Male circumcision and risk of HIV-1 and other sexually transmitted infections in India

doi:10.1016/S0140-6736(04)15840-6

The Lancet

Volume 363, Issue 9414, 27 March 2004, Pages 1039-1040

https://doi.org/10.1016/S0140-6736(04)15840-6 Get rights and content

Summary

Circumcised men have a lower risk of HIV-1 infection than uncircumcised men. Laboratory findings suggest that the foreskin is enriched with HIV-1 target cells. However, some data suggest that circumcision could simply be a marker for low-risk behaviours. In a prospective study of 2298 HIV-uninfected men attending sexually transmitted infection clinics in India, we noted that circumcision was strongly protective against HIV-1 infection (adjusted relative risk 0·15; 95% CI 0·04–0·62; p=0·0089); however, we noted no protective effect against herpes simplex virus type 2, syphilis, or gonorrhoea. The specificity of this relation suggests a biological rather than behavioural explanation for the protective effect of male circumcision against HIV-1.

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Cited by (137)

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LE: 1B) A cross-sectional self-reported data from a community-based surveillance system in South Africa showed that circumcision had a protective association with HSV-2 among men (odds ratio 0.66, 95 % CI 0.50 to 0.86) and among women with partner circumcision (odds ratio 0.71, 95 % CI 0.53 to 0.95) [30]. ( LE: 2C) While, in an Indian prospective cohort study of 2298 HIV-uninfected men attending STI clinics between 1993 and 2000, no statistically significant protection against HSV2 was found to be conferred on circumcised males [31]. A systematic review of 7 publications (RCT and cross-sectional) from Africa, Asia, and the USA with moderate generalisability showed high-consistency evidence of protective association of male circumcision and HSV-2 infection in women [32]. (
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Based on observational studies conducted in the USA, it is likely that circumcision both prevents HPV and increases the likelihood for clearing existing HPV infections [36,37]. Data on HSV are conflicting as a cohort study conducted in Australia showed a protective effect of circumcision, whereas trials in America and India failed to demonstrate such an effect [38–40]. Studies conducted in the USA, India, and Austria demonstrated conflicting results with regard to the effect of circumcision on the incidence of HSV and syphilis [38–41].
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Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Association of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results.
The purpose of this review is to draw attention to the gaps within the circumcision literature that need to be addressed before significant changes to public policy regarding neonatal circumcision are made within North America.
A literature review of peer‐reviewed journal articles was performed.
The main outcome measure was the state of circumcision research, especially with regard to new developments in the field, as it applies to North American populations.
This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men's sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes.
Further research is needed to inform policy makers, health‐care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America. Bossio JA, Pukall CF, and Steele S. A review of the current state of the male circumcision literature. J Sex Med 2014;11:2847–2864.

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Research LettersMale circumcision and risk of HIV-1 and other sexually transmitted infections in India

Summary

Am J Pathol

Effect of circumcision on incidence of human immunodeficiency virus type 1 and other sexually transmitted diseases: a prospective cohort study of trucking company employees in Kenya

J Infect Dis

Research Letters
Male circumcision and risk of HIV-1 and other sexually transmitted infections in India