Male circumcision: a cut to save lives?

Male circumcision is the removal of the foreskin of the penis. This is the retractable fold of the skin that covers the end of the penis. It is an ancient ritual in Islam and Judaism and historians originally believed that it arose as an ancient public health measure in preventing balanitis or the swelling of the penis due to an accumulation of sand under the penis.

However more recently it has been found that it has additional health benefits i.e. the prevention of sexually transmitted diseases (STIs) such as herpes – HSV2 (the cause of genital herpes), human papillomavirus (HPV) which can also cause cervical and penile cancer and genital warts and even HIV.

Trials

A study conducted by scientists at the Rakai Health Sciences Program in Uganda in collaboration with researchers at the John Hopkins University Bloomberg School of public health who examined samples from 2 parallel and similar clinical trials in Rakai that successfully proved that male circumcision as an HIV prevention method, also prevented other STIs such as HSV-2 and HPV infections.

The two trials enrolled 3,393 uncircumcised men between the ages of 15-49 who initially tested negative for both HIV and HSV-2 and they were assigned at random to one of 2 different conditions (study groups): 1,684 received immediate circumcision performed by a medically trained professional and 1,709 received medical circumcision after a delay of 24 months (is the control group). Then they tested these volunteers at 6,12 and 24 months for HSV-2 and syphilis prevention.

Another group of 697 volunteers (352 participants in the group who received immediate circumcision and 345 in the group who received circumcision 24 months afterwards) were evaluated for HPV infection.

Study participants also had physical examinations and their sociodemographic characteristics and specific sexual risk behaviors were recorded during each clinical visit.

After analyzing the effect of circumcision on HSV-2 acquisition across this study, they found that the probability of HSV-2 infection as significantly lower amongst the volunteers who received  immediate circumcision than those in the control group. However, circumcision did not affect the incidence of syphilis.

HIV prevention

The ANRS study showed that in a group of 3,274 uncircumcised men, aged 18–24 yrs old from South Africa showed that the group who underwent circumcision, men who were negative for HIV when they had sex with women, it showed that circumcised heterosexual men were approximately 50% to 60% less likely to become infected with HIV than uncircumcised men. However, circumcision does not protect women from HIV infection if they had sex with a HIV positive circumcised male.

Biological mechanisms 

The biological reasons for this is however unknown. We do know that HSV-2, HIV and HPV multiply in epithelial cells (one of the most common types of cells found on the surfaces of the body and its organs) which are found on the surface of the penis so the foreskin may facilitate the entry of the virus into those cells. However as circumcision reduced the number these epithelial cells therefore the risk of epithelial infection may be reduced.

Conclusion 

Although there is a significant decrease in the risk of HSV-2 and HPV infection, however it is not 100% effective, therefore safe sex practices and the consistent use of condoms is still necessary to provide the best protection against STIs.

References

A.A.R Tobian et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis.New England Journal of Medicine. (2009)

Auvert B, Taljaard D, Lagarde E et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298.

Books that may be of interest

  • Circumcision: A History Of The World’s Most Controversial Surgery

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  • Circumcision Exposed: Rethinking a Medical and Cultural Tradition

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1 Comment

  1. Are you from China? May I ask what your job is? Because I’m getting interested knowing that you’re giving us new information about medical procedures.

    Like

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