Abstract
Randomized trials have shown that voluntary medical male circumcision (VMMC) significantly reduces the risk of HIV acquisition in men. However, the rate of complications associated with the surgical procedure varies from 0.7% to 37.4% in real-world settings. We assessed the frequency, type and severity of adverse events following VMMC among 427 adult men surgically circumcised in southeastern Botswana; 97% completed ≥1 follow-up visit within seven days post-circumcision. Thirty moderate AEs were observed in 28 men resulting in an overall AE rate of 6.7%. Patient satisfaction was high: >95% were very or somewhat satisfied with the procedure and subsequent follow-up care.
Highlights
Three randomized controlled trials demonstrated that male circumcision, when performed in a clinical setting by a trained provider, safely and significantly reduces the risk of heterosexually-acquired HIV infection in men [1,2,3] leading to a 2007 endorsement by the World Health Organization (WHO) of voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention
The rate of moderate or severe adverse events (AE) following circumcision ranged from 0.8% to 3.6% in the two randomized trials conducted in Kenya and Uganda, respectively [1,2]; the South African trial reported an overall AE rate of 3.5%, inclusive of mild events [3]
We found an overall AE rate that was approximately twice that observed in the trials, the rate was consistent with previously published reports with high retention
Summary
Three randomized controlled trials demonstrated that male circumcision, when performed in a clinical setting by a trained provider, safely and significantly reduces the risk of heterosexually-acquired HIV infection in men [1,2,3] leading to a 2007 endorsement by the World Health Organization (WHO) of voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention. The rate of moderate or severe adverse events (AE) following circumcision ranged from 0.8% to 3.6% in the two randomized trials conducted in Kenya and Uganda, respectively [1,2]; the South African trial reported an overall AE rate of 3.5%, inclusive of mild events [3]. Following the WHO’s endorsement, circumcision services have been rolled out in more than 14 countries across eastern and southern Africa [4]. A 2012 systematic review of 10 safety studies conducted across sub-Saharan Africa reported an overall pooled AE rate of 2.3%. There was significant heterogeneity: circumcision-associated AE rates ranged from 30% in South Africa [6,7,8].
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