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Editor,—The study by Diseker et al,1 though examining too small a study population to obtain statistically meaningful results in some aspects, is commendably objective. Their study tends to confirm previous research findings relative to circumcision versus syphilis and gonorrhoea, the majority of which indicate a strong (protective) relation between the non-circumcised state and syphilis and a weaker relation with gonorrhoea.
A brief examination of this and several previous studies going back 150 years on circumcision versus syphilis and gonorrhoea reveals an intriguing relation: syphilis is proportionally lower in circumcised men than it is in uncircumcised men.
In 1855, Hutchinson,2 in England, reported a syphilis:gonorrhoea ratio of 0.23:1 for Jews and 1.54:1 for non-Jews (all ratios in this letter are my re-expressions of the original data). In 1934 Wolbarst,3 a NY urologist examining 1500 cases, reported a ratio of syphilis and chancroid to gonorrhoea of 0.36:1 for circumcised men and 0.78:1 for uncircumcised men (only 5–25% of American men were routinely circumcised in the late 19th century/early 20th century).4 I note from Diseker et al's table 2 (Cross section analysis at baseline) that the ratio of syphilis to gonorrhoea is 0.06:1 in circumcised men and 0.09:1 for uncircumcised men, while Table 4 (Cohort analysis—new STD) reveals 0.07:1 for circumcised men and 0.11:1 for uncircumcised men.
While the foregoing is obviously a very limited statistical analysis and other factors may play a part, it is nevertheless fascinating to see the consistently lower syphilis:gonorrhoea ratio in circumcised men, indicating a potential protective effect by circumcision against syphilis far more so than against gonorrhoea. Secondly, the syphilis:gonorrhoea ratio would appear to have decreased dramatically over time, which raises a question: if circumcision is more effective against syphilis than it is against gonorrhoea and considering the popularity of neonatal circumcision in the United States over many decades, would we not expect—ceteris paribus—to see in time a general decrease in the United States of syphilis in both relative and absolute terms?
I would encourage Diseker and colleagues to follow up their interesting study with further research on a larger scale into the relation between circumcision and STDs in order to establish more precisely the degree of protection, if any, afforded by circumcision as a prophylactic health measure.
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