Circumcision Cuts HPV Risk for Both Sexes

[emeraldize]

Circumcision Cuts HPV Risk for Both Sexes
By Michael Smith, North American Correspondent, MedPage Today
Published: January 06, 2011
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.   Earn CME/CE credit
for reading medical news


Action Points  
________________________________________
   Note that circumcision, which is known to reduce the prevalence of high-risk HPV infection in men, also significantly reduced the incidence and prevalence in women.

   Point out that the protection in women was only partial.



Male circumcision can reduce the risk that female partners will acquire human papillomavirus (HPV), researchers reported.
Women in two large trials of circumcision had a lower incidence and prevalence of HPV if their partners got the procedure, according to Aaron Tobian, MD, of Johns Hopkins University, and colleagues.
But protection was only partial so other safe sex practices remain important, Tobian and colleagues reported online in The Lancet.
The findings come from two parallel but independent trials in Rakai, Uganda, whose main purposes were to establish the effect of circumcision on the risk of men catching HIV in one case and the risk of transmitting the virus to their partners in the other.
The researchers separately contacted partners of trial participants who were married or in a long-term relationship and asked them to take part in a follow-up study looking at the effect of circumcision on the prevalence and incidence of high-risk strains of HPV.
Earlier studies had shown that the procedure reduces both prevalence and incidence in men, and observations had suggested it might have a beneficial effect in women, Tobian and colleagues noted.
To find out, they enrolled 648 partners of men in the circumcision group, and 597 partners of men in the control group between 2003 and 2006. The women were asked to provide vaginal swabs for HPV testing at baseline, 12 months, and 24 months.
At the two-year follow-up, data were available for 544 women in the intervention group and 488 in the control group.
Of those, 151 women in the intervention group (27.8%) had a high-risk HPV infection, defined as one or more of the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.
In comparison, 189 women in the control group (38.7%) had a high-risk HPV infection, leading to a prevalence risk ratio of 0.72 (95% CI 0.60 to 0.85, P=0.001).
Incidence of high-risk HPV infection during the trial was also lower in the intervention group than in the control group -- 20.7 infections per 100 person-years versus 26.9, yielding an incidence rate ratio of 0.77 (95% CI 0.63 to 0.93, P=0.008).
Given that persistent high-risk HPV infection is a recognized cause of cervical malignancies, the finding "accords with observational studies that show lower rates of cervical cancer associated with male circumcision," the researchers argued.
But the study did not assess cervical neoplasia directly, they noted.
Tobian and colleagues cautioned that men and women in the study were in stable relationships and did not have HIV at baseline, so the results may not apply to other populations. The analysis may also have underestimated incidence, they cautioned, because infections acquired and cleared between the yearly follow-up points would have been missed.
An estimate of protection against cervical disease as a result of circumcision can't be made, according to Anna Giuliano, PhD, of the H. Lee Moffitt Cancer Center in Tampa, Fla., and colleagues.
But the results do add weight to programs that promote circumcision in countries without cervical screening programs, Giuliano and colleagues argued in an accompanying commentary.
The procedure offers limited protection against most high-risk types, they noted, while the HPV vaccine is highly effective, but only against a limited number of genotypes. "The two interventions are likely to have important synergistic effects," they concluded.
The study was supported by the Bill & Melinda Gates Foundation, the NIH, and the Fogarty International Center.
One author reported a financial link with Roche Molecular Diagnostics, which makes the HPV genotyping test used in this study. All other authors declared they had no conflicts of interest.
The commentary authors reported financial links with Merck, GlaxoSmithKline, and Roche.


Primary source: The Lancet
Source reference:
Wawer MJ, et al "Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: A randomised trial in Rakai, Uganda" Lancet 2010; DOI: 10.1016/S0140-6736(10)61967-8.

[Hoover]

Circumcision has been used since the days of Dr Kellogg to stop all evils:
Masturbation
Kleptomania
alcoholism
cancer
the list goes on and on...... if you do the research.

If you will read the alleged research for HIV, it was done in some of areas of Africa where most the participants didn't even know what circumcision was! The whole report is fraudulent and is yet another attempt to rationalize the sexual mutilation of our baby boys.
But lets look at if from another point of view, all of my gay friends from college were circumcised and are now dead from HIV. Looks like it didn't help them and most gay North American men much.
Lets not sexually mutilate our children, tell them to use condoms.

These are just my thoughts since I am still pissed for being mutilated as an infant.
If anyone wants to see how badly they were hurt, try foreskin restoration for a month.
Find out what you have been missing.

Cheers from paradise,
Hoover

[Granny60]

Well said Hoover!

[edfu]

But lets look at if from another point of view, all of my gay friends from college were circumcised and are now dead from HIV. Looks like it didn't help them and most gay North American men much.

