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Morris BJ, Moreton S, Krieger JN, Klausner JD. Infant Circumcision for Sexually Transmitted Infection Risk Reduction Globally. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00811. [PMID: 36041835 PMCID: PMC9426975 DOI: 10.9745/ghsp-d-21-00811] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/21/2022] [Indexed: 12/26/2022]
Abstract
Population-based studies in high-income countries have failed to find that male circumcision protects against sexually transmitted infections. Using evidence from several sources, we show that male circumcision does protect against HIV during insertive intercourse for men who have sex with men.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, Australia.
| | | | - John N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeffrey D Klausner
- Department of Medicine, Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Agras K, Doluoglu OG, Acikgoz ZC, Ener K, Ocal A. Detection of human papillomavirus subtypes harbored in the foreskin of asymptomatic boys: Controlled study. J Pediatr Urol 2020; 16:388.e1-388.e6. [PMID: 32389587 DOI: 10.1016/j.jpurol.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/24/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Human papillomavirus infection (HPV) is one of the most common sexually transmitted infections and can cause penile and anal cancer in men, and invasive cervical cancer in women. OBJECTIVE To evaulate the colonization of 32 HPV subtypes in the foreskin of boys. STUDY DESIGN A prospective analysis was made of the data of 62 healthy boys who had undergone standard circumcision. Deoxyribonucleic acid (DNA) was isolated from the foreskin tissues, and the integrity of DNA was tested. The DNA of each patient was further assessed with real-time polymerase chain reaction (PCR) and the presence of 32 subtypes of HPV was explored. To confirm the results, melting curve analysis and agarose gel electrophoresis (AGE) were performed for all samples. Further analysis was made using LCD-array on six randomly selected samples to confirm the results together with negative and positive controls. RESULTS The mean age of the boys was 6.8 ± 2 years at the time of surgery. All positive controls and samples were positive, all negative controls were negative in the first HPV amplification assay. All positive controls had typical melting curve peaks, whereas all sample amplifications had non-specific, atypical melting curves not fitting with those of the positive controls. Two bands of expected sizes (124 and 405 bp) were only observed in positive controls, but not in negative controls or samples on AGE. The same results were observed on the 6 randomly selected samples using LCD-array. Consequently, all the foreskin samples were evaluated as negative for the 32 HPV types investigated in the study. DISCUSSION Literature shows a high prevalence of genital HPV in newborns, in early infancy, late adolescence and adulthood. However there is a lack of data in literature on the prevalence in early and late childhood. The negative results of HPV colonization on the foreskin in the current study may be attributed to the conservative and mostly monogamous nature of most family structures in Turkey. CONCLUSION The results of the present study have shown that foreskin tissue is not a natural reservoir for HPV and subclinical HPV infection is not likely in the absence of suspected sexual contact.
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Affiliation(s)
- Koray Agras
- Department of Urology, Clinic of Ankara Training and Research Hospital, University of Medical Sciences, Ankara, Turkey.
| | - Omer Gokhan Doluoglu
- Department of Urology, Clinic of Ankara Training and Research Hospital, University of Medical Sciences, Ankara, Turkey.
| | - Ziya Cibali Acikgoz
- Department of Microbiology, Clinic of Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Kemal Ener
- Department of Urology, Clinic of Umraniye Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey.
