Association between male circumcision and women's biomedical health outcomes: a systematic review

Abstract

SummaryBackgroundMale circumcision reduces men’s risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women’s health outcomes to benefit women’s health programmes.MethodsIn this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women’s health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency.Findings60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate.InterpretationScale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly consistent. Synergies between male circumcision and women’s health programmes should be explored.FundingUS Centers for Disease Control and Prevention and Jhpiego

Critical evaluation of arguments opposing male circumcision: A systematic review

“…The present systematic review has contrasted evidence used to argue against MC with evidence from RCTs, systematic reviews, and metaanalyses, in particular, that has demonstrated the multiple medical and health benefits and low risk of MC to males 269,316,427 and their female sexual partners. 249,303 The key publications forming the framework of the present systematic review are provided in Table 10, as required by PRISMA guidelines. We find that, based on the evidence rated by quality, MC, especially when performed in early infancy, is favored.…”

“…HIV prevalence was 78% lower ( P = .035) in South African women who only had circumcised male partners . Recent systematic reviews have documented all MC and HIV studies in women …”

“…A recent systematic review of MC and STIs in women identified 9 RCTs and 48 observational studies of populations globally . Overall, MC reduced acquisition of STIs and cervical cancer in women, being strongest for HSV‐2, chlamydia, and syphilis.…”

“…RCTs and 48 observational studies of populations globally. 249 HIV, high-risk HPV, nonspecific genital ulcers, trichomonas, and vaginal discharge that rendered the latter low consistency. More information was presented in an editorial.…”

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

“…Another RCT found that male circumcision decreased Trichomonas vaginalis infection among men (OR 0.49, p = 0.030, AOR 0.41, p = 0.030 (11) among men aged 18-24 years, in Orange farm in South Africa. A systematic review of 57 observational studies also found that females were at a decreased risk of STIs when their male partners were medically circumcised (12). Another systematic review and meta-analysis of global data from April 2019 of 62 observational studies including 119248 men who have sex with men (MSM) found that circumcision was associated with 23% reduced odds of HIV infection among MSM (OR 0.77, 955 CI 0.67-0.89) (13).…”