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Male Circumcision

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Picture of vials in laboratory Carcinogenic subtypes of human papillomavirus (HPV)—which are believed to cause 100% of cervical cancers, 90% of anal cancers, and 40% of cancers of the penis, vulva, and vagina26—have also been associated with lack of circumcision in men. A Ugandan RCT found a lower prevalence of high-risk HPV subtypes among men in the circumcised group. 27 In a South African trial, circumcision was also associated with a lower prevalence of high-risk HPV subtypes.28 These prevalence associations may result from an effect of circumcision on HPV acquisition by men, its persistence, or both. The Ugandan RCT also found incidence of high-risk HPV infection among women to be lower among those with circumcised male partners.29

The lifetime risk for a U.S. male of ever being diagnosed with penile cancer is 1 in 1,437.30 In a retrospective analysis of 89 cases of invasive penile cancer diagnosed from 1954 through 1997, 98% were in uncircumcised men; of 118 cases of carcinoma in situ, 84% were in uncircumcised men.31 Schoen published a retrospective review of 5 studies with 592 cases of invasive penile cancer in the United States; none of the cases were in men who had been circumcised in infancy.32

In a meta-analysis of male circumcision status and cervical cancer in female partners, data from 7 case-control studies were pooled.33 Circumcision was associated with significantly less HPV infection in men. In an analysis restricted to monogamous women, there was a nonsignificant reduction in the odds of having cervical cancer among women with circumcised partners (OR, 0.75; 95% CI, 0.49-1.14). When the couples with men with 5 or fewer lifetime partners (40% of the study population) were excluded, there was a significantly reduced odds of cervical cancer in female partners of circumcised men compared with the female partners of uncircumcised men (OR, 0.42; 95% CI, 0.23-0.79).

Studies have consistently demonstrated decreased incidence of urinary tract infections (UTIs) among circumcised compared with uncircumcised boys. A meta-analysis including 18 studies found a pooled UTI prevalence of 20.1% among febrile uncircumcised boys <3 months of age and a prevalence of 2.4% among febrile circumcised boys <3 months of age.34 Another systematic review35 included 12 studies and over 400,000 children and concluded that male circumcision was associated with a significantly reduced risk of UTI (OR, 0.13; 95% CI, 0.08-0.20; p<0.001).

Overall, UTIs are not common among male infants, with estimates of the annual rate of UTI in uncircumcised infants being 0.70% versus 0.18% for circumcised infants.36

Data from clinical trials also provides evidence that circumcision is significantly associated with decreased incidence of herpes simplex virus type 2 (HSV-2).27, 37, 38 The Ugandan trial also found that male circumcision may reduce self-reported genital ulcer disease in men.18 In female partners of circumcised men, evidence from the trials showed a significant reduction of female genital ulceration, bacterial vaginosis, and trichomoniasis.39

Results from observational studies have been mixed but have found lower risk for some STDs in circumcised men. A 2006 meta-analysis included 26 studies that assessed the association between male circumcision and risk for male genital ulcer disease. The analysis concluded that, overall, there was a significantly lower risk for syphilis (however, an RCT showed that syphilis was not reduced) and chancroid among circumcised men, whereas the reduced risk of herpes simplex virus type 2 infection had a borderline statistical significance.6

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