The majority of your gay friends from college who were circumcised and are now dead from HIV acquired the virus from bottoming in anal intercourse without the use of condoms.  The fact that they were all circumcised is irrelevant to the cause of their deaths.   

[jkinatl2]

Circumcision has been used since the days of Dr Kellogg to stop all evils:
Masturbation
Kleptomania
alcoholism
cancer
the list goes on and on...... if you do the research.

If you will read the alleged research for HIV, it was done in some of areas of Africa where most the participants didn't even know what circumcision was! The whole report is fraudulent and is yet another attempt to rationalize the sexual mutilation of our baby boys.
But lets look at if from another point of view, all of my gay friends from college were circumcised and are now dead from HIV. Looks like it didn't help them and most gay North American men much.
Lets not sexually mutilate our children, tell them to use condoms.

These are just my thoughts since I am still pissed for being mutilated as an infant.
If anyone wants to see how badly they were hurt, try foreskin restoration for a month.
Find out what you have been missing.

Cheers from paradise,
Hoover

(rolls eyes)

Good thing you have me on ignore.

[RapidRod]

Circumcision has been used since the days of Dr Kellogg to stop all evils:
Masturbation
Kleptomania
alcoholism
cancer
the list goes on and on...... if you do the research.

If you will read the alleged research for HIV, it was done in some of areas of Africa where most the participants didn't even know what circumcision was! The whole report is fraudulent and is yet another attempt to rationalize the sexual mutilation of our baby boys.
But lets look at if from another point of view, all of my gay friends from college were circumcised and are now dead from HIV. Looks like it didn't help them and most gay North American men much.
Lets not sexually mutilate our children, tell them to use condoms.

These are just my thoughts since I am still pissed for being mutilated as an infant.
If anyone wants to see how badly they were hurt, try foreskin restoration for a month.
Find out what you have been missing.

Cheers from paradise,
Hoover

[mecch]

Why not give the vaccine instead.

[emeraldize]

Hoover,
I'm curious. Did you read this as HIV instead of HPV?
Em

[Hoover]

EM, you are correct, I read this as HIV. The HIV report is similar...

Anyone who would take the time to read the study that made up this idea of sexually mutilating baby boys to protect them from HIV, they would realize it is bogus. There is no substitute for condoms, implying that circumcised men are less likely to get HIV is irresponsible.

As probably the only person here who has restored his foreskin after the at age 40, I have a perspective that no one else has. If cut men knew how much they lost, they would be pissed to hell.
After regrowing my skin, my partner and I both have longer and fatter dicks which are more sensitive.

Hoover

[RapidRod]

EM, you are correct, I read this as HIV. The HIV report is similar...

Anyone who would take the time to read the study that made up this idea of sexually mutilating baby boys to protect them from HIV, they would realize it is bogus. There is no substitute for condoms, implying that circumcised men are less likely to get HIV is irresponsible.

As probably the only person here who has restored his foreskin after the at age 40, I have a perspective that no one else has. If cut men knew how much they lost, they would be pissed to hell.
After regrowing my skin, my partner and I both have longer and fatter dicks which are more sensitive.

Hoover

The studies have shown not only does it lower HPV but also HIV.

[edfu]

The underlying biological rationale for the fact that uncircumcised men face a higher risk of acquiring HIV via the penis and passing it along is fairly clear-cut (pun intended).

The foreskin, which if unfolded would measure 20 to 30 square inches (that's 400-600 inches for size queens), contains a large number of a variety of cells called Langerhans.  They are concentrated on the inner foreskin layer, which lies directy against the head of the penis.  Langerhan cells are biological magnets for HIV.  Because of this, the inner foreskin layer can absorb HIV up to nine times more efficiently than a woman's cervix. 

Usually, Langerhan cells play a protective role.  They ingest pathogens and ferry them down lymph channels along the penis to the lymph glands in the groin, to be killed by white cells.  A Langeran cell will swallow HIV as readily as any other bacterium or virus, but unlike other pathogens, HIV will reproduce thousands of copies of itself inside the Langerhan's belly for the duration of its trip through the lymph system (about five days).  After reaching the lymph nodes in the groin, the Langerhan cell explodes--literally--spewing tens of thousands of copies of HIV and rapidly infecting other immune cells before slipping into the bloodstream.  If that's not enough, the intact foreskin is also susceptible to small tears and abrasions during sex that can provide even more opportunities for HIV to enter the body. 

That said, the only thing that fully protects men, cut or uncut, from acquiring HIV via the penis is a condom.  HIV can (and does) enter the body through a circumcised penis via small abrasions, preexisting sexually transmitted diseases, such as herpes, and/or the urethra. The important difference is the significant degree of HIV risk between circumcised and uncircumcised.

[Ann]

The important difference is the significant degree of HIV risk between circumcised and uncircumcised.

Actually, it has not been proven that there is a "significant degree of HIV risk between circumcised and uncircumcised."

