Male Circumcision for HIV Prevention fact sheet
In 2014, CDC released information for providers to share with male patients and parents of patients about voluntary medically performed male circumcision for the prevention of HIV, sexually transmitted infections (STIs), and other health outcomes in the U.S. These documents are designed to assist clinicians in providing accurate information to help males and parents make informed decisions about circumcision.
Personal decisions about circumcision are influenced by information on the preventive health benefits, safety, and risk factors of the procedures as well as ethical, religious, cultural, familial, and economic considerations.
CDC published draft recommendations and made them available online for public comment in 2014. Following completion of the public comment period, CDC began a systematic review process to finalize the document. This included a thorough review and written responses for more than 3,000 public comments and an assessment of the proposed information by an independent panel of public health experts. Feedback from the peer review and public comment process, as well as additional data from an updated literature review informed the final documents.
The information states that the health benefits and risks of voluntary neonatal, adolescent, or adult medically performed male circumcision should be considered in consultation with health care providers. Information varies for each population based on the relative risk of HIV and STI acquisition, availability of evidence on effectiveness by population, and other key issues to consider.
Heterosexually active adolescent and adult males (including bisexual males): Health care providers should inform all uncircumcised adolescent and adult males that male circumcision reduces, but does not eliminate, the chance of acquiring HIV and other STIs during heterosexual contact. Additionally, the patients should be informed of the potential risks associated with the procedure. Health care providers should assess the sexual risk behaviors of their male patients, and the patients who engage in activities that may increase their chances of acquiring HIV should be counseled about voluntary male circumcision as another potential strategy. Those patients who choose to be circumcised should be offered medically performed circumcision services and information on HIV prevention. Heterosexual males who engage in behaviors that increase the chances of getting HIV include:
- Males who are in sexual relationships with HIV-infected female partners
- Males with multiple female partners
- Males in relationships with females who engage in behaviors that may increase their chances of getting HIV or are part of communities over-represented in the HIV epidemic (e.g., commercial sex workers, females who inject drugs, and females in defined populations with HIV prevalence of one percent or higher)
Gay and bisexual males: Providers should inform uncircumcised gay and bisexual males that data from several observational studies indicate that male circumcision provides partial protection from HIV acquisition for gay and bisexual males who practice mainly or exclusively insertive anal sex (top). However, no clinical trials have included large enough numbers of gay and bisexual males to make a definitive conclusion regarding the usefulness of male circumcision in reducing the chances of acquiring HIV among this community. Additionally, there is no evidence that male circumcision reduces the chances of acquiring HIV through receptive anal sex (bottom).
Parents and guardians of male newborns, children, and adolescents: Parents should be informed of the medical benefits – including a lower chance of getting HIV – and the risks of male circumcision and should make decisions in consultation with a health care provider. When providing information to parents about male circumcision for an adolescent minor, the adolescent should be included in the decision-making process.
Several key issues should be considered during the decision-making process:
Health benefits: Male circumcision can reduce a male’s chances of acquiring HIV by 50% to 60% during heterosexual contact with female partners with HIV, according to data from three clinical trials. Circumcised men compared with uncircumcised men have also been shown in clinical trials to be less likely to acquire new infections with syphilis (by 42%), genital ulcer disease (by 48%), genital herpes (by 28% to 45%), and high-risk strains of human papillomavirus associated with cancer (by 24% to 47% percent).
While male circumcision has not been shown to reduce the chances of HIV transmission to female partners, it does reduce the chance that a female partner will acquire a new syphilis infection by 59%. In observational studies, circumcision has been shown to lower the risk of penile cancer, cervical cancer in female sexual partners, and infant urinary tract infections in male infants.
Health risks: The overall risk of adverse events associated with male circumcision is low, with minor bleeding and inflammation cited as the most common complications. A CDC analysis found that the rate of adverse events for medically attended male circumcision is 0.4% for infants under 1 year, about 9% for children ages 1 to 9 years, and about 5% for males 10 years and older. More severe complications can occur but are exceedingly rare. Adult men who undergo circumcision generally report minimal or no change in sexual satisfaction or function.
Stage of life: Circumcision is simpler, safer, and less expensive for newborns and infants than for adult males. Delaying circumcision until adolescence or adulthood enables the male to participate in – or make – the decision, but could diminish the potential benefits related to sexual health and increases the risks.
Informed Choice: Male circumcision is a voluntary procedure. The decision regarding circumcision should be made in consultation with a health care provider, and consider personal, cultural, religious, and ethical beliefs.
Given the urgency of ending the HIV epidemic in the U.S., CDC believes it is essential to maximize the impact of all available prevention options and is working to provide clinicians the best possible information on the full range of proven approaches. Male circumcision is one strategy that may help reduce the continued spread of HIV in the U.S. Ultimately, the degree to which male circumcision affects overall HIV transmission in the U.S. in the future will depend on a number of factors whose impact is not yet known. Those factors include the future contribution of heterosexual contact to the number of HIV infections that occur each year; future rates of infant male circumcision; the percentage of males who engage in heterosexual contact as well as behaviors that increase their chances of getting HIV who elect to be circumcised; and whether the approach can be effectively integrated with other proven HIV prevention strategies. Data on the cost-effectiveness of male circumcision to prevent HIV in the U.S. are limited, but suggest that newborn circumcision would offer long-term cost savings by reducing their lifetime risk of HIV infection.
At an individual level, male circumcision may help reduce the risk of acquiring HIV among males, and may be combined with other proven risk reduction strategies to provide even greater protection. While the benefits of circumcision can be high for males without HIV who engage in behaviors that may increase their chances of getting HIV, the overall public health benefit for the entire U.S. population may be limited due to the lack of definitively proven benefits among HIV transmission categories at a national level, including male-to-male sexual contact and heterosexual contact. The greatest benefit will be among uncircumcised males who engage in heterosexual contact living in geographic areas with a high prevalence of HIV.
CDC is committed to ensuring that health care providers have the information they need to make informed decisions about circumcision and other approaches that may reduce the chances of HIV and STIs. For more information, please visit www.cdc.gov/hiv.
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
