Mike emails: I agree with you about the circumcision ban 100%
Hi There
Beware that you may get bombarded by anti-circ activists
they brainwash each other through their protest ,symposiums, and books etc that circumcison is the worst thing on the planet. If you ask me many of these people have some mental problems..
Below is a list of Informative and educational medical sites regarding the topic of circumcision
It will allow you to see how the Anti-circ activists are lying and distorting the truth..
Just cut and paste the URL
I also posted my testimonial as a father who had his son circumcised..below that is a list of some of the latest medical news articles.
any questions please feel free to contact me
thanks
Mike
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Department of Health and Human Resources
May, 2011
Center For Disease Control and Prevention
http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm
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Dr.Brian Morris, Australia
The best information site , with a great deal of the medical facts.
http://circinfo.net/
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Dr.Neil Pollock, Vancouver Canada
You can also view a video of how circumcision is vertually painless today..
check on the yellow left hand column, Video Circumcision
http://www.pollockclinics.com/circumcision/circumcision-index.html
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This site is put out by the United Nation Aids (UNAIDS), World Health Organisation (WHO),
Aids Vaccine Advocacy Coalition (AVAC) and the Family Health International (FHI)
http://www.malecircumcision.org/publications/male_circumcision_news.html
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I am a father of a circumcised son. Yes I was circumcised too and wanted to pass on the benefits to him .
There is nothing wrong for a father to want this for his son, especially if he is aware of all the benefits
to it.
If there was only one or two benefits to being circumcised then maybe I or other fathers would think
differently. But when you add them all together the case in favor for circumcision becomes very apparent.
By being circumcised at birth, the first year of life has a less chance of having a UTI and probably lessens
the Uti chance later in life too. Throughout the rest of his life he will be less likely to have penile
problems such as torn frenulum, paraphimosis, phimosis, balanititis, thrush, small tares and abrasions on the
foreskin and upper shaft. Less chance of contracting HIV, HPV and the Herpes virus. Therefore less chance to
pass them on to his parnter.. cleanliness is also enhanced by eliminating the accumulation of smegma,
fermented urine and other smelly messes..
Pain during circumcision today is almost nil, with proper pain medication .. Circumcision has been around a
long time and will be around for many many years to come.. Circumcision is not a medical necessity but it
is definately a preventive measure . With all the deseases and weakened immune systems in people today it only
makes sense to help prevent infection and help prevent transmission of it as well. Circumcision does just that.
Proud and glad to be circumcised…Just like the vast majority of all other circumcised males out there…
I believe parents should have the right to make this decision for their child and those who are in favour
agree that it has some medical advantages.. Many studies show benefits to it and
rarely do you find medical studies showing medical benefits to being uncircumcised…
I have included a list of the latest news articles relating to the benefits
you can verify most of them online..
Thanks
Mike
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if the choice is made to circumcise, several excellent, safe alternatives are now
available to provide pain relief: EMLA cream is easy to use. When spread onto half
the length of the penis 60 to 90 minutes prior to the procedure, this topical anesthetic
provides moderate pain relief (New England Journal of Medicine, 1997; 336:1197-1201).
Dorsal penile nerve block (DNPB) involves two deep injections of lidocaine at the base of
the penis. Despite the shots, this technique greatly reduces overall pain (Journal of
Pediatrics, 1978; 92:998-1000). Bruising is the most common complication (Pediatrics,
1995; 95:705-708). Lasting problems almost never occur. .
Best is the subcutaneous ring block. Here, lidocaine is injected just under the skin in
a ring around the shaft of the penis, about halfway back from the tip. Recent evidence
suggests that it is more consistently powerful in preventing pain through all phases of
the circumcision than either EMLA or DPNB (JAMA, 1997; 278:2157-2162). There are no reports
in the medical literature of any complications.
Sugar water (or brandy) on a fingertip or pacifier may decrease crying. Acetaminophen may
blunt the pain (Pediatrics, 1994; 93:641-646); however, these and other “home remedies”
are insufficient for surgical pain, as anyone who has had an operation knows well.
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pdf of full article available free from: http://www.hindawi.com/journals/au/2011/812368/
Advances in Urology. Volume 2011 (2011), Article ID 812368, 21 pages: pp 1-12
The Strong Protective Effect of Circumcision against Cancer of the Penis
Brian J. Morris,1 Ronald H. Gray,2 Xavier Castellsague,3 F. Xavier Bosch,3 Daniel T. Halperin,4 Jake H. Waskett,5 and Catherine A. Hankins
School of Medical Sciences and Bosch Institute, Sydney Medical School, The University of Sydney, Sydney, NSW 2006,
Australia Population and Family Planning,
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA Institut Català d’Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L’Hospitalet de Llobregat, Catalonia, Spain Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA5Circumcision Independent Reference and Commentary Service, Radcliffe, Manchester M261JR, UK6Joint United Nations Programme on HIV/AIDS, 1211 Geneva, Switzerland
Received 15 December 2010; Accepted 9 March 2011
Male circumcision protects against cancer of the peni^s, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans peni^s and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly.
Phimosis (a constricted foreskin opening impeding the passage of urine) is confined to uncircumcised men, in whom balanitis (affecting 10%) is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer.
Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners.
Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV.
Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted.
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World J Urol. 2011 May 18. [Epub ahead of print]
Male circumcision and HIV infection risk.
Krieger JN.
Source
Department of Urology, School of Medicine, University of Washington, Seattle, WA, 98195, USA, jkrieger@u.washington.edu.
Abstract
BACKGROUND:
Male circumcision is being promoted to reduce human immunodeficiency virus type 1 (HIV) infection rates. This review evaluates the scientific evidence suggesting that male circumcision reduces HIV infection risk in high-risk heterosexual populations.
METHODS:
We followed the updated International Consultation on Urological Diseases evidence-based medicine recommendations to critically review the scientific evidence on male circumcision and HIV infection risk.
RESULTS:
Level 1 evidence supports the concept that male circumcision substantially reduces the risk of HIV infection. Three major lines of evidence support this conclusion: biological data suggesting that this concept is plausible, data from observational studies supported by high-quality meta-analyses, and three randomized clinical trials supported by high-quality meta-analyses.
CONCLUSIONS:
The evidence from these biological studies, observational studies, randomized controlled clinical trials, meta-analyses, and cost-effectiveness studies is conclusive. The challenges to implementation of male circumcision as a public health measure in high-risk populations must now be faced.
