Protective Effect of Circumcision on Rates of STIs?
Protective Effect of Circumcision on Rates of STIs?
Dickson NP, van Roode T, Herbison P, Paul C
J Pediatr. 2008;152:383-387
This report reconstructs the history of a New Zealand birth cohort, born in 1972 and 1973.
The subjects had frequent assessments through childhood. During their adult years, the subjects were assessed at 18, 21, 26, and 32 years of age. Data on whether the child was circumcised were obtained through hospital records or at the 3-year visit.
The subjects were queried (by computerized questionnaire) about sexually transmitted infections (STIs) at the 21-, 26-, and 32-year visits. The questionnaire captured patients' history of bacterial STIs (chlamydia, gonorrhea, syphilis, and urethritis) and viral STIs (genital warts or herpes). The study also collected extensive demographic data about the subjects and their families, along with subjects' sexual behaviors.
There were 535 subjects in the initial cohort, and > 90% participated at the 3 adult follow-up points. Forty percent of the survivors had been circumcised by age 3 years. There was a slight difference between number of sexual partners per year between the 2 groups (1.4/year for circumcised vs 1.7 per year for uncircumcised).
The percentages who experienced any STI were virtually the same -- 23.4% of the whole cohort; 23.4% of circumcised subjects; and 23.5% of uncircumcised subjects. In unadjusted analyses, there was no difference in the STI incidence rate ratio of circumcised vs uncircumcised, and adjusting for the covariates did not change this. Even when looking at specific types of STIs, there were no significant differences between the 2 groups.
The authors conclude that these data do not support a protective effect of circumcision on rates of STIs.
The authors note that the STI data were collected by self-report rather than by more objective means. However, the investigators did have serologic data on herpes to compare with their data, and they found no differences between the 2 groups on rate of seroprevalence of herpes. They note that African studies demonstrate a protective effect of circumcision in preventing HIV infection. They conclude that in a developed country, circumcision does not appear to offer benefit relative to STIs exclusive of HIV.
Abstract
Circumcision and Risk of Sexually Transmitted Infections in a Birth Cohort
Dickson NP, van Roode T, Herbison P, Paul C
J Pediatr. 2008;152:383-387
Summary
This report reconstructs the history of a New Zealand birth cohort, born in 1972 and 1973.
The subjects had frequent assessments through childhood. During their adult years, the subjects were assessed at 18, 21, 26, and 32 years of age. Data on whether the child was circumcised were obtained through hospital records or at the 3-year visit.
The subjects were queried (by computerized questionnaire) about sexually transmitted infections (STIs) at the 21-, 26-, and 32-year visits. The questionnaire captured patients' history of bacterial STIs (chlamydia, gonorrhea, syphilis, and urethritis) and viral STIs (genital warts or herpes). The study also collected extensive demographic data about the subjects and their families, along with subjects' sexual behaviors.
There were 535 subjects in the initial cohort, and > 90% participated at the 3 adult follow-up points. Forty percent of the survivors had been circumcised by age 3 years. There was a slight difference between number of sexual partners per year between the 2 groups (1.4/year for circumcised vs 1.7 per year for uncircumcised).
The percentages who experienced any STI were virtually the same -- 23.4% of the whole cohort; 23.4% of circumcised subjects; and 23.5% of uncircumcised subjects. In unadjusted analyses, there was no difference in the STI incidence rate ratio of circumcised vs uncircumcised, and adjusting for the covariates did not change this. Even when looking at specific types of STIs, there were no significant differences between the 2 groups.
The authors conclude that these data do not support a protective effect of circumcision on rates of STIs.
Viewpoint
The authors note that the STI data were collected by self-report rather than by more objective means. However, the investigators did have serologic data on herpes to compare with their data, and they found no differences between the 2 groups on rate of seroprevalence of herpes. They note that African studies demonstrate a protective effect of circumcision in preventing HIV infection. They conclude that in a developed country, circumcision does not appear to offer benefit relative to STIs exclusive of HIV.
Abstract
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