• Circumcision

Circumcision

Two articles in this issue of the Journal of Infection Diseases add to the growing body of evidence that male circumcision may reduce carriage of penile human papillomavirus (HPV). The first article is a secondary analysis from a randomised trial of male circumcision for HIV prevention among South African men aged 18-24 years. The investigators reported that, after 21 months of follow‐up, the point prevalence of high‐risk HPV (HR‐HPV) in urethral swab samples was 14.8 percent among men in the intervention arm compared with 22.3 percent in uncircumcised control subjects.

The second article is a cross‐sectional analysis of HPV detected at multiple anogenital sites in 463 US men, 16 percent of whom were uncircumcised. The investigators found a prevalence of any HPV genotype of 51.2 percent in circumcised men and 51.4 percent in uncircumcised men, suggesting that there was no protective effect. However there were substantial differences in risk profiles between the circumcised and uncircumcised men. In particular, the uncircumcised men were younger, less likely to be white, and more likely to be Hispanic, and they reported having had significantly more sex partners during the prior 3 months. These characteristics are likely to be associated with increased HPV infection and could confuse results. The authors show how the lack of clarity in the studies of circumcision and HPV infection stands in sharp contrast to the consistency of evidence that circumcision reduces HIV acquisition in men, which has been demonstrated in 3 previous randomised trials. The articles conclude that the public health importance of this surgery needs to be recognised for the prevention of HIV infection in minority US populations.

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