New data from Ugandan scientists and investigators at Johns Hopkins University find that adult male circumcision decreased rates of the two most common sexually transmitted infections – herpes and the human papillomavirus (HPV), the virus that causes cervical cancer and genital warts – according to a report issued in the New England Journal of Medicine March 26, 2009.
In an accompanying editorial, "Prevention of Viral Sexually Transmitted Infections – Foreskin at the Forefront," two local University of Washington researchers say these new findings provide compelling new evidence on circumcision's effect on decreasing currently incurable viral sexually transmitted infections.
"These new data should prompt a major reassessment of the role of male circumcision not only in HIV prevention but also in the prevention of other sexually transmitted infections," write authors Drs. Matthew R. Golden and Judith N. Wasserheit.
"We already knew that circumcision can decrease men's HIV risk by 60%," said Golden, who is also director of the STD Control Program for Public Health – Seattle&King County. "Now we know that male circumcision reduces men's risk of herpes by 25% and of human papillomavirus by a third."
The data could be a major game changer for how health providers counsel patients and parents on circumcision.
Circumcision rates have been declining in the United States and are lowest among black and Hispanic patients -- groups with the highest rates of HIV, herpes and cervical cancer.
"These new, compelling data mean that,all providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured," said Wasserheit, who is also the vice chair of the UW Department of Global Health.
Herpes and HPV infection are extremely common, can have severe consequences and are not curable.
In the United States alone, almost one in five Americans is infected with herpes simplex virus type 2 (HSV-2).Furthermore, roughly three quarters of sexually active Americans will have at least one human papillomavirus (HPV) infection and approximately 4,500 women die every year from cervical cancer.
In many low and middle income countries, these infections are even more common and more serious. Cervical cancer is the second most common cause of cancer deaths in women worldwide.
Golden and Wasserheit say these findings should prompt professional organizations to play a leadership role in sharing with their members and the public this new information about the benefits of circumcision in preventing all three of the major viral STIs -- not only HIV, but also herpes and HPV infection.
Comments
Anonymous (not verified) | 03/26/09 | 11:11 AM
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Unless it can be demonstrated that all the studied individuals had the same behaviors sexually and that they were exposed to the same risks throughout the study, this sounds bogus to me. This sounds like someone is drawing a statistical relationship without having established a causal one first.
Gerhard Adam | 03/26/09 | 11:29 AM
To Gerhard's point, however, associations are not necessarily causal.
Heidi Henderson | 03/27/09 | 17:34 PM
Prevention, as another responder pointed-out, is preferable to the excision of healthy tissue as the primary means of disease control. Attention to proper hygiene is essential for the health of uncircumcised males and their partners. Safer sex practices, including condom use, are a far more reliable form of prophylaxis than circumcision. A fair possibility exists that circumcised men who become aware of the conclusions drawn from this data will acquire a false sense of security and forego condom use.
Public health education requires funding and continuous effort. It is less expensive to snip off a bit of men's genitalia in the service of a 30% decrease in rates of HPV, but is it ethical? Golden and Wasserheit note that groups with the lowest rates of circumcision in the U.S., namely black and Hispanic patients, also have the highest rates of HIV, herpes and cervical cancer. But they fail to note that these groups also have the highest rates of poverty, are most likely to lack access to adequate health care, have lower rates of full health insurance coverage, and are less well-served by public education programmes.
It is well worth noting that, according to a recent study in American Journal of Public Health, in U.S. jurisdictions where circumcisions are not covered by health insurance, rates of circumcision tend to be almost half that of places where the procedure is covered. In other words, if it isn't paid for, fewer people opt for it, and so doctors are making less money. Conflict of interest?
Based on this kind of specious analysis, calling for an increase in circumcision to reduce rates of STIs is analogous to calling for tooth extraction to prevent gum disease.
ramswrsw (not verified) | 03/29/09 | 22:03 PM
Not Histologically, not Epidemiologically.
If you understand Tyson's Cells, Langerhan Cells, HPV, and all the obstructive and filthy characteristics of foreskin, then you wouldn't maintain your incorrect stance that foreskin is "healthy".
Irresponsible and un-educated filthy men from Fascist/Socialist nations tend to compare a useless extra skin to an organ. That is simple-minded and insane..
Doctors should just routinely circumcise all males, consent shouldn't be required. Then all the misunderstandings about Circumcision will be resolved.
Uneducated_Simpetons_Reject_Circumcision (not verified) | 05/23/09 | 08:17 AM
