A population-based study of circumcision and non-HIV sexually transmitted infections in a contemporary group of African American men: the flint men's health study

Abstract

INTRODUCTION AND OBJECTIVES: An estimated 19 million new sexually transmitted infections (STI) are reported annually in the United States, which cost the health care system $17 billion each year. The relationship between circumcision and STI risk remains controversial, despite several randomized controlled trials out of Africa demonstrating that circumcision reduces the rate of HIV transmission by up to 76%. We sought to assess potential variable risk of non-HIV sexually transmitted infections among a large community-based cohort of circumcised and uncircumcised African American men. METHODS: We performed a cross-sectional analysis of data from the Flint Men’s Health Study, a population-based cohort study of African American men. 817 men, ages 40-79, from Genesee County, Michigan provided information on clinical and sociodemographic characteristics, and sexual and reproductive health and practices. Relevant data collected included information on demographics, circumcision history, STI history, and sexual behaviors. Differences in the distributions of these factors by circumcision and STI status were examined and tested using Pearson chi-squared tests. Additionally, a multivariate logistic regression examined the association between circumcision and STI, controlling for age, income, and number of sexual partners. RESULTS: Overall, 51% of men were circumcised with nearly 60% of circumcisions occurring in the first year of life. Men aged 40-49 (58.5%) were circumcised more than older men (55.9%, 44.1%, and 44.0% of men aged 50-59, 60-69, and 70-79, respectively, p 1⁄4 0.0026). 55% of men reported some history of STI with lower income associated with a higher rate of STI (p 1⁄4 0.015). Men with the greatest number of sexual partners generally had the highest rates of STI (p < 0.0001). There was no significant association between circumcision status and STI in the multivariable model. CONCLUSIONS: After adjusting for known confounders, men in our study who were uncircumcised were not any more likely to report a history of STI. Our data may challenge common beliefs regarding the protective nature of circumcision against STI, which have mostly been extrapolated from studies looking at HIV rates in primarily non-American men. Further investigation may elucidate the complicated relationship between circumcision and STI and help draw lasting conclusions on the potential protective benefit of circumcision in American males.