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Circumcision reduces the prevalence of high-risk human papillomavirus (HR-HPV) infection and HIV in men, according to studies from South Africa and the USA published in the January 1 issue of the Journal of Infectious Diseases.

Dr. Bertran Auvert from Assistance Publique-Hpitaux de Paris, University of Versailles, France, and his team in South Africa evaluated the effects of male circumcision on HR-HPV infection in a cohort of initially uncircumcised men aged between 18 and 24 years.

A total 637 men who opted for circumcision and 627 uncircumcised controls were followed from 2002-2004 with periodic physical examinations and interviews about their sexual behavior. Urethral swabs were taken from participants at their 21-month visit.

The prevalence of HR-HPV was 23.2% and 14% in the uncircumcised and circumcised groups, respectively, Dr. Auvert's team observed. After adjusting for confounding factors, including HIV status and sexual behavior patterns, circumcision protected from HPV with a prevalence rate ratio of 0.62, they report.

In the second study, Dr. Lee Warner from the US Centers for Disease Control and Prevention, Atlanta, and colleagues evaluated the association of circumcision with a reduced risk of HIV infection in a US population.

The investigators analyzed records of 40,571 visits by heterosexual African American men who took an HIV test in a sexually transmitted diseases clinic in Baltimore.

Dr. Warner's group identified 394 visits by men having a documented exposure to HIV-positive partners. In this sub-group, the prevalence of HIV was over twice as high among uncircumcised men as circumcised men, at 22.0% and 10.2%, respectively, they report.

"The foreskin contains target cells for HIV, herpes and HPV," Dr. Ronald H. Gray, the lead author of a related editorial, explained to Reuters Health. "In addition, the foreskin is vulnerable to ulcers probably as a result of trauma during intercourse, and its removal reduces rates of ulceration by 50%," he added.

"Circumcision is a critical intervention to reduce HIV transmission," Dr. Gray, from the Johns Hopkins Bloomberg School of Public Health, concluded.

Source : http://www.medscape.com/viewarticle/585841