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Circumcision key to HPV prevention

Friday January 7th, 2011

Male circumcision can help to stop the spread of human papillomavirus, an African study has revealed.

Research by the Rakai Health Sciences Program in Uganda found that while it was an effective way of preventing high-risk HPV infection in female partners of men, protection was only partial.

All participants, who were HIV-negative, were enrolled into two randomised controlled trials of male circumcision and it was found that it reduced the prevalence and incidence of high-risk human papillomavirus (HPV) infection in men.

The results are reported in The Lancet by Drs Aaron Tobian and Maria Wawer, Johns Hopkins University, Baltimore, USA, who say: “These findings indicate that male circumcision should now be accepted as an efficacious intervention for reducing heterosexually-acquired high-risk and low-risk HPV infections in men who do not have HIV and in their female partners.

“However, our results indicate that protection is only partial; the promotion of safe sex practices is also important."

The study, which took place between 2003 and 2006, assigned 648 men to an intervention group for an immediate circumcision and 597 in a control group, who were advised to have the surgery after 24 months.

Their female partners were enrolled at the same time, providing information and self-collected vaginal swabs at baseline, 12 months, and 24 months, which were tested for high-risk HPV.

At the 24-month follow-up, researchers found those who had not been circumcised had a 28 per cent higher risk of being infected with HPV. Of the 544 women in the intervention group, 28 per cent had HPV, while of the 488 in the control group, 39 per cent tested positive.

The authors say: "Circumcision of adolescent and adult men in a rural Ugandan population significantly reduced the prevalence and incidence of both low-risk and high-risk HPV infections and increased clearance of high-risk HPV infections in their female partners."

In a linked Comment, Dr Anna R Giuliano, Department of Cancer Epidemiology and Genetics, H Lee Moffitt Cancer Center, Tampa, USA, and colleagues said: "Recent findings add important evidence for the promotion of male circumcision in countries without well-established programmes for cervical screening. Additional interventions to reduce HPV infection, such as provision of vaccines for HPV prevention, will be essential to reduce invasive cervical cancer worldwide.

“Male circumcision is associated with slight reductions in high-risk HPV, while licensed HPV vaccines protect with high effectiveness against only a limited number of HPV types. Therefore, the two interventions are likely to have important synergistic effects."

The Lancet January 7 2011

Tags: Africa | Flu & Viruses | Menís Health

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