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Circumcision Guards Against STDs
Date:3/25/2009

Study finds procedure dramatically reduces transmission of herpes, human papillomavirus

WEDNESDAY, March 25 (HealthDay News) -- The decision of whether or not to circumcise an infant can be a difficult one, but new research suggests that having the procedure may reduce the risk of certain infections later in life.

In a study of more than 5,000 uncircumcised adult Ugandan males, researchers found that after circumcision, the rates of infection with the virus that causes herpes went down by 28 percent, and the transmission of human papillomavirus (HPV) -- the virus that can cause cervical cancer and genital warts -- was reduced by 35 percent.

In a previous study, the same researchers found that circumcision reduced infection with the HIV virus by 60 percent. Two other research groups -- one working in Kenya and the other in South Africa -- have also had similar findings.

"We hope these data will ultimately result in policy changes in recommending circumcision for young boys or adult men to decrease the rates of infection with HIV, HPV and herpes," said the lead author of the Ugandan study, Dr. Thomas Quinn, a senior investigator in infectious diseases at the National Institute for Allergy and Infectious Diseases (NIAID) and a professor of medicine at Johns Hopkins School of Medicine in Baltimore.

Results of Quinn's study appear in the March 26 issue of the New England Journal of Medicine.

Quinn said there are several reasons that removing the foreskin of the penis might help reduce transmission of certain infections. The foreskin, he explained, has two different sides. The outside is much like regular skin cells. However, the inside is mucosal, similar to a woman's vagina, Quinn explained. During intercourse, the skin side is pulled back and the mucosal side is open and exposed. And, he said, it's likely that there are viral receptors on that mucosal side that make it easier for a virus to get into the cells.

Additionally, if a woman has passed along viral cells, they're now trapped inside the foreskin, in a moist environment that's conducive for the virus to replicate.

Once Quinn's team found that circumcision reduced the transmission of HIV so dramatically, they went back and rescreened the blood samples to see if circumcision cut down on the rates of other common sexually transmitted viruses. They screened the blood samples for HPV, herpes (specifically HSV-2) and syphilis.

Two years after circumcision, 7.8 percent of those who'd been circumcised had been infected with the herpes virus, while 10.3 percent of the men in the control group had been infected. For high-risk genotypes of HSV, transmission was 18 percent in the circumcision group and just under 28 percent in the control group. There were no statistically significant differences in the rates of syphilis transmission.

Both Quinn and the author of an accompanying editorial in the same issue of the journal, Dr. Matthew Golden, director of Public Health for Seattle and King County Sexually Transmitted Diseases Control Program, said they believed that the benefits found in this study would be similar for circumcised infants.

Golden, who's also an associate professor of medicine at the University of Washington Center for AIDS and STD in Seattle, said, "Circumcision should be routinely offered and available for those who want it. I think circumcision is in the best interest of the child, but not everyone will come to an identical conclusion. What's critical is that parents are getting the right information and that they know there are real health benefits."

"Parents need to talk to their physicians about circumcision. They need to know what are the risks of the surgery? For the neonate, it's an easier procedure; it's less expensive, and there are less complications," said Quinn, who added that there were only minimal adverse events in the adult population that was circumcised.

Although both Quinn and Golden felt the decision about whether or not to circumcise was best left up to individual parents, both wanted to see policy recommendations changed so that Medicaid and other insurers would consistently cover the cost of circumcision, so that anyone who wanted to have the procedure also had access to it.

More information

To learn more about circumcision, visit KidsHealth.



SOURCES: Thomas C. Quinn, M.D., M.Sc., senior investigator, infectious diseases, National Institute of Allergy and Infectious Diseases, and professor, medicine, Johns Hopkins School of Medicine, Baltimore; Matthew Golden, M.D., M.P.H., director, Public Health for Seattle and King County Sexually Transmitted Diseases Control Program; and associate professor, medicine, University of Washington Center for AIDS and STD, Seattle; March 26, 2009, New England Journal of Medicine


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