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Foreskin may be reservoir for HPV
By Maureen Salamon HealthDayUpdated 05/20/2011 2:21 PM
The penile foreskin can harbor the human papillomavirus (HPV) responsible for cervical cancer and genital warts, although experts disagree on whether this means that boys as well as girls should get vaccinations designed to prevent later sexual transmission.
In a small Austrian study, nearly a third of the foreskins in males examined contained strains of human papillomavirus (HPV), one of the most common sexually transmitted infections and the cause of 70% of cervical cancers. HPV can also lead to genital warts in males and females.
The results were to be presented Tuesday at the annual meeting of the American Urological Association (AUA) in Washington, D.C. Research presented at meetings is considered preliminary until it is published in a peer-reviewed journal.
“To have (HPV) present in about 30% of males is pretty interesting,” AUA spokesman Dr. Kevin McVary said. “What we don’t know is if any HPV in it was potentially transmittable. Having it present isn’t the same thing as being able to pass it on. There are a lot of unknowns.”
In the study, scientists from Innsbruck Medical University in Austria examined foreskin samples from 133 males between 7 months and 82 years old who had undergone circumcision to treat phimosis, a condition in which the foreskin cannot be pulled back from the head of the penis.
Researchers took DNA from 40 tissue sections to evaluate the prevalence of HPV and found low-risk HPV genotypes in 18.8% of the foreskins and high-risk HPV in 9.77%. None of the patients had clinical symptoms of disease.
Two vaccines are available to protect females against the types of HPV that cause most cervical cancers, and one of them — Gardasil — also protects against certain genital warts in both genders, according to the U.S. Centers for Disease Control and Prevention (CDC). HPV has also been linked to penile cancer and other malignancies in men.
The shots — about $390 for a series of three — have generated controversy for several reasons, including the high cost, reports of side effects, the early age at which girls are recommended to receive them (11 or 12 years) and the CDC’s 2009 vote against routine use in boys and men.
At least 50% of the sexually active people in the United States will have HPV at some point in their lives, according to the CDC, though the majority won’t know it. In 90% of these cases, the body’s immune system gets rid of the virus naturally within a few years.
But the study authors said the data indicate it is wise to vaccinate not only girls before adolescence, but boys as well. Agreeing with them is Fred Wyand, a spokesman for the American Social Health Association’s HPV Resource Center. Wyand said the research “lead(s) us to look at vaccines as part of a risk reduction strategy in both men and women.”
“While the impact in men is not as great as in females, men are obviously at risk for HPV infections and related diseases,” Wyand said. “Also, by extending the vaccine to boys and young men, it drives home the point that we’re talking about the human papillomavirus. Otherwise, it might be too easy to slot HPV as a ‘women’s infection,’ which both unfairly isolates women and deprives men of their rightful place in these discussions.”
Another issue the study raises is the role foreskin plays in HPV transmission, and whether circumcision might effectively reduce the risk. The circumcision rate among American newborns dropped precipitously between 2006 and 2009, from 56% to about 33%, according to the CDC.
But experts says the study results do not necessarily warrant any reversal in thinking among those opposed to the procedure.
“What this doesn’t tell us is anything regarding the relative risk of having a partner who’s circumcised vs. uncircumcised,” said Dr. Jonathan L. Temte, professor of family medicine at the University of Wisconsin School of Medicine and Public Health and a voting member on the CDC’s Advisory Committee on Immunization Practices. “I don’t think this changes the argument very much regarding pros vs. cons on circumcision.”
McVary added: “I wouldn’t overreact and start circumcising all the boys. This is pilot data, and it needs to be repeated.”
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Histopathology. 2011 May;58(6):925-33. doi: 10.1111/j.1365-2559.2011.03816.x.
Differentiated precursor lesions and low-grade variants of squamous cell carcinomas are frequent findings in foreskins of patients from a region of high penile cancer incidence.
Oertell J, Caballero C, Iglesias M, Chaux A, Amat L, Ayala E, Rodríguez I, Velázquez EF, Barreto JE, Ayala G, Cubilla AL.
Source
Instituto de Previsión Social Instituto de Patología e Investigación, Asunción, Paraguay Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Baylor College of Medicine, Houston, TX, USA.
Abstract
Oertell J, Caballero C, Iglesias M, Chaux A, Amat L, Ayala E, Rodríguez I, Velázquez E F, Barreto J E, Ayala G & Cubilla A L (2011) Histopathology 58, 925-933
Differentiated precursor lesions and low-grade variants of squamous cell carcinomas are frequent findings in foreskins of patients from a region of high penile cancer incidence
Aims: About 10-20% of all penile squamous cell carcinomas (SCCs) originate in the foreskin, but knowledge about preputial precursor and associated lesions is scant. The aims of the present study were to determine the prevalence of various precancerous and cancerous lesions exclusively affecting the foreskin, and to describe their pathological features.
Methods and results: One hundred consecutive circumcision specimens from symptomatic patients living in a region of high penile cancer incidence were analysed. Clinical diagnoses included mostly phimosis and chronic balanoposthitis (40 and 35 cases, respectively), but also a tumour mass (11 cases). Histopathological lesions found included: squamous hyperplasia in 61 cases; lichen sclerosus in 53 cases; penile intraepithelial neoplasia (PeIN) in 30 cases (all differentiated PeIN, with two cases showing multicentric foci of basaloid and warty-basaloid PeIN); and invasive SCC in 11 cases (three usual, three pseudohyperplastic, two verrucous-pseudohyperplastic, and one case each of basaloid, papillary and mixed usual-basaloid carcinomas). Lichen sclerosus was present in all low-grade SCC cases. Patients with no lesions were younger (mean age 44 years) than those with precursor lesions (mean age 54 years) or with invasive SCC (mean age 68 years). Immunohistochemistry for p16(INK4a) was performed in 19 precancerous lesions. All differentiated PeINs (18 lesions) were negative, and one basaloid PeIN was positive.
Conclusions: The frequent coexistence of lichen sclerosus, squamous hyperplasia, differentiated PeIN and low-grade SCC suggests a common non-human papillomavirus related pathogenic pathway for preputial lesions, and highlights the importance of circumcision in symptomatic patients for the prevention of penile cancer.
© 2011 Blackwell Publishing Limited.
PMID:
21585428 [PubMed – in process]Related citations
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Infect Dis Obstet Gynecol. 2011;2011:567408. Epub 2011 Apr 7.
Association of low-risk human papillomavirus infection with male circumcision in young men: results from a longitudinal study conducted in orange farm (South Africa).
Tarnaud C, Lissouba P, Cutler E, Puren A, Taljaard D, Auvert B.