Have a read through some of this. I'm not convinced there is enough of a correlation to support wholesale mutilation of boys genitalia.

And yes, I'm aware of the biology and cellular make-up of the foreskin. I'm still not convinced it makes that much difference. My ex-partner was uncut and despite eighteen months of unprotected intercourse with me, and I always had a detectable viral load, he remained hiv negative.

And if you read through the link I provided, you'll see all the flawed studies, misreported studies and unreported contradictory studies there have been where this is concerned.

I'm not convinced and if I were to have a baby boy, they'd cut him over my dead body.

[mecch]

In my opinion, this is all about post-colonial but still existing discomfort and fear of the subaltern.  The subaltern "persons socially, politically, and geographically outside of the hegemonic power structure" are both desired sexually and feared - source of diseases, etc.

If you dont realise the issue and research about circumcision and its relation to HIV is mostly connected to Africa - you'll laugh at my contention.

Ill take this all seriously when I see public health officials talk about the STD prevention benefits of cutting European men at birth.

[Hoover]

Good comment Ann.

Let us not forget something important, babies DIE from this surgery.
Yes the number is very low, but they also hide these deaths with the term "complications" so we will never know the true number. Condoms are the answer, not mutilating infants.
If adults want to do it, I have no issue.

[skeebo1969]

I agree with Edfu.  Langerham cells are thought to be the initial cellular targets in HIV sexual transmission.  While occurring in the stratum spinosum, they are found in abundance in the foreskin, vaginal walls, and to a lesser degree in oral mucosa.  

It's one of the reasons oral is not believed to be a viable source of transmission, while areas with greater concentrations of Langerham cells could pose easier pathways to infection.

While it may have not been conclusively proven to be a greater risk per say, theoretically due to the abundance of Langerhams in the foreskin one can safely assume it to be true...  I say assume only because I never read any of those studies, I'm bad.

Is it not believed to be the way so many hetero males in Africa are infected?


LOL I just took a roadside call about a woman locked out of a convertible..... she said the top was down.  

[Ann]

Skeebs, there are plenty of studies linked to in the link I provided earlier. Maybe you should do some reading.

[Rev. Moon]

After regrowing my skin, my partner and I both have longer and fatter dicks which are more sensitive.

Hoover

How lovely.

Let us not forget something important, babies DIE from this surgery.
Yes the number is very low, but they also hide these deaths with the term "complications" so we will never know the true number.

Any scientific data to back this up?

[skeebo1969]

Skeebs, there are plenty of studies linked to in the link I provided earlier. Maybe you should do some reading.

I checked it out.  This is the problem I have with that site:

"This site differs from others opposed to genital mutilation - its focus is on intactness, rather than on circumcision."

It seems to be a site against circumcision if anything.  Do you have some links with a little more unbiased info in it.  The info on the site contradicts repeatedly.

One example: "Circumcsion does not protect black South Africans"  then it goes on to say in the same paragraph, "Conclusion In general, circumcision offers slight protection."  And it doesn't stop there.... but, alas I have to get back to dispatching... it seems a lot of men have forgot how to change a tire as of late.

[Dachshund]

After regrowing my skin, my partner and I both have longer and fatter dicks which are more sensitive.

Hoover

A little sphincteroplasty and you should be good as new.

[Miss Philicia]

This is the fertility vase of the Ndebele tribe, does that mean anything to you?

[carousel]

If adults want to do it, I have no issue.

I used to sleep with somebody who had this done.  It looked like a pet had gnawed the end off, lumps and bumps left and he hadn't even bothered to take the stitches out. 

It wasn't pretty.

[Hellraiser]

This is the fertility vase of the Ndebele tribe, does that mean anything to you?

<3 Mean Girls

[mecch]

I used to sleep with somebody who had this done.  It looked like a pet had gnawed the end off, lumps and bumps left and he hadn't even bothered to take the stitches out. 

It wasn't pretty.

ewe thanks for sharing. Why did you continue? I would have been out of there.  Are you joking? The stitches still in? Maybe the explains some of the lumps.... Fresh wounds.

I've seen some butcher jobs but assumingly from infancy.  Mine is well done but "tight" which I dont appreciate. Thanks a lot.  If the cut removes the frenulum the boy will have lost some pleasure in life.

[sharkdiver]

EM, you are correct, I read this as HIV. The HIV report is similar...

Anyone who would take the time to read the study that made up this idea of sexually mutilating baby boys to protect them from HIV, they would realize it is bogus. There is no substitute for condoms, implying that circumcised men are less likely to get HIV is irresponsible.

As probably the only person here who has restored his foreskin after the at age 40, I have a perspective that no one else has. If cut men knew how much they lost, they would be pissed to hell.
After regrowing my skin, my partner and I both have longer and fatter dicks which are more sensitive.

Hoover

ewwww. thanks for sharing...NOT!