Sunday, March 29, 2009
Not all venereal diseases care whether you're circumcised
I don't normally post this in here, after reading this below, maybe that's a need to rethink how the venereal diseases and how it affect both circumcised males and non-circumcised males.
These are quite interesting observations and findings and I can sensed there will be some new debates (?) regarding pros and cons of circumcised.
Anyway, let's have a look:
"Not all venereal diseases care whether you're circumcised: A little while back, it was announced that male circumcision significantly reduced the odds of picking up an HIV infection. That finding undoubtedly sparked a series of follow up studies to confirm the effect, and the results of one of them appeared in this week's New England Journal of Medicine. This one doesn't focus on HIV, however. As part of the follow-up process, the authors screened for a variety of additional sexually transmitted diseases.
It turns out that HIV is hardly the only virus where circumcision affects spread. Herpes simplex virus type 2, which (surprise!) causes genital herpes, had a slightly reduced transmission to circumcised males. Human papillomavirus, or HPV, a major contributor to cervical cancer, saw a much larger reduction. This doesn't mean that circumcision is a general good deal when it comes to STDs, however, as the one bacterial infection they tracked, syphilis, seemed to spread to both the circumcised and control populations at equivalent rates."
Abstracts (here):
Male Circumcision for the Prevention of HSV-2 and HPV Infections and SyphilisBackground Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men.
Methods We enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2–seronegative at enrollment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, we tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months.
Results At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P=0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P=0.44).
Conclusions In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure. (ClinicalTrials.gov numbers, NCT00425984 [ClinicalTrials.gov] and NCT00124878 [ClinicalTrials.gov] .)and also
Male Circumcision and STI Prevention: More Good News
Add protection against HSV-2 and HPV infections to the list of circumcision’s benefits.
Although we have strong evidence that male circumcision reduces the incidence of HIV infection in high-risk men, its benefits regarding other sexually transmitted infections (STIs) have remained unclear. To examine this wider issue, researchers examined data obtained in Uganda during two earlier trials of male circumcision for preventing HIV infection. A total of 5534 uncircumcised males aged 15 to 49 were involved.
Of 3393 participants who were HIV and herpes simplex virus type 2 (HSV-2) seronegative at enrollment, 1684 were randomized to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision 24 months later (control group). Serial screening (physical examination, an interview, and testing for HSV-2 and HIV infection and syphilis), conducted at baseline, was repeated for both groups at 6, 12, and 24 months. A subset of study participants also underwent screening for human papillomavirus (HPV) infection at baseline and at 24 months.
At 24 months, the cumulative probability of HSV-2 infection was lower for the intervention group than for the control group (7.8% vs. 10.3%; adjusted hazard ratio, 0.72; 95% confidence interval, 0.56–0.92). In addition, the prevalence of high-risk HPV genotypes was lower in the intervention group than in the control group (18.0% vs. 27.9%; adjusted risk ratio, 0.65; 95% CI, 0.46–0.90). However, no significant between-group difference in syphilis incidence was demonstrated (adjusted HR, 1.10; 95% CI, 0.75–1.65).
Comment: Studies conducted in Africa have shown that male circumcision decreases the rates of several STIs in men and in their female partners. Such benefits should guide public health policy for neonatal, adolescent, and adult male circumcision programs in areas such as Uganda, where prevalence of HIV infection is high. Whether circumcision confers similar benefits in other settings is unclear.
I don't think our library has access to these journals, but if you have, please share. =)
- wong chee tat :)
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