Source
CESP, INSERM-UVSQ, UMRS 1018, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France.
Abstract
Background. Low-Risk Human Papillomavirus (LR-HPV) genotypes 6 and 11 cause genital warts. This study investigated the association of LR-HPV infection with male circumcision (MC). Methods. We used data from the South African MC trial conducted among young men. Urethral swabs, collected among intervention (circumcised) and control (uncircumcised) groups, were analyzed using HPV linear array. Adjusted LR-HPV prevalence rate ratio (aPPR) and Poisson mean ratio (aPMR) of number of LR-HPV genotypes were estimated using log-Poisson regression, controlling for background characteristics, sexual behaviour, and HIV and HSV-2 statuses. Results. Compared to controls, LR-HPV prevalence and mean number of genotypes were significantly lower among the intervention group ((8.5% versus 15.8%; aPRR: 0.54, P < .001) and (0.33 versus 0.18; aPMR: 0.54, P < .001), resp.). Mean number of LR-HPV genotypes increased with number of lifetime sexual partners and decreased with education level and consistent condom use. Conclusions. This study shows a reduction in LR-HPV infection among circumcised men.
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The skinny on circumcision
Newborns are very resilient and circumcision performed at that time results in fewer complications
By Dr. Ed Schoen And Dr. Neil Pollock, Vancouver Sun April 12, 2011 1:46 AM
In response to the article by Sharon Kirkey (Circumcision best left to prepubescence, disease expert says) published April 4 in The Vancouver Sun, we wish to share further relevant information to help readers gain a deeper understanding of the issues that frequently arise in the circumcision debate.
We agree with the health benefits of circumcision that were highlighted in the article, and add that many health care providers today feel that those benefits outweigh the minor complications, and these benefits accrue from infancy through old age. Some argue that an uncircumcised male infant may have a lifetime health disadvantage.
Many people wonder why having a foreskin poses a risk. The basic problem is that the inner layer of the foreskin is a mucous membrane, like the lining of the cheek. It is moist, delicate, tears easily, and harmful germs tend to stick to and/or invade it. It contains a large number of specialized cells (phagocytes) to trap and destroy invading organisms, but in some instances, such as HIV, these cells trap the virus but are unable to destroy it, thus aiding its introduction into the body.
As Kirkey's article pointed out, repeated studies have shown that circumcision is 50 to 60 per cent protective against HIV/AIDS in heterosexual men.
Other sexually transmitted infections (STIs) are also more likely in uncircumcised men. These include human papillomavirus (HPV), genital herpes, trichomonas and bacterial vaginosis. HPV causes both penile and cervical cancer. Penile cancer is found almost exclusively in uncircumcised men and cervical cancer is twice as common in women with uncircumcised partners. Sexual pleasure and power are not significantly affected by circumcision.
We disagree with the suggestion, made by Dr. Noni Macdonald in Kirkey's article, to wait until prepubescence to circumcise boys. This is because the advantages of circumcision begin in infancy. In the first year of life, uncircumcised boys are 10 times as likely to get serious urinary tract infections (UTIs), with possible future kidney damage. Dr. Tom Wiswell provided the original evidence in the 1980s after studying over 200,000 deliveries from the Armed Forces files. In addition to preventing UTIs, newborn circumcision prevents childhood foreskin infections, and inability to retract the foreskin (phimosis). It also promotes better genital hygiene, particularly in infancy and old age, when self-cleaning can't be done.
The newborn period is the "window of opportunity" for circumcision. Newborns are very resilient, have high levels of endorphins, heal faster, and their thin foreskin rarely requires suturing. Notwithstanding this, local anesthesia should always be used in newborn circumcision, because when administered properly, it prevents pain for the baby. The complication rate is under 0.5 per cent, 10 times less than if the procedure is done later when the foreskin is thicker, bleeds more and needs stitches. The serious risks and costs to the patient are higher later in life, because general anesthesia and hospitalization is generally considered to be required.
From my (Dr. Pollock's) own experience of safely completing in B.C. more than 30,000 newborn circumcisions, I feel strongly that in experienced hands, newborn circumcision is a quick (under 30 seconds start to end), safe, and a virtually painless procedure. Significant post-operative bleeding is rare.
Many people opposed to circumcision argue against it based on the evaluation of a specific benefit compared to the overall risk. However, when the many small cumulative benefits of circumcision are compared to the overall risks, the benefit-to-risk ratio is significant.
Parents considering newborn circumcision should seek a knowledgeable medical professional who is able to provide an unbiased summary of both the benefits and risks so that parents can make an informed, independent decision.
When choosing a circumcision provider, the experience of that provider, more than which technique or instrument is used, is the key to safe outcomes.
Dr. Ed Schoen is based in San Francisco and Dr. Neil Pollock is a physician in Vancouver.
© Copyright (c) The Vancouver Sun
Read more: http://www.vancouversun.com/health/skinny+circumcision/4599446/story.html#ixzz1JJPXaSMt
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HIV Protection Lasts After Circumcision
By Michael Smith, North American Correspondent, MedPage Today
Published: February 28, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
BOSTON -- The benefit of male circumcision for HIV prevention persists, even long after the procedure, a researcher reported here.
The finding comes from surveillance after the end of one of the major trials -- in the Ugandan district of Rakai -- that first established the benefit of the procedure, according to Xiangrong Kong, PhD, of Johns Hopkins University.
Moreover, the procedure did not induce men who were circumcised to change their sexual behavior in risky ways, Kong reported at the annual Conference on Retroviruses and Opportunistic Infections.
The post-trial period -- now almost five years -- "approximates" normal life and allowed researchers to see how circumcision affects both the risk of HIV and human behavior, Kong told reporters.
After the end of the trial, she said, the researchers offered men in the control arm the chance to be circumcised, and 80.4% accepted.
At the end of last year, she reported, HIV incidence was 73% lower among the original trial participants who were circumcised and those who got circumcised later, compared with those in the control arm who did not accept circumcision.
All three of the original randomized trials showed that circumcision reduced the risk of catching HIV by about 50%.
Among control participants who were circumcised after the end of the trial, Kong reported, the risk of HIV was reduced 67%, compared with the men who declined the procedure.
Even outside a controlled trial, she said, "male circumcision continues to provide significant protection."
One concern has been that men who were circumcised -- knowing that they had some protection -- might change their sexual behavior, adopting more risky practices, Kong noted.
But in the post-trial surveillance that did not seem to occur, she reported.
Controls who accepted or refused circumcision were similar in age, education, marital status, number of sex partners, and condom and alcohol use with sex.
