Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda

Wawer, Maria J.; Tobian, Aaron A.R.; Kigozi, Godfrey; Kong, Xiangrong; Gravitt, Patti E.; Serwadda, David; Nalugoda, Fred; Makumbi, Frederick; Ssempiija, Victor; Sewankambo, Nelson; Watya, Stephen; Eaton, Kevin; Oliver, Amy E.; Chen, Michael Z.; Reynolds, Steven J.; Quinn, Thomas C.; Gray, Ronald H.

doi:10.1016/s0140-6736(10)61967-8

Cited by 159 publications

(152 citation statements)

References 30 publications

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“…There is also good evidence from randomized controlled trials that male circumcision is associated with a lower prevalence of human papillomavirus (HPV) infection 31,32 and herpes simplex virus type 2 (HSV-2) transmission, 31,33 as well as a decreased likelihood of bacterial vaginosis (BV) in female partners. 80 The evidence for male circumcision being protective against syphilis is less strong, [65][66][67][68] however, and male circumcision was not found to be associated with decreased risk of gonorrhea 84,85,91-93 or chlamydia.…”

Section: Resultsmentioning

confidence: 99%

“…In the Uganda randomized controlled trial, the prevalence of high-risk HPV infection was 28% lower in female partners of circumcised HIV-uninfected men, while the incidence was 23% lower. 32 Good evidence from another Uganda randomized controlled trial of male circumcision in HIV-infected men indicates that a circumcision did not reduce the risk of male-to-female transmission of high-risk HPV from HIV-infected men. 103 …”

Section: Gonorrheamentioning

confidence: 99%

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Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

297

149

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Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

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Section: Resultsmentioning

confidence: 99%

Section: Gonorrheamentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

297

149

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show abstract

“…1 Circumcision is generally considered as a simple, rapid operation with efficacy for protection against HIV and other sexually transmitted infections, as confirmed in numerous, highquality studies. [2][3][4][5][6][7] Circumcision has been reported to adversely affect sexual function; 8 however, the majority of studies, including highquality ones [9][10][11] and ones with data arising from randomized controlled trials (RCTs), 12,13 show no difference or improvement in sexual function, sensitivity and satisfaction after circumcision. All of the data were considered by the American Academy of Pediatrics in formulating its 2012 policy, which concluded that there were no adverse effects on these parameters.…”

Section: Introductionmentioning

confidence: 99%

Effects of circumcision on male sexual functions: a systematic review and meta-analysis

Liu¹,

Wang²,

Wazir³

et al. 2013

Asian J Androl

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This meta-analysis was performed to assess sexual functions following adult male circumcision. We searched the Cochrane Central Register of Controlled Trials, PUBMED, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2013 to identify all eligible studies that reported on men's sexual function after circumcision. The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity. We identified 10 studies, which described a total of 9317 circumcised and 9423 uncircumcised men who were evaluated for the association of circumcision with male sexual function. There were no significant differences in sexual desire (odds ratio (OR): 0.99; 95% confidence interval (CI): 0.92-1.06), dyspareunia (OR: 1.12; 95% CI: 0.52-2.44), premature ejaculation (OR: 1.13; 95% CI: 0.83-1.54), ejaculation latency time (OR: 1.33; 95% CI: 0.69-1.97), erectile dysfunctions (OR: 0.90; 95% CI: 0.65-1.25) and orgasm difficulties (OR: 0.97; 95% CI: 0.83-1.13). These findings suggest that circumcision is unlikely to adversely affect male sexual functions. However, these results should be evaluated in light of the low quality of the existing evidence and the significant heterogeneity across the various studies. Well-designed and prospective studies are required for a further understanding of this topic.

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“…Two trials conducted on HIV positive and negative men in Uganda analyzed transmission of HPV to female partners [101,102]. The implications of reduced HPV infection in female partner cervical cancer rates are not clearly discernible since there are several other confounding risk factors.…”

Section: Hpv In Female Partnersmentioning

confidence: 99%

“…In the first trial on HIV negative men and their partners, the year-2 prevalence of HR-HPV infection in partners was 28% in the circumcised group and 39% in the uncircumcised group (PRR 0.72, 95% CI 0.60-0.85) [101]. The incidence of any HR-HPV infection between 0 and 2 years was also lower in the circumcised group female partners (IRR 0.77, 95% CI 0.63-0.93).…”

Section: Hpv In Female Partnersmentioning

confidence: 99%