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PL04.1 Male circumcision for sti prevention: how well does it work and how is it done?
  1. Kawango Agot
  1. University of Nairobi and CEO, Impact Research & Development Organization, Kenya

Abstract

Interest in the possible association between male circumcision (MC) and sexually transmitted infections (STIs), including HIV, began in earnest in 1980s with studies exploring the tripartite relationship of circumcision, genital ulcer disease and HIV. The interest gathered momentum in the 1990s with more studies exploring these associations beyond within and Africa. In 2002, the first randomised controlled trial (RCT) was initiated in Kisumu, Kenya, with two others following shortly after in Orange Farm, South Africa and Rakai, Uganda. Although the RCTs focused primarily on MC and HIV, they also explored associations of MC and different STIs. This presentation focuses on the association between MC and human papillomavirus (HPV), herpes simplex virus type 2 (HSV-2), syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis reported by the three RCTs as well as in systematic reviews, meta-analyses and other studies that followed.

The protective effect of MC against HPV was consistent across the three trials; in addition, the Uganda trial found that female partners of circumcised men had lower rates of HPV infection. While results from the RCTs were somewhat inconsistent on the association between MC and gonorrhoeae, HSV-2, syphilis, chlamydia and trichomoniasis, several meta-analyses and post-RCT studies have reported that MC protects against most of these conditions. As a result of these benefits, several MC devices have been developed to fast-track the provision of MC services, notably PrePex and ShangRing that have been pre-approved by the World Health Organization.

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