Male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis: observations after a randomised controlled trial for HIV prevention
- 1INSERM U687, Hôpital Paul Brousse, Villejuif, France
- 2Progressus, Johannesburg, South Africa
- 3National Institute for Communicable Diseases, Johannesburg, South Africa
- 4INSERM U687, Assistance Publique-Hôpitaux de Paris, University of Versailles, France
- Dr Bertran Auvert, INSERM U687, 12 avenue Paul Vaillant-Couturier, 94804 Villejuif Cedex, France;
- Accepted 28 November 2008
- Published Online First 15 December 2008
Objective: To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial.
Methods: We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18–24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression.
Results: In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030).
Conclusions: This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.
Trial registration number: NCT00122525.
Funding: This study was supported by ANRS (France) grant 1265, NICD (South Africa), Gates Foundation (USA) grant 33759 and INSERM (France).
Competing interests: None.
Ethics approval: The research protocol was reviewed and approved by the University of Witwatersrand Human Research Ethics Committee (Medical) (protocol study number M020104). The trial was also approved by the Scientific Commission of the French National Agency for AIDS Research (ANRS, protocol study numbers 1265, 2002, decision number. 50) and authorisation was obtained from the City of Johannesburg, Region 11.
Contributors: JT and BA analysed the data and wrote the first draft. DT organised the collection of the samples. MN and AP analysed the samples. All authors contributed to the writing of the paper.