During the post-trial surveillance, both groups of controls reported overall:
•No change in number of non-marital sex partners.
•A 9.5% decline in alcohol use with sex, which was significant at P<0.001.
•A 4.3% decrease in consistent condom use and a 6.2% decline in any condom use, both of which were significant at P<0.001.
•However, there was no significant difference in condom use between the 1,321 men who got circumcised and the 372 who did not.
Kong said the observed changes in behavior, which were seen equally in both groups, are probably a consequence of the end of the intensive counseling and education programs that accompanied the trial.
"I'm not exactly surprised," commented Kevin De Cock, MD, of the CDC, mainly because the original trials were based on observations that HIV incidence was lower among circumcised men with little or no difference in behavior.
In a sense, he told MedPage Today, researchers knew the results of implementation of the procedure before they actually did the randomized trials.
"We had the epidemiological cart before the horse," said De Cock, who was not part of the research but who chaired a press conference at which it was presented.
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Zhonghua Nan Ke Xue. 2010 Dec;16(12):1095-7.
[Sexual function and mental state in patients with redundant prepuce or phimosis].
[Article in Chinese]
Yang L, Ruan LM, Yan ZJ, Cheng Y, Wang GY, Ji YX.
Department of Psychology, The First Hospital of Ningbo, Ningbo, Zhejiang 315010, China. yanglu20091111@hotmail.com
Abstract
OBJECTIVE: To investigate the correlation of sexual dysfunction with psychological abnormalities by analyzing the sexual function and mental state of the patients with redundant prepuce or phimosis.
METHODS: This study included 216 randomly selected patients with redundant prepuce or phimosis and 85 normal male controls. We conducted investigations among the subjects using a questionnaire on the general data of the patients, Chinese Index of Sexual Function for Premature Ejaculation (CIPE), International Index of Erectile Function (IIEF), and Symptom Checklist 90 (SCL-90). Then we assessed the status of premature ejaculation (PE) and erectile dysfunction (ED), calculated the incidence of psychological abnormalities, such as depression and anxiety, and analyzed the correlation of PE and ED with the mental state of the patients.
RESULTS: The PE and ED patients scored significantly higher than normal controls on SCL-90, somatization, compulsion, depression, anxiety and other factors (P < 0.05). CIPE scores were correlated with the scores on SCL-90, somatization, compulsion, interpersonal sensitivity, depression, anxiety and other factors, while ED-related scores showed no correlation with the scores on SCL-90 and other factors.
CONCLUSION: Patients with redundant prepuce or phimosis have poor mental health, and there is an interaction between PE and the mental state of the patient.
PMID: 21348200 [PubMed - in process]
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Circumcision Is a Good Decision, Reduces HPV Transmission
Deborah Mitchell on 2011-01-07
Sexual Health
EmaxHealth.com
Adult male circumcision can reduce the prevalence and incidence of HPV transmission (human papillomavirus)
from men to their female partners, according to a new study published in Lancet. Although male circumcision
may be a good decision, safe sex practices are still necessary for full protection.
Women can benefit from male circumcision
According to the World Health Organization, HPV is the second largest cause of female cancer deaths worldwide,
with 288,000 deaths per year. About 80 percent of cervical cancer cases occur in developing countries. While
HPV is the most common cause of cervical cancer, the infection can also cause vulvar, vaginal, penile, and
anal cancer, as well as some cases of head and neck cancers.
Two independent randomized controlled trials of male circumcision were conducted in Uganda. All the men in the
trials were HIV-negative at the time of enrollment. Of the 2,786 men assigned to undergo circumcision
(intervention) immediately, nearly half (49%) were married or in a consensual relationship with a total of
1,463 women. Of the 2,819 men in the control group (postponement of circumcision for 24 months), 48 percent
were married or in a committed relationship with a total of 1,429 women.
The researchers also enrolled the female partners of the male participants and provided self-collected vaginal
swabs at the start of the trial and at 12 and 24 months. Due to difficulties with the collection swabs, the
presence of HIV in some women, and loss at follow-up, a total of 544 women of men from the intervention group
and 488 of men from the control group completed the study.
At the 24-month mark, 151 (27.8%) of women who had circumcised partners had high-risk HPV infection compared
with 189 (38.7%) of women of uncircumcised partners. Although this study did not investigate the relationship
between HPV infection and cervical cancer, previous research shows lower rates of cervical cancer associated
with male circumcision.
The authors note that male circumcision appears to be an effective way to reduce HPV transmission. Other
studies have already shown that male circumcision reduces the risk of HIV and other sexually transmitted
diseases such as herpes simplex virus-2, and genital ulcer disease in men, as well as trichomoniasis,
bacterial vaginosis, and genital ulcer disease in female partners.
SOURCES
Centers for Disease Control and Prevention
Wawer MJ et al. Lancet 2011 Jan 7
World Health Organization
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By Maggie Fox
WASHINGTON | Fri Jan 7, 2011 11:23am EST
WASHINGTON (Reuters) - Circumcision can protect men against the AIDS virus, it can also protect their wives
and girlfriends from a virus that causes cervical cancer.
Wives and girlfriends of circumcised men had a 28 percent lower rate of infection over two years with the
human papilloma virus or HPV, which causes warts and cervical cancer, they reported in the Lancet medical
journal on Thursday.
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The Lancet, Early Online Publication, 7 January 2011
Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women:
a randomised trial in Rakai, Uganda
Prof Maria J Wawer MD a f Ý, Dr Aaron AR Tobian MD a c Ý, Godfrey Kigozi MBChB f, Xiangrong Kong PhD a d,
Patti E Gravitt PhD e, David Serwadda MMed f g, Fred Nalugoda MHS f g, Frederick Makumbi PhD f g, Victor
Ssempiija ScM f, Nelson Sewankambo MMed f h, Stephen Watya MMed i, Kevin P Eaton BS b, Amy E. Oliver BA b,
Michael Z Chen MSc a, Steven J Reynolds MD b j, Prof Thomas C Quinn MD b j, Prof Ronald H Gray MD a f
Randomised trials show that male circumcision reduces the prevalence and incidence of high-risk human
papillomavirus (HPV) infection in men. We assessed the efficacy of male circumcision to reduce prevalence and
incidence of high-risk HPV in female partners of circumcised men.
