Abstract
Injuries to the penis during intercourse represent a hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma to our knowledge. We identified risks of self-reported penile coital injuries in men 18 to 24 years old in a randomized trial of circumcision to prevent HIV in Kisumu, Kenya. Each participant underwent standardized interview, medical history and physical examination at baseline, and 6, 12, 18 and 24 months after enrollment. Self-reported penile coital injuries were assessed at each visit, and were defined as penis feels sore during sex, penis gets scratches, cuts or abrasions during sex, and skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios for penile coital injuries. From February 2002 to September 2005, 2,784 participants were randomized. At baseline 1,775 (64.4%) men reported any coital injury including 1,313 (47.6%) soreness, 1,328 (48.2%) scratches, abrasions or cuts and 461 (16.7%) bleeding. On multivariable analysis coital injury risk was lower for circumcised than for uncircumcised men with soreness (OR 0.71, 95% CI 0.64-0.80), scratches/abrasions/cuts (OR 0.52, 95% CI 0.46-0.59), bleeding (OR 0.62, 95% CI 0.51-0.75) and any coital injury (OR 0.61, 95% CI 0.54-0.68). Other significant risks included increasing age, multiple recent sex partners, HSV-2 seropositivity and genital ulcers (p <0.05). Condom use, cleaning the penis soon after intercourse and being married/cohabiting were protective (p <0.05, each). Self-reported penile coital injuries were common in these healthy young men. Circumcised men were at lower risk for coital injuries. Verifying penile coital injuries, the mechanism of acquisition and the association with HIV risk is needed.
Highlights
Penile cuts, abrasions, and tears are cited as occurring more frequently in uncircumcised men[1,2]
To increase understanding of the prevalence and risk factors for penile coital injuries and how this may be related to sexually transmitted infection (STI) and HIV acquisition, we evaluated the effect of adult male circumcision and behavioral risks three types of penile coital injuries
Scratches, or cuts to the penis might represent a misclassification of herpes simplex virus type 2 (HSV-2) symptoms, we examined the association with baseline HSV-2 serostatus and genital ulcers on physical examination or by self-report
Summary
Abrasions, and tears are cited as occurring more frequently in uncircumcised men[1,2] Such mild injuries represent one potential mechanism by which uncircumcised men are at increased risk for HIV acquisition compared to circumcised men[1,2], through disruption of epithelial and mucosal barriers at anatomic sites with a high density of HIV-1 target cells[3,4,5,6]. In our cohort of sexually active men in a clinical trial of male circumcision to reduce HIV risk, self-reported penile coital injuries (defined as scratches, cuts, abrasions, or soreness of the penis during sex) increased risk for incident Neisseria gonorrhoeae infections by 1.6-fold in multivariable analyses[14]. To increase understanding of the prevalence and risk factors for penile coital injuries and how this may be related to sexually transmitted infection (STI) and HIV acquisition, we evaluated the effect of adult male circumcision and behavioral risks three types of penile coital injuries
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