Male Circumcision for Prevention of HIV and Other Sexually Transmitted Diseases

Abstract

A recent commentary in Pediatrics reviewed the documented medical benefits of newborn male circumcision including protection against balanoposthitis phimosis infections of the urinary tract in male infants and protection against human papillomavirus-associated genital cancers and HIV and Chlamydia infection in adolescents and adults. Low rates of minor surgical complications (0.2%-0.6%) and safety and efficacy of local anesthesia were noted. The ability of newborn circumcision to protect against sexually transmitted diseases (STDs) was also shown in a recently published cohort study from New Zealand. Recent large randomized clinical trials in South Africa Kenya and Uganda demonstrated reduction of HIV-acquisition risk by male circumcision performed outside the newborn period showing the role of adult male circumcision in prevention of STDs in adolescents and adults. An association between lack of male circumcision and acquisition of HIV infection was first noted in 1986. Over the next 10 years more than 35 studies including ecologic cross-sectional case-control and cohort studies in general and high-risk populations throughout the world evaluated the possible protective effect of male circumcision against HIV acquisition. A systematic review summarized the studies from sub-Saharan Africa and showed an estimate of the adjusted relative risk of HIV acquisition of 0.42 (95% confidence interval [CI]: 0.34-0.54; protection of 58%) in circumcised compared with uncircumcised male subjects. The impact of male circumcision on prevention of HIV acquisition was greater in high-risk groups than in the general population. A cohort study has also suggested that transmission of HIV to female partners of men with HIV may be lower when the male partner is circumcised. (excerpt)