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Male circumcision reduces penile high-risk human papillomavirus viral load in a randomised clinical trial in Rakai, Uganda
  1. Lauren E Wilson1,
  2. Patti Gravitt2,
  3. Aaron A R Tobian1,3,
  4. Godfrey Kigozi4,
  5. David Serwadda4,5,
  6. Fred Nalugoda4,
  7. Stephen Watya6,
  8. Maria J Wawer1,4,
  9. Ronald H Gray1,4
  1. 1Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Departments of Epidemiology and Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Rakai Health Sciences Program, Entebbe, Uganda
  5. 5School of Public Health, Makerere University, Kampala, Uganda
  6. 6Department of Urology, Makarere University, Kampala, Uganda
  1. Correspondence to Lauren E Wilson, Bg 101 Room A361B MSC A3-05, 111 T W Alexander Drive, Research Triangle Park, NC 27709, USA; lawilson{at}


Objectives Male circumcision reduces penile high-risk human papillomavirus (HR-HPV) prevalence in randomised trials. The goal of this study was to examine the effect of circumcision on HPV viral load among HPV-infected men in a randomised trial of male circumcision.

Methods In a randomised trial to assess the efficacy of circumcision on HIV acquisition in Rakai, Uganda, HIV-negative men were randomised to immediate (intervention) or delayed (control) circumcision and followed over 24 months. We performed quantitative-PCR HPV viral load assays on penile swabs which tested positive by Linear Array (LA) for six HR-HPV genotypes and estimated viral load in the remaining types by LA signal strength.

Results At 24 months, circumcision intervention arm men infected with one of the six selected HR-HPV genotypes had a lower viral load and significantly reduced HR-HPV high LA band intensity (PRR=0.61, 95% CI 0.43 to 0.86) compared to infected men in the control arm of the trial. The decreased viral load associated with circumcision was seen among HPV infections acquired after enrolment but not among infections that persisted from trial enrolment to 24 months (p=0.80).

Conclusions The decreased penile HR-HPV shedding observed among HPV-infected circumcised men may help to explain the protective association observed between circumcision and reduced acquisition of HR-HPV in female partners.

  • Circumcision
  • Hpv
  • Africa
  • Molecular Epidemiology

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