No abstract

Background-A randomized trial of male circumcision (MC) was conducted among HIVinfected males to test the hypothesis that MC would reduce HIV transmission to female sexual partners.

Objective-To assess effects of male circumcision on female genital symptoms, and vaginal infections.Methods-HIV-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, BV and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (95%CI) were assessed by multivariable log-binomial regression, intent-to-treat analyses.Results-783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, p=0.001). At one year follow up, intervention arm wives reported lower rates of genital ulceration (adjPRR 0.78, 95%CI 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR 0.52, 95%CI 0.05-0.98), as were the risks of any BV (adjPRR 0.60, 95%CI 0.38-0.94) and severe BV (PRR = 0.39, 95%CI 0.24-0.64).Conclusions-Male circumcision reduces the risk of ulceration, trichomonas and BV in female partners.

Uncircumcised HIV-negative men aged 15-49 years were randomized to immediate circumcision (n=441) or delayed circumcision (n=399). HPV was detected by Roche HPV Linear Array at enrollment, 6, 12 and 24 months. Incident HR-HPV was estimated in men who acquired a new HR-HPV genotype. HR-HPV clearance was determined in men with prior genotype-specific HR-HPV infections. Rate ratios (RR) and 95% confidence intervals (95%CI) of HR-HPV acquisition were estimated by Poisson multiple regression Enrollment characteristics were comparable between groups. HR-HPV incidence was 19.7/100 py in the intervention (70/355.8 py) and 29.4/100 py (125/424.8 py) in the control arm (RR=0.67, 95%CI 0.51-0.89, p = 0.006.) The incidence of multiple HR-HPV infections was 6.7/100 py in the intervention and 14.8/100 py in control arm (RR = 0.45, 95%CI 0.28-0.73), but there was no significant effect on single infections (RR=0.89, 95%CI 0.60-1.30). HR-HPV incidence was lower in the intervention arm for all genotypes and demographic/behavioral subgroups. The clearance of pre-existing HR-HPV infections was 215.8/100py (205/95 py) in intervention and 159.1/100py (255/160.25 py) in control arm men (adjRR=1.39, 95%CI 1.17-1.64). Male circumcision reduces the incidence of multiple HR-HPV infections and increases clearance of HR-HPV infections in HIV-uninfected men. The trial was registered with ClinicalTrials.gov numbers NCT00425984