A Comparison of the Prevalence of Sexually Transmitted Infections Among Circumcised and Uncircumcised Adult Males in Rustenburg, South Africa: A Cross-Sectional Study

Abstract

Background South Africa has a persistent burden of sexually transmitted infections (STIs), despite improvements in prevention, treatment, screening, and surveillance. Male circumcision has been shown to be effective in preventing HIV, and other STIs. However, there is minimal data on the protective effect of circumcision in high-risk populations such as migrant miners. The objective of this study was to compare the prevalence of STIs between circumcised and uncircumcised adult males in Rustenburg, North West Province, South Africa Methods The study used baseline data collected in an observational cohort study. Adult males in a mining town were assessed for STIs (gonorrhea, chlamydia, and trichomoniasis) using syndromic assessment. Data on circumcision status and other risk factors for STIs were collected using an interview administered structured questionnaire. Multiple logistic regression analysis was used to assess the independent effect of circumcision on STI presence after adjusting for confounders. Results A total of 339 participants with a median age of 25 years (IQR 22–29) were included in the study, of whom 116 (34.2%) of whom were circumcised. The overall STIs prevalence was 27.4% (95% CI 22.8–32.6%) and was lower in the circumcised participants compared with those who were uncircumcised (15.5% vs 33.6%, respectively, p < 0.001). Circumcision was strongly associated with a lower risk of STIs (OR 0.359, 95% CI 0.196–0.656, p = 0.001) after adjustment for employment and condom use. Conclusion In this high-risk population, with a relatively high prevalence of STI, and 34% circumcision, circumcision appears to be protective against STIs.

Etiological Surveillance of Male Urethritis Syndrome in South Africa: 2019 to 2020

“…Traditional circumcision may involve only partial removal of the foreskin, and therefore, the impact on STI and HIV acquisition may be lower than with medical circumcision. However, a recent study among adult males in a mining town in South Africa revealed a strong protective effect against symptomatic urethritis in both medically and traditionally circumcised men, even after controlling for potential confounders such as employment status and condom use 24 . We did not find an association between STI or HIV positivity and circumcision method among our participants with symptomatic urethral discharge, as these were high-risk individuals for both HIV and STIs.…”