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P3.228 HSV-2 Seroincidence and Its Association with Medical Male Circumcision, HIV, Genital Ulcer Disease, and Penile Epithelial Trauma
  1. S D Mehta1,
  2. S Moses2,
  3. K Agot3,
  4. I Maclean2,
  5. E Odoyo-June4,
  6. H Li1,
  7. R C Bailey1
  1. 1University of Illinois at Chicago, Chicago, IL, United States
  2. 2University of Manitoba, Winnipeg, MB, Canada
  3. 3IRDO, Kisumu, Kenya
  4. 4Nyanza Reproductive Health Society, Kisumu, Kenya

Abstract

Background We estimated the 72-month efficacy of medical male circumcision (MMC) against HSV-2 seroincidence among men in the randomised trial of MMC in Kisumu, Kenya.

Methods From 2002–2005, 2,784 men aged 18–24 were randomised 1:1 to immediate circumcision or control. At trial end in December 2006, control men were offered free circumcision. Follow-up continued through September 2010. Cox proportional hazards regression incorporating stabilised inverse probability of treatment and censoring weights generated through marginal structural modelling was used to account for potential time-varying confounding and censoring to estimate the efficacy of MMC on HSV-2 risk. Conventional Cox regression identified multivariable risks for HSV-2 acquisition.

Results Among 2,044 men who were HSV-2 seronegative at baseline, the cumulative 72-month HSV-2 seroincidence was 33.1%: 32.7% among circumcised men, 33.5% among uncircumcised men. In weight-adjusted Cox regression, the HR was 0.88 [95% CI: 0.77 – 1.10]. In conventional multivariable analyses, risks (p < 0.05) for HSV-2 included: HIV infection [aHR = 3.75], GUD [aHR = 4.75], penile epithelial trauma [aHR = 1.47], ≥ 2 recent sex partners [aHR = 1.54], and being married/cohabiting [aHR = 1.66]. Of men with seroincident HSV-2, 21% experienced GUD and 80% reported penile epithelial trauma. Conversely, 45% of men with GUD and 80% of men reporting penile epithelial trauma did not acquire HSV-2. GUD preceded HSV-2 in 59% of men with both conditions, with median time to HSV-2 of 12 months. Penile epithelial trauma preceded HSV-2 in 92% of men with both conditions, with median time to HSV-2 of 24 months.

Conclusion MMC had no effect on HSV-2 acquisition at 72 months. The temporal sequence and limited correlation between HSV-2, GUD, and penile epithelial trauma indicate these are distinct phenomena, rather than misclassification of HSV-2 symptoms. Determining the aetiology of non-STI GUD and penile epithelial trauma is necessary as both are risks for HIV acquisition, and are common in populations in sub-Saharan Africa.

  • GUD
  • HSV-2
  • Medical Male Circumcision

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