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Background Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men.
Methods We enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2–seronegative at enrollment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, we tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months.
Results At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P=0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P=0.44).
Conclusions In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure. (ClinicalTrials.gov numbers, NCT00425984
[ClinicalTrials.gov]
and NCT00124878
[ClinicalTrials.gov]
.)
Source Information
From the Departments of Pathology (A.A.R.T.) and Medicine (T.C.Q., O.L., A.E.O., S.J.R.), School of Medicine, and the Departments of Epidemiology and Molecular Microbiology and Immunology (P.E.G., R.G.N.), Population, Family, and Reproductive Health (B.C., M.Z.C., M.J.W., R.H.G.), and International Health and Biostatistics (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore; the Institute of Public Health, Makerere University, Kampala (D.S.), and Rakai Health Sciences Program, Entebbe (G.K., V.S.) — both in Uganda; and the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (T.C.Q., O.L., M.R., S.J.R.).
Drs. Quinn and Gray contributed equally to this article.
Mr. Charvat is deceased.
Address reprint requests to Dr. Quinn at the Rangos Building, Rm. 530, 855 N. Wolfe St., Baltimore, MD 21205, or at tquinn{at}jhmi.edu.
Related Letters:
Male Circumcision for the Prevention of HSV-2 and HPV Infections
Storms M. R., Ridzon R., Singh K., Tobian A. A.R., Serwadda D., Gray R. H.
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N Engl J Med 2009;
361:307-308, Jul 16, 2009.
Correspondence
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