Methods
In two parallel but independent randomised controlled trials of male circumcision, we enrolled HIV-negative
men and their female partners between 2003 and 2006, in Rakai, Uganda. With a computer-generated random number
sequence in blocks of 20, men were assigned to undergo circumcision immediately (intervention) or after 24
months (control). HIV-uninfected female partners (648 of men from the intervention group, and 597 of men in
the control group) were simultaneously enrolled and provided interview information and self-collected vaginal
swabs at baseline, 12 months, and 24 months.
Vaginal swabs were tested for high-risk HPV by Roche HPV Linear
Array. Female HPV infection was a secondary endpoint of the trials, assessed as the prevalence of high-risk
HPV infection 24 months after intervention and the incidence of new infections during the trial. Analysis was
by intention-to-treat. An as-treated analysis was also done to account for study-group crossovers. The trials
were registered, numbers NCT00425984 and NCT00124878.
Findings
During the trial, 18 men in the control group underwent circumcision elsewhere, and 31 in the intervention
group did not undergo circumcision. At 24-month follow-up, data were available for 544 women in the
intervention group and 488 in the control group; 151 (27·8%) women in the intervention group and 189 (38·7%)
in the control group had high-risk HPV infection (prevalence risk ratio=0·72, 95% CI 0·60-0·85, p=0·001).
During the trial, incidence of high-risk HPV infection in women was lower in the intervention group than in
the control group (20·7 infections vs 26·9 infections per 100 person-years; incidence rate ratio=0·77,
0·63-0·93, p=0·008).
Interpretation
Our findings indicate that male circumcision should now be accepted as an efficacious intervention for
reducing the prevalence and incidence of HPV infections in female partners. However, protection is only
partial; the promotion of safe sex practices is also important.
Funding
The Bill & Melinda Gates Foundation, National Institutes of Health, and Fogarty International Center.
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Travis, Mason, Van Howe et al. seem to have not a clue about epidemiology by saying there is HIV in the USA
and that most men in the USA are circumcised, so this proves circumcision doesn't prevent HIV. How ridiculous!
Proper studies (see below) COMPARING circumcised and uncircumcised heterosexual men in the USA show much
lower HIV in the circumcised. And of course the major route of infection is receptive anal intercourse, which
MC would obviously offer no protection against when it comes to HIV.
In referring to Millett et al., Boyle & Hill fail to point out that this study, like others, including in
Australia, found that the small proportion of "insertive-only" men who have sex with men (ie, closest to
insertive sex as heterosexual men) have lower risk of HIV infection. Of course, MSM overall are unlikely to
show lower HIV if they are circumcised versus uncircumcised, since (i) circumcision status would have no
effect for a man who engages in receptive anal intercourse, and (ii) most MSM engage in exclusive receptive
anal intercourse or a mixture. This is the kind of deceit that the anti-circs like to engage in.
The claim by Darby that there is no evidence that neonatal circumcision protects against HIV is false. There
is plenty of data from US studies of heterosexual men (and insertive-only MSM), who were circumcised as
infants, that show much lower HIV. To quote from my internet review (www.circinfo.net):
"An association of higher incidence of HIV with being uncircumcised in the USA was first noted in 1989
[Whittington, 1989]. A study of heterosexual couples in Miami found a higher incidence of HIV in men who
were uncircumcised. A study in New York City found that risk ratio for HIV infection in heterosexual men as
a result of being uncircumcised was 4.1, rate being 2.1% versus 0.6% for uncircumcised men as compared
circumcised men [Telzak et al., 1993]. Another US study that looked at heterosexual sex found a risk ratio of
2.9 [Kassler & Aral, 1995]. (See also review by Moses et al. [1998].)
In heterosexual African American men attending STI clinics in Baltimore from 1993 to 2000, the prevalence of
HIV was 2.7%. Looking at the data for those with known exposure to HIV, infection was seen in 10.2% of the
men who were circumcised, compared with 22.0% of the men who were uncircumcised (adjusted prevalence ratio
= 0.49) [Warner et al., 2009].
In homosexual men a study in Seattle found a 2.2-times higher HIV-positivity in the 15% who were uncircumcised
[Kreiss & Hopkins, 1993]. A later study in Seattle found no difference, however [Jameson et al., 2009].
But caution is needed in interpretation of the latter results, since they were derived from men attending a
STI clinic. Since circumcised men are protected from STI because of being circumcised they will be less
likely to attend an STI clinic, meaning data from STI clinic cohorts are biased, i.e, such data do not
necessarily represent the prevalence of an STI amongst men of each circumcision status in the general
population. The bias is, moreover, away from showing a protective effect of circumcision. Another study,
involving 3257 homosexual men in 6 US cities studied from 1995-1997, identified various risk factors, lack of
circumcision once again being found to double the risk of acquiring HIV [Buchbinder et al., 2005]. A failed
HIV vaccine trial stopped in 2007 noted that "infected men were less likely to be circumcised" [Fox, 2007].
No association between circumcision status and either HIV or syphilis infection in homosexual men was seen in
a San Francisco study, although the authors noted that a large proportion of gay men practice both insertive
and receptive anal intercourse [Mor et al., 2007]. The latter would dampen the possibility of seeing an
association with circumcision status.
Interestingly, per-contact risk of infection from receptive 0ral sex is claimed to be comparable to that of
insertive anal sex [Vittinghoff et al., 1999; Celum et al., 2001; Buchbinder et al., 2005]. This is not,
however, generally accepted as yet.
The relatively moderate HIV infection rate in the USA is likely contributed by the high prevalence of
circumcision in this country [Addanki et al., 2008].
A position paper in 2007 stated "it is likely that circumcision will decrease the probability of a man
acquiring HIV via penile-vaginal sex with an HIV-infected woman in the USA" and that "some sexually active
men may consider circumcision as an additional HIV prevention measure" [Sullivan et al., 2007]. This was in
addition to c0ndoms of course, although in the USA condoms were never used during heterosexual sex with a
non-primary partner in the case of 16% of men and 24% of women [Sanchez et al., 2006].
The Report warned, however, that any reduction in reimbursement by public and private medical insurance for
circumcision, and any decline in rate of circumcision, could reverse the benefit that the USA has enjoyed
to date because of its high rate of circumcision [Sullivan et al., 2007].
As mentioned above, the Centers for Disease Control announced in 2009 that it would be recommending infant
male circumcision for prevention of HIV and other medical conditions (New York Times, Aug 24, 2009)
[Rabin, 2009], thus answering those who had been equivocating on this issue [Xu et al., 2009]."
