spenac Posted March 26, 2009 Posted March 26, 2009 (edited) http://news.yahoo.com/s/ap/20090325/ap_on_...umcision_stds_2 http://www.malecircumcision.org/ http://content.nejm.org/cgi/content/short/360/13/1298 Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis Aaron A.R. Tobian, M.D., Ph.D., David Serwadda, M.Med., M.P.H., Thomas C. Quinn, M.D., M.Sc., Godfrey Kigozi, M.B., Ch.B., M.P.H., Patti E. Gravitt, Ph.D., Oliver Laeyendecker, M.S., M.B.A., Blake Charvat, M.Sc., Victor Ssempijja, B.Stat., Melissa Riedesel, M.P.H., Amy E. Oliver, B.A., Rebecca G. Nowak, M.P.H., Lawrence H. Moulton, Ph.D., Michael Z. Chen, M.Sc., Steven J. Reynolds, M.D., M.P.H., Maria J. Wawer, M.D., M.H.Sc., and Ronald H. Gray, M.D., M.Sc. Editorial by Golden, M. R. PubMed Citation ABSTRACT 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] .) Edited March 26, 2009 by spenac
VentMedic Posted March 26, 2009 Posted March 26, 2009 Interesting article and one that has been researched many times since the late 1980s. There are also 40 references cited at the end of this article. Something about it makes sense.
Mateo_1387 Posted March 28, 2009 Posted March 28, 2009 Condoms are effective to prevent the spread of HIV, HPV, and HSV-2, yet condoms require no cutting or altercation of a defenseless infant.
VentMedic Posted March 28, 2009 Posted March 28, 2009 Condoms are effective to prevent the spread of HIV, HPV, and HSV-2, yet condoms require no cutting or altercation of a defenseless infant. Unfortunately, where a lot of the studies have been done, it may be hard to find a Walgreens. We conducted two parallel but independent trials of male circumcision for the prevention of HIV infection and other sexually transmitted infections in Rakai, Uganda, as described previously
VentMedic Posted March 28, 2009 Posted March 28, 2009 (edited) How does one sign up for these studies? Usually you agree to have your medical history followed and you will fall either into the circumcised or uncircumcised group depending on what your parents' preference had been. If you are near a teaching hospital or medical university, you may be able to sign up for whatever they happen to be studying. Sometimes you may even be paid for being part of a study. Others may get the benefits of a new medicine or treatment that is considered to still be in the trialing phase. In the first trial (Rakai-1, which was funded by the National Institutes of Health), we enrolled 4996 HIV-negative, uncircumcised boys and men between the ages of 15 and 49 years who accepted voluntary HIV counseling and testing and agreed to learn their HIV results. The second trial (Rakai-2, which was funded by the Bill and Melinda Gates Foundation) had as its primary goal the assessment of the safety of male circumcision and its effects on sexually transmitted infections in HIV-infected men and their partners. However, the latter trial also included 595 HIV-negative subjects, of whom 155 (26.1%) declined to learn their HIV results and 440 (73.9%) agreed to learn their HIV results but were included in the study to provide blinding of subjects' HIV status so as to prevent potential stigmatization of HIV-infected subjects who were participating in the trial. The two trials, which were conducted concurrently, had identical protocols. At each visit, all subjects were offered free HIV counseling and testing, health education, and condoms. All subjects who were found to be HIV-positive were referred to an HIV treatment program funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). All subjects provided written informed consent. Edited March 28, 2009 by VentMedic
FireMedic65 Posted March 28, 2009 Posted March 28, 2009 Usually you agree to have your medical history followed and you will fall either into the circumcised or uncircumcised group depending on what your parents' preference had been. It was a joke.
Mateo_1387 Posted March 28, 2009 Posted March 28, 2009 Unfortunately, where a lot of the studies have been done, it may be hard to find a Walgreens. That may be. Condoms were just a suggestion to prevent an invasive procedure. I still say circumcision needs to be the decision of the adult male. It is not right to force that decision on a male when he will have to live with it for the rest of his life.
VentMedic Posted March 28, 2009 Posted March 28, 2009 (edited) That may be. Condoms were just a suggestion to prevent an invasive procedure. I still say circumcision needs to be the decision of the adult male. It is not right to force that decision on a male when he will have to live with it for the rest of his life. I've heard plastic surgeons can do creative things either way. Edited March 28, 2009 by VentMedic
Eydawn Posted March 28, 2009 Posted March 28, 2009 Circumcision, on the other hand, if we're talking quality of life via decreased chance for disease transmission, is not a behaviorally based intervention and therefore much less likely to fail. Only yesterday I read a lengthy article on MSNBC about how educated women end up pregnant even after having been educated on birth control and being economically capable of using birth control... yet not following birth control regimens appropriately and surprise! Baby's on the way. Male circumcision has been shown to reduce risks for certain cancers. It's also a cultural practice that does not hinder a man's sexual pleasure or performance in any way, making it much less of an issue than say, female circumcision. I'd put male circumcision along the lines of infantile ear-piercing; causes minor temporary pain and is at the discretion of the parents. When we have the Pope perpetuating the idea that condoms lead to promiscuity, leading to higher chances for HIV infection in countries like Africa, we need every tool we've got at our disposal if it means less people will suffer from HIV and less children will be orphaned and subjected to the horrors of exploitation, starvation, and prostitution. A half centimeter of flesh to reduce the risk of a life of horror? If they can prove that the disease transmission reduction is VERY significant, I'm all for it. What if they decided that removing the appendix at birth eliminated the possibility for colorectal cancer (give me this one, it's just an analogy)... would you be as up in arms about performing surgery to eliminate the risk of cancer? The reason people react strongly to this particular procedure is because it's something that most men are highly innately protective of... their penises. However, the penis itself is not being removed, nor is its functionality or sensitivity being damaged. If it were, this would be another discussion entirely. Here in America and in Western cultures it's all well and good to sit there and say "condoms are effective, so there's no need to perform this procedure on babies" but in Africa or poverty stricken areas of Asia, where condoms may not be available (or in good quality or subject to severe cultural tabu that prevents their use to the point where it's useless) it's a different discussion. It's all a matter of proportion. Wendy CO EMT-B
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