Although circumcision does not offer 100% protection, it does provided significant risk reduction of health-related problems related to sexually transmitted disease. Differences exist between hetersosexual sex and homosexual sexual activity. Other risk factors are also important besides circumcision.
Circumcision of males represents a surgical “vaccine” against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain-free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis (a condition where the foreskin cannot be fully retracted from the head of the penis), thrush (fungal infection affecting the mouth or vagina), and inflammatory dermatoses. In relation to women, circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio-sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals.
Little scientific evidence of adverse effects on sexual, psychological, or emotional health was found by researchers; but, surgical risks associated with circumcision, such as bleeding, penile injury, and local infection, and the consequences of pain experienced with neonatal circumcision are valid concerns.
Important Findings of Circumcision Related to HIV/AIDS
One African study found no seroconversions (HIV negative to HIV positive status) among 50 circumcised male partners in heterosexual relationships. In the study in rural Uganda, researchers examined the influence of viral load in relation to other risk factors for the heterosexual transmission of human immunodeficiency virus type 1 (HIV-1). In a community-based study of 15,127 persons in a rural district of Uganda, researchers identified 415 couples in which one partner was HIV-1-positive and one was initially HIV-1-negative (a sero-discordant couple) and followed them prospectively for up to 30 months. The incidence of HIV-1 infection per 100 person-years among the initially seronegative partners was examined in relation to behavioral and biologic variables.
The male partner was HIV-1-positive in 228 couples, and the female partner was HIV-1-positive in 187 couples. Ninety of the 415 initially HIV-1-negative partners seroconverted (incidence, 11.8 per 100 person-years). The rate of male-to-female transmission was not significantly different from the rate of female-to-male transmission (12.0 per 100 person-years vs. 11.6 per 100 person-years). The incidence of seroconversion was highest among the partners who were 15 to 19 years of age (15.3 per 100 person-years). The incidence was 16.7 per 100 person-years among 137 uncircumcised male partners, whereas there were no seroconversions among the 50 circumcised male partners (P<0.001). The mean serum HIV-1 RNA level was significantly higher among HIV-1-positive subjects whose partners seroconverted than among those whose partners did not seroconvert (90,254 copies per milliliter vs. 38,029 copies per milliliter, P=0.01). There were no instances of transmission among the 51 subjects with serum HIV-1 RNA levels of less than 1500 copies per milliliter; there was a significant dose-response relation of increased transmission with increasing viral load. In multivariate analyses of log-transformed HIV-1 RNA levels, each log increment in the viral load was associated with a rate ratio of 2.45 for seroconversion (95 percent confidence interval, 1.85 to 3.26).
The researchers concluded that viral load is the chief predictor of the risk of heterosexual transmission of HIV-1, and transmission is rare among persons with levels of less than 1500 copies of HIV-1 RNA per milliliter.
Another study in three U.S. cities of homosexual black and Latino men who have sex with men found no evidence that circumcision offered protection against HIV infection.
There is a biological rationale that the increase surface area of the uncircumcised foreskin increases risk of HIV infection due to the high density of HIV target cells and lack of keratinization of the inner mucosal surface of the foreskin.
One researcher reviewed medical literature to study AIDS and hetersosexual anal intercourse and suggested the following: (1) anal coitus carries a greater risk to women than does vaginal intercourse; (2) it is probable, but unknown whether women having receptive anal intercourse with bisexual men are at a greater risk than those with heterosexual partners; and (3) female-to-male transmission of HIV is not considered as likely in Western countries as is male-to-male transmission.
SOURCES:
Jin F, Prestage GP, Zablotska I, Rawstorne P, Kippax SC, Donovan B, Cunningham PH, Templeton DJ, Kaldor JM, Grulich AE. High rates of sexually transmitted infections in HIV positive homosexual men: data from two community based cohorts. Sex Transm Infect. 2007 Aug;83(5):397-9. Epub 2007 Jun 7.
Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, Meehan MO, Lutalo T, Gray RH. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000 Mar 30;342(13):921-9.
Millett GA, Ding H, Lauby J, Flores S, Stueve A, Bingham T, Carballo-Dieguez A, Murrill C, Liu KL, Wheeler D, Liau A, Marks G. Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities. J Acquir Immune Defic Syndr. 2007 Dec 15;46(5):643-650.
Morris BJ. Why circumcision is a biomedical imperative for the 21(st) century. Bioessays. 2007 Nov;29(11):1147-58.
Moses S, Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks. Sex Transm Infect. 1998 Oct;74(5):368-73.
Voeller B. AIDS and heterosexual anal intercourse. Arch Sex Behav. 1991 Jun;20(3):233-76.
Weiss HA. Male circumcision as a preventive measure against HIV and other sexually transmitted diseases. Curr Opin Infect Dis. 2007 Feb;20(1):66-72.
Keywords: Sero discordant, AIDS, HIV, homsexual
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