[SEE: http://www.circinfo.net for references to these publications]
=============================================================================================
To read download printable version of article go to:
http://abcnews.go.com/CleanPrint/cleanprintproxy.aspx?1294434747142
On the site below there is an associated video interview on "Good Morning America" with a female doctor in
Baltimore on "Intactivism", etc, a lawyer re a consent case in Florida, people on the street and finally
a female pediatrician on benefits (and who clearly has only a superficial understanding of the issues and
benefits):
http://abcnews.go.com/Health/Wellness/circumcision-public-health-concern/story?id=12555810
Circumcision's Public Health Benefits
Circumcision Rates Drop, Though It Decreases HPV Rates in Men and their Partners
By COURTNEY HUTCHISON, ABC News Medical Unit
Jan. 7, 2011
When parents put their baby boys under the knife for circumcision, it's usually for religious or cultural
reasons, but mounting evidence suggests that the removal of the foreskin might also serve a public health
purpose: reducing the spread of human papillomavirus (HPV).
Not only does past research show that circumcised men are 32 to 35 percent less likely to contract HPV, but
a new study published in the Lancet Thursday shows that women whose partners are circumcised are 28 percent
less likely to become infected with HPV.
This finding has particular weight considering that persistent infections with high-risk strains of HPV in
women can lead to cervical cancer. Cervical cancer is the leading cause of cancer deaths internationally for
women.
Over the past five years, randomized controlled trials have shown that circumcision decreases the risk of HIV,
HPV, and herpes. In women it reduces the risk of bacterial vaginosis, trichomoniasis, and now HPV. Though
these studies have been done in African countries, their findings, including Thursday's, support observational
studies already performed in the U.S., says study author Dr. Aaron Tobian of Johns Hopkins University.
"Many will argue that these findings are in Africa and they do not represent the U.S., however almost all of
the supporting observational studies for this area were performed on U.S. populations," he says. "We believe
the cumulative scientific evidence supporting circumcision is now overwhelming."
Given this evidence, Tobian says it's disquieting to see the rate of circumcision in the U.S. decline as it
has in recent decades. Though estimates vary between data sources, one CDC presentation put in-hospital
neonatal circumcisions (which leaves those done in the Jewish ritual circumcisions) at 32.5 percent in 2009,
compared to 56 percent in 2006 and somewhere around 65 percent in the 1980s.
The debate over whether or not to circumcise newborn boys has been a passionate one in the U.S., with some
anti-circumcision "inactivists," such as San Franciscan Lloyd Schofield, proposing to ban the practice.
Though proponents often cite cleanliness and lowered risk of infection as reasons to favor circumcision,
the practice has not yet become one of public health import in the U.S. as it has for certain developing
nations.
The question, in light of growing concerns over HPV and increasing evidence of its moderately
infection-protective effect, is whether it should be.
Circumcise Men, Benefit Women
In the study, HIV-negative Ugandan men and women who were in monogamous relationships were randomized into a
treatment group, where the men were circumcised, or a control group, where men were left uncircumcised.
After two years, 28 percent of the women whose partners had been circumcised had high risk HPV infection
compared to 39 percent of those whose partners had remained uncut. This constitutes a 28 percent increased
risk of infection for those women who were sexually active with uncircumcised partners.
So what is going on here? There are several possible explanations for why the foreskin may be promoting
infection and transmission of infection to female partners, Tobian says. There may be micro-tears in the skin
that lead to higher viral infection. Perhaps the quality of foreskin allows for easier infection of epithelial
cells. It's also possible that the moist environment beneath the foreskin may be favorable to infection.
"Once you remove that area," Tobian says, "it's harder for the virus to enter and infect."
And when the infection rate is lower for men, they are less likely to transmit this infection to their female
partners. This is especially important, Tobian says, because an HPV infection -- unlike HIV can clear and
become non-active.
"Viruses are permanent, but the activity of the virus is what we're more concerned with," says director of
Gynecology at Albert Einstein Medical School Dr. Erika Banks. "It's not really HPV that's the problem, it's
the persistence of infections with high-risk strains."
Study authors cautioned, however, that while circumcision reduced the risk of infection, it did not eliminate
the need for other forms of protection from sexually transmitted diseases. They said men should still use
cond0ms and women should get the HPV vaccine.
Circumcision as a Public Health Debate
For developing nations with particularly high levels of HIV and HPV, circumcision may offer a cost-effective
means of reducing transmission rates in an environment where access to vaccines and medical care are lacking.
"Circumcision may offer a low cost minimal risk one-time procedure that could decrease the transmission of
the virus that can cause cervical cancer" in developing nations who do not have access to regular screenings,
says Banks.
In Africa circumcision programs to provide the procedure to adult males have been "ramping up," says
Dr. Thomas Quinn, co-author on the study and researcher for Johns Hopkins University and the National
Institute of Allergy and Infectious Diseases. For instance in Kenya, more than 250,000 males have been
circumcised so far as part of HIV prevention programs sponsored by the government.
Back in the U.S., the health benefit may not be as "imminently relevant," she says, but the evidence is
compelling enough nonetheless to consider strengthening recommendations for circumcision.
American Academy of Pediatrics recommendations say the data are "not sufficient to recommend routine neonatal
circumcision," and as a result, Medicaid in many states does not cover the practice. The academy is currently
reviewing the recent data emerging from African studies like Thursday's in order to update the guidelines.
"The data on sexually transmitted diseases [and circumcision] are the data we didn't have five to ten years
ago when we were making the recommendations," says Dr. Doug Diekema, a member of the academy's circumcision
task force. He says new recommendations will likely come out within a year. Though he couldn't say for
certain whether the academy's stance on circumcision would change, he said he "wouldn't be very surprised if
the academy leaves it ultimately up to the parents and says it's the physician's job to make sure the parents
understand fully the benefits and risks of this procedure."
Study authors are hoping for a more substantial change in policy, however.
"We are not at all mandating that everyone should be circumcised, but we disagree that the evidence is
'conflicting' as the AAP says. We believe the public should be aware of the existing evidence and it should
be a decision among parents that are informed of this evidence," Tobian says.
"There's no doubt that male circumcision provides a certain degree of protection against sexually transmitted
diseases," adds Quinn, "and male circumcision needs to be reevaluated by leading health authorities as to its
true public health benefit, not just to men but to future female partners."
============================================================================================================
5th International AIDS Society Conference, Cape Town, South Africa, Jul 2009,
abstract no. LBPEC06
Male circumcision and male-to-female HIV-1 transmission risk: a multinational
prospective study
Presented by Jared Baeten (United States).
