Abstract
Due to the reduction in HIV transmission through male medical circumcisions (MMC), numerous clinics throughout South Africa offer a voluntary free service to boys from the age of ten years and above. An examination prior to the procedure may detect congenital abnormalities missed after birth. The aim of this study was to measure the incidence of these abnormalities, determine the demographic and clinical characteristics of this group and determine what referral systems, interventions, and follow-up is available to them. The study was a descriptive, observational, retrospective analysis of de-identified medical records at a routine MMC service at a Johannesburg clinic in 2015. The participants were male patients between the ages of 10 - 49. Out of 1548 participants, 91.0% (n=1409) had a normal genital examination while 3.7% (n=57) had an abnormal examination and 5.1% (n=79) had no examination recorded. Thirty five congenital anomalies were detected and only 2 patients (diagnosed with hypospadias) were seen at the urology out-patient's department. The incidence of congenital genital abnormalities of males presenting for routine circumcision is low. Despite the low incidence the effect on fertility, sexuality, ability to urinate and on psychological wellbeing is significant. Referral services to the urology department should be restructured to improve all outcomes.
Highlights
Due to the reduction in HIV transmission through male medical circumcisions (MMC), numerous clinics throughout South Africa offer a voluntary free service to boys from the age of ten years and above
The aim of this study was to measure the incidence of these abnormalities, determine the demographic and clinical characteristics of this group and determine what referral systems, interventions, and follow-up is available to them
The aim of this study was to measure the incidence of congenital genital abnormalities in male patients over ten years of age presenting for routine medical circumcision in an urban MMC clinic in Johannesburg, South Africa
Summary
Due to the reduction in HIV transmission through male medical circumcisions (MMC), numerous clinics throughout South Africa offer a voluntary free service to boys from the age of ten years and above. General awareness scores were found to be significantly higher with increasing age and year of study They found that some of the reasons for late detection of external male genital defects are “ignorance, religious and cultural inhibitions about sexuality, denial, false beliefs and alternative health care-seeking behaviour.”. In a Nigerian study of adult men, awareness about undescended testes was very poor, as only two (11.1%) men had self-diagnosed their condition and sought medical attention after 30 years.[7] In the developed world, Donaruma-Kwoh[8] at a children’s hospital in Houston, Texas found that paediatric chief residents don’t examine the genitalia of their male patients; and have difficulty in diagnosing common abnormalities- with only 22% of the residents being able to detect hypospadias correctly. Osifo & Osaigbovo[7] recommend that health awareness programs should be established as these will aid in early presentation and prevent the development of irreversible complications
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