Male Circumcision and STI Acquisition in Britain: Evidence from a National Probability Sample Survey

Abstract

BackgroundIt is well-established that male circumcision reduces acquisition of HIV, herpes simplex virus 2, chancroid, and syphilis. However, the effect on the acquisition of non-ulcerative sexually transmitted infections (STIs) remains unclear. We examined the relationship between circumcision and biological measures of three STIs: human papillomavirus (HPV), Chlamydia trachomatis and Mycoplasma genitalium.MethodsA probability sample survey of 15,162 men and women aged 16-74 years (including 4,060 men aged 16-44 years) was carried out in Britain between 2010 and 2012. Participants completed a computer-assisted personal interview, including a computer-assisted self-interview, which asked about experience of STI diagnoses, and circumcision. Additionally, 1,850 urine samples from sexually-experienced men aged 16-44 years were collected and tested for STIs. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR) to quantify associations between circumcision and i) self-reporting any STI diagnosis and ii) presence of STIs in urine, in men aged 16-44 years, adjusting for key socio-demographic and sexual behavioural factors.ResultsThe prevalence of circumcision in sexually-experienced men aged 16-44 years was 17.4% (95%CI 16.0-19.0). There was no association between circumcision and reporting any previous STI diagnoses, and specifically previous chlamydia or genital warts. However, circumcised men were less likely to have any HPV type (AOR 0.26, 95% confidence interval (CI) 0.13-0.50) including high-risk HPV types (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and/or 68) (AOR 0.14, 95% CI 0.05-0.40) detected in urine.ConclusionsCircumcised men had reduced odds of HPV detection in urine. These findings have implications for improving the precision of models of STI transmission in populations with different circumcision prevalence and in designing interventions to reduce STI acquisition.

Unpacking early infant male circumcision decision-making using qualitative findings from Zimbabwe

“…Although its effects on HIV will take longer to realise, EIMC is likely to ultimately be more effective at preventing HIV acquisition than VMMC as the procedure is carried out long before the individual becomes sexually active, negating the risk associated with sex during the healing period [4]. Like VMMC, EIMC will therefore protect against other sexually transmitted infections and genital cancers in addition to HIV [5, 6]. …”

Critical evaluation of arguments opposing male circumcision: A systematic review

“…After adjustment for age at first intercourse, lifetime number of sexual partners, and other potential confounders, circumcised men were 63% less likely to be infected with HPV . A large UK survey found high‐risk HPV types were 86% less prevalent in uncircumcised men . A RCT published in 2012 found that the incidence of flat penile lesions (mostly caused by high‐risk HPV types) was 98% lower among circumcised men .…”

“…270 A large UK survey found high-risk HPV types were 86% less prevalent in uncircumcised men. 271 A RCT published in 2012 found that the incidence of flat penile lesions (mostly caused by high-risk HPV types) was 98% lower among circumcised men. 262 Thus, high-quality studies and analyses confirm the protective effect of MC against high-risk HPV types.…”

“…Morris et al, 269 Castellsagué et al, 270,300 Homfray et al, 271 Backes et al, 262 Hernandez et al, 273 Lu et al, 274 Albero et al, 275 Tobian et al, 277,278 Sobngwi-Tambekou et al, 279,282 Mehta et al, 280 Pintye et al, 284,302 Otieno-Nyunya et al, 285 Nasio et al, 286 Poynten et al, 304 Templeton et al 305…”

Circumcision and Sexually Transmitted Disease Prevention: Evidence and Reticence

“…On the point of view of health professionals and physicians duties, by applying the "beneficence" ethical principle, benefits must "simply" exceed predictable risks and complications, all evaluated in the light of scientific evidence principles. Values of integrity and honesty of health professionals are moral aptitudes worldwide mentioned, which must contribute to reach a convinced opinion of the patient [44], with a proper illustration of pros and cons attributable to each medical practice, taking into account all aspects worthy of consideration in patient's perspective [45][46][47][48]. The ratio between risks and benefits, in the case of adult patient, may justify the proposal and adoption of male circumcision, within updated medical guidelines evidence, provided it does not impose to anyone an also minimal genital surgery, even in consideration of absolutely rare frequency of risks and complications related to this practice.…”