J. Baeten1, D. Donnell2, M. Inambao3, G. John-Stewart1, S. Kapiga4,5, R. Manongi5,
A. Ronald6, B. Vwalika7, C. Celum1, Partners in Prevention HSV/HIV Transmission
Study Team
1University of Washington, Seattle, United States, 2Fred Hutchinson Cancer Research
Center, Seattle, United States, 3Rwanda Zambia HIV Research Group, Ndola, Zambia,
4London School Hygiene and Tropical Medicine, London, United Kingdom, 5Kilimanjaro
Christian Medical Centre, Moshi, Tanzania, United Republic of, 6University of
Manitoba, Winnipeg, Canada, 7Rwanda Zambia HIV Research Group, Lusaka, Zambia
Background: Male circumcision reduces female-to-male HIV-1 transmission risk by ~50%.
However, few studies have assessed the effect of circumcision on male-to-female
HIV-1 transmission. One previous observational study suggested circumcision reduced
male-to-female transmission only from men with plasma HIV-1 concentrations
< 50,000 copies/mL.
Methods: Data were from a clinical trial of acyclovir HSV-2 suppressive therapy
provided to HIV-1/HSV-2 co-infected members of African HIV-1 serodiscordant couples
(Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda, Zambia). We evaluated the
relationship between circumcision status of HIV-1 seropositive men and risk of HIV-1
acquisition among their female sexual partners. Circumcision status was determined
by physical examination at study enrollment. Cox proportional hazards analysis was
used.
Results: 1097 HIV-1 serodiscordant couples were enrolled in which the male partner
was HIV-1 infected; 374 (34%) male partners were circumcised. Median follow-up was
18 months. 64 female partners seroconverted to HIV-1 (incidence 3.8 per 100
person-years). Circumcision of the HIV-1 infected male partner was associated with a
47% decrease in the risk of HIV-1 acquisition by the female partner (hazard ratio
[HR] 0.53, 95% confidence interval [CI] 0.29, 0.99, p=0.046). The magnitude of this
effect was similar in analyses adjusting for male partner plasma HIV-1
concentrations (HR 0.56, p=0.06) and unprotected sexual activity (HR 0.52, p=0.03),
and when restricted to the subset of HIV-1 transmission events that were confirmed
by viral sequencing to have occurred within the partnership (n=49, HR 0.51, p=0.06).
The effect of circumcision on male-to-female HIV-1 transmission risk was similar
among those with male plasma HIV-1 concentrations >50,000 and ¾50,000 copies/mL.
Randomization to acyclovir did not significantly alter the effect of circumcision
on male-to-female HIV-1 transmission risk.
Conclusions: In this multinational prospective observational study among HIV-1
serodiscordant couples, female partners of circumcised HIV-1 infected men had
decreased HIV-1 risk.
—————————————————————————————————————————————
Male Circumcision Improves Sex for Women
Survey Results Are Part of Study That Showed Circumcision Reduces a Man’s HIV Risk
By Charlene Laino
WebMD Health NewsReviewed by Louise Chang, MDJuly 21, 2009 (Cape Town, South Africa) — Women whose male
sexual partners were circumcised report an improvement in their sex life, a survey shows.
Researchers studied 455 partners of men in Uganda who were recently circumcised. Nearly 40% said sex was
more satisfying afterward. About 57% reported no change in sexual satisfaction, and only 3% said sex was
less satisfying after their partner was circumcised.
Also, some women said their partner had less or no difficulty maintaining or getting an erection.
Among the 3% of women who reported reduced sexual satisfaction, the top two reasons were lower levels of desire on the part of either partner.
Top reasons cited by women for their better sex life: improved hygiene, longer time for their partner to achieve orgasm, and their partner wanting more frequent sex, says Godfrey Kigozi, MD, of the Rakai Health Sciences Program in Kalisizo, Uganda.
Kigozi tells WebMD he undertook the survey because some activists have objected to male circumcision as a means of combating HIV because of a lack of data on female sexual satisfactions.
The findings were presented at the Fifth International AIDS Society Conference on Pathogenesis, Treatment and Prevention of HIV.
The women in the study all participated in the landmark Rakai circumcision trial, one of three studies that showed that the procedure reduces a heterosexual man’s risk of acquiring HIV by more than 50%.
“We included only women who said they were sexually satisfied before [their partner was circumcised],” Kigozi says. “Then we asked them to compare their sexual satisfaction before and afterward.”
Men feel much the same way, he adds. In a previous survey, 97% of men said their level of sexual satisfaction was either unchanged or better after they were circumcised.
Naomi Block, MD, of the CDC’s HIV Prevention Branch, who chaired the session at which the study was presented, says that other surveys have shown that women don’t expect their sex lives to change if their partners are circumcised.
But those were “what if?” surveys, she tells WebMD, while the new study involves women whose partners were actually circumcised.
The findings are “good news” as they show that the use of circumcision to fight HIV is acceptable to women, Block says.
=============================================================================================================
Adult Circumcision Reduces Risk Of HIV Transmission Without Reducing Sexual Pleasure
ScienceDaily (Apr. 26, 2009)
— Two studies presented at the 104th Annual Scientific
Meeting of the American Urological Association (AUA) show that adult circumcision
reduces the risk of contracting the human immunodeficiency virus (HIV) and the risk
of coital injury — without reducing pleasure or causing sexual dysfunction.
——————————————————————-
Circumcision does not dull sensitivity: study
Last Updated: 2003-04-29 10:32:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) – Circumcised men appear to have the same degree of penis
sensitivity as men who are uncircumcised, a new study suggests — in a finding that
will probably just add fuel to the fire of a controversial subject debated for years.
The findings are to be presented Tuesday by Dr. Arnold Melman at a meeting of the
American Urological Association in Chicago.
“We demonstrated that there are no significant differences in penile sensation
between circumcised and uncircumcised men in both patients with and without erectile
dysfunction,” said Melman in a prepared statement.
“This study does not address whether or not patients should be circumcised, however,
it merely served to test sensitivity,” added Melman, who is with Montefiore Medical
Center in New York City.
The current policy of the American Academy of Pediatrics is that the potential
medical benefits of male circumcision are not substantial enough to recommend that
all boys become circumcised.
Around three-quarters of American-born men in the U.S. are circumcised, although that
number appears to be declining rapidly in some regions of the country.
Male circumcision is common in North America and elsewhere for religious and cultural
reasons and is known to help prevent urinary tract infections, sexually transmitted
diseases and penile cancer, a rare condition. In the minor surgical operation, the
foreskin is removed, which can help prevent bacteria from growing under the fold of
skin.
