Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening impeding the passage of urine) is confined to uncircumcised men, in whom balanitis (affecting 10%) is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer. Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners. Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV. Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted.

Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

No abstract

undetectable throughout all pregnancy and after delivery. Caesarean section was performed at week 38, when maternal CD4 count was 787 (25%) cells/mL and viral load undetectable. The newborn was healthy with HIV RNA below 50 copies at birth and six months later. At delivery, maternal plasma darunavir was 4350 ng/mL. The darunavir concentration in the umbilical cord was 1370 ng/mL (child-to-mother ratio: 31.5%).Generally, PIs can cross the placenta at a low level. When umbilical cord/maternal blood ratios has been performed, the ratios varied from 0% to 25% for several PIs commonly used in pregnancy. 7 -10 The reason for such a low transfer probably lies in their high protein-binding capacity and their large molecular size. Darunavir 11 is 95% bound to plasma proteins (mostly a1-acid glycoprotein). The extent to which a low, but still detectable, PI plasma concentration can provide a direct protection for the newborn is uncertain, although a low level of placental passage may prevent toxic effects in the fetus. The DRV levels measured in our two umbilical cords were substantially higher than the median EC 50 for wild-type virus (i.e. 0.7-5.0 ng/mL, increased by a median factor of 5.4 in the presence of human serum), although we should bear in mind that this option is considered for patients harbouring PI-resistant virus.Both our newborns were healthy and tested HIV RNA negative six months after delivery. Safety and efficacy of DRV/r in pregnancy remains undefined (Food and Drug Administration pregnancy category C), but our information can be of help in the case of women with child-bearing potential or willing to get pregnant in the presence of MDR virus and limited treatment options.

No abstract

No abstract

No abstract

No abstract