vaginosis or trichomoniasis (a parasite associated with sexual transmission), among the most common STIs.

The authors conclude, “This review evaluates the recent data that support revision of the AAP [American Academy of Pediatrics] policy to fully reflect the evidence of long-term health benefits of male circumcision.” The current position taken by AAP (and some other organizations) is that evidence is insufficient to recommend circumcision be done routinely with infants and boys. However, a story in the Washington Post (Stein, January 19, 2010) says both the AAP and Centers for Disease Control and Prevention (CDC) are evaluating whether or not to recommend routine circumcision for boys (and possibly men) as a result of these study results.

Dr. James Allen, a pediatrician, public health physician and former president of ASHA, applauded these new developments but urged caution in developing policy recommendations based on them.

"I applaud the continuing studies that have been done to clarify the relationship between circumcision and risk of HIV and other sexually transmitted infections in both the man and his female partner. This is important information to consider in terms of formulating prevention recommendations. But there are several perspectives to consider, however.

First, regardless of the significant reduction in risk of infection among men who are circumcised, responsible health personnel would still recommend that people use condoms and other proven prevention techniques at all times. Circumcision is not a substitute for other prevention methods.

Second, the studies were done in countries in which the risk of HIV and other STIs may be quite different than in the United States, so the actual risk reduction and perceived benefits may be different in this country.

Third, one would want to consider all the implications of developing policy recommendations for a particular area. For example, in an area of the world in which medical care is at a premium, where would this come as a priority and what would be the implications of devoting precious resources to providing circumcisions for newborns as opposed to all of the other important health care needs?

And finally, it is essential in formulating policy recommendations in this country to consider all of the relevant issues. Among these is the fact that circumcision is a surgical procedure that has financial costs associated with it. There are also certain risks and complications, even though they are infrequent and most of them are not severe. But there will rarely be a significant problem or complication associated with circumcision, and this has to be factored into the policy considerations."

References
Aaron A. R. Tobian, Ronald H. Gray, Thomas C. Quinn. Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections. Archives of Pediatric and Adolescent Medicine, 2010. 164(1): 78-84. 
Michael T. Brady. Newborn Circumcision. Routine or Not Routine, That Is the Question. Archives of Pediatric and Adolescent Medicine, 2010. 164(1): 94-96.