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Home Sexual Health Sexual Health Male Circumcision and HSV Acquisition

Male Circumcision and HSV Acquisition

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In contrast to the findings of some other studies, recent research with men in Kenya found that male circumcision no effect on the acquisition of HSV infections. The data were presented at the 18th Conference on Retroviruses and Opportunistic Infections (CROI).

To assess the impact of male circumcision on the development of genital ulcer disease (GUD) and incident HIV and HSV infections, a team of researchers from North America and Africa followed a cohort of 18-24 year old men for 24 months. The subjects were given blood tests to check for HSV-2 antibodies, and samples were taken from any GUD and tested for DNA from HSV-2, syphilis, and chancroid.

Circumcision was “62% protective” against the risk of new HIV infections (incidence was 1.41/100 person-years), and the risk of GUD in this group was cut by approximately half (2.7/100 person-years among circumcised men against 5.2/100 person-years in the uncircumcised). There was no reduction in risk regarding new HSV-2 infections (5.8/100 person years among the circumcised vs. 6.1 in the uncircumcised), though.

Other studies have found that male circumcision reduces HSV-2 acquisition, however: in one from 2009, investigators with the National Institute of Allergies and Infectious Diseases (NIAID) randomized nearly 3,400 subjects – all of which were negative for HIV, HSV-2, and human papillomavirus (HPV) - into two groups: one that received immediate circumcision and another for which circumcision was delayed for the 24-month period of the study. At enrollment and six month intervals, subjects were tested for HSV-2 and syphilis. A subset within each of the groups was also evaluated for genital HPV infection.

At 24 months the “cumulative probability” of HSV-2 infection among the circumcision group was 7.8%, compared with 10.3% for the control group. Subjects who were circumcised were also much less likely to have acquired a high-risk HPV infection (some of which are linked with cervical, penile, and anal cancers): nearly 28% of those in the control group were positive for HPV after 24 months, against only 18% in the circumcision group. Circumcision had no impact, however, on syphilis acquisition.

References
Mehta S, Parker C, Ndinya-Achola J, Moses S, Maclean I, Agot K, et al. MMC Is Not Protective against HSV-2 Incidence but Halves the Risk of GUD Incidence: Results from the Randomized Trial of MMC to Reduce HIV in Kisumu, Kenya. Conference on Retroviruses and Opportunistic Infections, March 2011, Boston, MA; paper 147LB.
A Tobian, D Serwadda, T Quinn, G Kigozi, P Gravitt, O Laeyendecker, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. New England Journal of Medicine, 2009. 360(13):1298-1309.

 

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