On the other hand, many parents feel it inflicts unnecessary pain, and in many
countries circumcision is rarely performed. In recent years, the issue has been
highly controversial with vocal opponents to the procedure likening it to mutilation.
Still, few studies have aimed to investigate the differences in penile sensitivity,
if any, between the two groups.
In the current investigation, Melman’s team evaluated the penile sensitivity among 43
uncircumcised men and 36 circumcised men through a variety of methods, including
vibration, pressure, spatial perception and warm and cold thermal thresholds. Both
groups contained men with and without erectile dysfunction.
In uncircumcised men, the foreskin was pulled back during the sensitivity testing
procedures.
The investigators found no statistically significant differences in sensitivity
between the two groups of men, regardless of whether they had erectile dysfunction.
In other findings, the researchers found that white men were 25 times as likely and
African-American men were eight times as likely as Hispanics to be circumcised.
============================================================================================================
Am J Obstet Gynecol. 2009 Jan;200(1):42.e1-7. Epub 2008 Oct 30.
The effects of male circumcision on female partners’ genital tract symptoms and
vaginal infections in a randomized trial in Rakai, Uganda.
Gray RH, Kigozi G, Serwadda D, Makumbi F, Nalugoda F, Watya S, Moulton L, Chen MZ,
Sewankambo NK, Kiwanuka N, Sempijja V, Lutalo T, Kagayii J, Wabwire-Mangen F, Ridzon
R, Bacon M, Wawer MJ.
Department of Population, Family, and Reproductive Health, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD 21205, USA. rgray@jhsph.edu
OBJECTIVE: The objective of the study was to assess effects of male circumcision on
female genital symptoms and vaginal infections. STUDY DESIGN: Human immunodeficiency
virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed
circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and
trichomonas were assessed in HIV-negative wives of married participants.
Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs)
were assessed by multivariable log-binomial regression, intent-to-treat analyses.
RESULTS: A total of 783 wives of control and 825 wives of intervention arm men were
comparable at enrollment. BV at enrollment was higher in control (38.3%) than
intervention arm spouses (30.5%, P = .001). At 1 year follow-up, intervention arm
wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97),
but there were no differences in vaginal discharge or dysuria. The risk of
trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05-0.98),
as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV
(prevalence risk ratios, 0.39; 95% CI, 0.24-0.64).
CONCLUSION: Male circumcision
reduces the risk of ulceration, trichomonas, and BV in female partners.
————————————————————————
Circumcision protects against genital wart virus
Wed, Mar 25, 2009
Reuters
NEW YORK (Reuters Health) – A study of nearly 1000 men in three countries has
yielded more evidence that circumcision helps protect against infection with human
papillomavirus.
Human papillomavirus has long been known as a cause of genital warts, but in recent
years most reports have focused on its association with cervical cancer. The virus,
which is transmitted sexually and by skin-to-skin contact, can also cause anal and
penis cancers.
“Interventions such as circumcision may provide a low-cost method to reduce human
papillomavirus infection,” Dr. Anna R. Giuliano, from the H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida, and colleagues conclude in a report in
the International Journal of Cancer.
Using data from the Human papillomavirus In Men (HIM) study group, the investigators
determined factors associated with human papillomavirus infection in 988 men, ages
18 to 70 years, living in Brazil, Mexico or the United States.
Human papillomavirus infection was strongly related to sexual behavior and
circumcision, the investigators found.
“In this multi-national study where approximately 60 percent of study participants
were un-circumcised, we found circumcision to be associated with a significantly
reduced risk of…human papillomavirus,” they report.
These findings, they point out, mirror those of a previous study in a mixed ethnic
group of men from Tucson, Arizona, and are similar to what others have reported in
studies conducted in Spain, Columbia, Brazil, the Philippines, Thailand, Mexico and
Denmark, the team notes.
By contrast, as the number of lifetime female sexual partners, number of female
partners in the past 3 months, and number of anal sex partners increased, so did the
risk of human papillomavirus infection.
Reported race of Asian/Pacific Islander was also linked to an increased risk of human
papillomavirus infection.
Unlike what has been shown in women, age appeared to have no bearing on the risk of
infection, the authors note.
SOURCE: International Journal of Cancer, March 15, 2009.
————————————————————————————
Circumcision Protects Against 2 Common Sexually Transmitted Diseases:
Last Updated: Wednesday, March 25, 2009 CBC News
Circumcision helps protect heterosexual men against genital herpes and a virus that
causes genital warts and cancer but has no effect on the bacteria that causes
syphilis, two trials in Uganda show.
The study in Wednesday’s New England Journal of Medicine builds on earlier research
that found circumcision reduces a man’s risk of HIV infection by more than 50 per
cent.
“Medically supervised adult male circumcision is a scientifically proven method for
reducing a man’s risk of acquiring HIV infection through heterosexual intercourse,
” said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and
Infectious Disease, which funded the study.
“This new research provides compelling evidence that circumcision can provide some
protection against genital herpes and human papillomavirus infections as well.”
The latest data showed a 25 per cent reduction in herpes and a 34 per cent reduction
in the prevalence of HPV among participants.
The 3,393 men were aged 15 to 49 and initially tested negative for both HIV and
herpes simplex virus type 2, which causes genital herpes.
A control group of 1,709 men received medical circumcision after a delay of 24 months.
All participants were followed for herpes and syphilis infection for two years.
In an editorial that accompanied the study, Dr. Matthew Golden of the University of
Washington called for circumcision to be made widely available in North America.
“For most parents, the default should be circumcision,” said Golden. “Obviously,
these are complex decisions, and parents have to do what they think is right for
their children, but there are significant health benefits.”
Canadian pediatricians weigh evidence
Circumcision rates have been plummeting in Canada since the 1970s, when the Canadian
Pediatric Society recommended against routinely performing the procedure.
The society has been reviewing that recommendation, and officials said the new study
will be included in the review.
“This certainly provides new information that would tip the scale to say there may be
quite relevant medical information that would demonstrate that there was a benefit
that previously wasn’t appreciated,” said Dr. Robert Bortolussi of the Canadian
Pediatric Society in Halifax.
If circumcision does become a recommended procedure, it could take time before it
becomes widely available — partly because many doctors were never taught how to do
it, Bortolussi said.
The human papillomavirus, or HPV, is the most common sexually transmitted infection
in the world. It causes cervical cancer, which kills 300,000 women globally every
year, and anal and penile cancers.
The World Health Organization and the United Nations’ program on HIV/AIDS have
promoted circumcision since 2007 for reducing the risk of AIDS in areas where
heterosexual transmission is high.
