Table 2

 Summary of studies of the association of male circumcision and risk of syphilis infection

First authorDesignLocation, date of
 >studyStudy 
 >populationOutcome*Study sizeSeropositiveCircumcisedAssessment of 
 >circumcisionCrude RR† 
 >(95% CI)Adjusted RR† 
 >(95% CI)Adjusted for
*RPR, rapid plasma regain test, TPHA, Treponema pallidum haemagglutination assay; TPPA, Treponema pallidum particle agglutination; TRUST, toludidine red unheated serum test; VDRL, Venereal Disease Research Laboratory Slide Test; FTA, fluorescent treponemal antibody absorbed (FTA-ABS) test
†Rate ratio in reference 26; prevalence ratio in references 43, 52, 53; odds ratio in references 25, 49, 50, 51, 54, 55, 56, 57, 58.
‡Circumcision before sexual debut.
§Baseline prevalence of TPHA in the study population.
Buve53Cross sectionalKisumu, Kenya 1997GeneralRPR TPHA5803%27%‡Clinical examination0 
 >(0 to 1.21)–
Buve53Cross sectionalNdola, Zambia 1997GeneralTPPA59317%9%‡Clinical examination0.63 (0.25–1.63)0.54 
 >(0.21 to 1.41)Age, marital status and number of lifetime partners
Bwayo52Cross sectional25 k from Nairobi 1989–92Truck driversTPHA57025%80%Not stated0.69 
 >(0.51 to 0.94)–
Cook54Cross sectionalKing County, US 1988STD clinic attendersRPR TPHA9853%79%‡Clinical examination0.16 
 >(0.08 to 0.31)0.25 
 >(0.12 to 0.53)Age, race, number of sexual partners in last month, place of residence, other STI
Diseker55CohortUS cities 1993–6STD clinic attendersRPR TPHA8653%74%Clinical examination0.53 
 >(0.15 to 1.85)0.52 
 >(0.16 to 1.74)Age, race/ethnicity and study location
Gray25Cross sectionalRakai, Uganda 1994–8GeneralTRUST TPHA507210%12%‡Self report1.00 
 >(0.76 to 1.32)1.01 
 >(0.76 to 1.35)Age, marital status, condom use and number of sexual partners
Lavreys43Cross sectionalMombasa, Kenya 1993–7Truck driversTPHA7468%87%‡Clinical examination0.64 
 >(0.34 to 1.18)to
Newell57Cross sectionalMwanza, Tanzania 1990–1GeneralRPR TPHA19968%32%Self report0.74 
 >(0.52 to 1.05)0.6 
 >(0.4 to 0.9)Age, residence, marital status, no. sex partners in past 5 years, travel to Mwanza town in past 2 years
Parker51Cross sectionalPerth, Australia 1981STD clinic attendersTPHA13192%55%Clinical examination0.20 
 >(0.06 to 0.74)0.19 
 >(0.05 to 0.73)Age only
Reynolds26CohortPune, India 1993–2000STD clinic attendersRPR TPHA22987%8%‡Clinical examination0.74 
 >(0.38 to 1.46)0.63 
 >(0.31 to 1.28)Religion, education, living with family, year, age, marital status, number of sex partners, contact with sex workers, condom use, tattoos, medical injections
Tabet56Cross sectionalLima, Peru 1996Men who have sex with menVDRL TPHA44016%8%‡Not stated0.46 
 >(0.14 to 1.53)0.78 
 >(0.22 to 2.77)Education level, HIV serostatus, sexual identity, history of rectal discharge
Todd50Nested case-controlMwanza, Tanzania 1991–6GeneralTPHA48214%§25%Self report0.54 
 >(0.34 to 0.86)0.70 
 >(0.37 to 1.32)Age, community, education, occupation, living away from community in past 2 years, perceived STD risk
Urassa492 cross sectional; 1 case-controlMwanza, Tanzania 1990–5General and factory workersTPHA498418%18–47%Clinical examination & self report0.87 
 >(0.76 to 1.00)0.95 
 >(0.79 to 1.15)Age, area of residence, education, ethnicity, occupation, religion
Vaz58Cross sectionalMaputo, Mozambique 1990–1PrisonersRPR FTA12848%36%Self report0.68 
 >(0.45 to 1.03)0.71 
 >(0.45 to 1.11)History of genital ulcer, captivity by RENAMO during the civil war