| | - Asli Ocal
- Department of Urology Clinic, Medisis Private Hospital, Ankara, Turkey
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Chung JM, Park CS, Lee SD. Microbiology of smegma: Prospective comparative control study. Investig Clin Urol 2019; 60:127-132. [PMID: 30838346 PMCID: PMC6397923 DOI: 10.4111/icu.2019.60.2.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/30/2019] [Indexed: 01/12/2023] Open
Abstract
Purpose The aim of the study was to investigate the common bacteria found in the smegma in the subpreputial space of asymptomatic boys prospectively, and to determine the difference of those bacteria according to the presence of smegma. Materials and Methods In our institution, 40 boys who performed penoplasty were recruited into the study. Swab was done using aseptic techniques on smegma and glans in the operation room. According to the presence of smegma in the subpreputial space, we classified glans as a group S (with smegma, n=20) and group C (without smegma, n=20). The swabs were immediately sent to microbiology laboratory for microscopy, culture, and sensitivity tests. Results The mean age was 30.4±26.4 months. Thirty-one bacteria were isolated from smegma, comprising 15 gram-positive species (48.4%) and 16 gram-negative species (51.6%). The most commonly isolated gram-negative bacterium was Escherichia coli (25.8%), while the commonly isolated gram-positive bacteria were Enterococcus faecalis (19.4%) and Enterococcus avium (12.9%). Most of the bacterial isolates were multi-drug-resistant (61.3%). In group S, 12 boys had 22 bacterial isolates in the glans. The commonly isolated bacteria were E. coli (27.3%), E. avium (22.7%) and E. faecalis (18.2%). In group C, 13 boys had 21 bacterial isolates in the glans. The most commonly isolated bacterium was E. faecalis (28.6%). Conclusions Smegma in the subpreputial space of children was colonized by many kinds of uropathogen.
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Affiliation(s)
- Jae Min Chung
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Soo Park
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Costa-Silva M, Fernandes I, Rodrigues AG, Lisboa C. Anogenital warts in pediatric population. An Bras Dermatol 2018; 92:675-681. [PMID: 29166505 PMCID: PMC5674701 DOI: 10.1590/abd1806-4841.201756411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/11/2016] [Indexed: 11/22/2022] Open
Abstract
The approach to children with anogenital warts in the context of sexual abuse is
a challenge in clinical practice. This study aims to review the current
knowledge of anogenital warts in children, the forms of transmission, and the
association with sexual abuse and to propose a cross-sectional approach
involving all medical specialties. A systematic review of the literature was
conducted in Portuguese and English from January 2000 to June 2016 using the ISI
Web of Knowledge and PubMed databases. Children aged 12 years or younger were
included. The ethical and legal aspects were consulted in the Declaration and
Convention on the Rights of Children and in the World Health Organization.
Non-sexual and sexual transmission events of human papillomavirus in children
have been well documented. The possibility of sexual transmission appears to be
greater in children older than 4 years. In the case of anogenital warts in
children younger than 4 years of age, the possibility of non-sexual transmission
should be strongly considered in the absence of another sexually transmitted
infection, clinical indicators, or history of sexual abuse. The importance of
human papillomavirus genotyping in the evaluation of sexual abuse is
controversial. A detailed medical history and physical examination of both the
child and caregivers are critical during the course of the investigation. The
likelihood of an association between human papillomavirus infection and sexual
abuse increases directly with age. A multidisciplinary clinical approach
improves the ability to identify sexual abuse in children with anogenital
warts.
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Affiliation(s)
- Miguel Costa-Silva
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE, Faculdade de Medicina da Universidade do Porto - Porto, Portugal
| | - Inês Fernandes
- Department and Laboratory of Microbiology, Faculdade de Medicina da Universidade do Porto - Porto, Portugal
| | - Acácio Gonçalves Rodrigues
- Department and Laboratory of Microbiology, Faculdade de Medicina da Universidade do Porto - Porto, Portugal
| | - Carmen Lisboa
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE, Faculdade de Medicina da Universidade do Porto - Porto, Portugal.,Department and Laboratory of Microbiology, Faculdade de Medicina da Universidade do Porto - Porto, Portugal
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Lee B, Lee SW, Kim DI, Kim JH. HPV prevalence in the foreskins of asymptomatic healthy infants and children: Systematic review and meta-analysis. Sci Rep 2017; 7:7050. [PMID: 28765591 PMCID: PMC5539194 DOI: 10.1038/s41598-017-07506-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/28/2017] [Indexed: 11/08/2022] Open
Abstract
The true HPV prevalence in the foreskins of infants and children has been little documented, but reporting on this prevalence is of great importance given its impact on the rationale for treating asymptomatic boys. We searched multiple databases from 1960 to 2016 for observational or prospective studies that reported on HPV prevalence in foreskins. We conducted a meta-analysis using a random-effects model to pool for HPV prevalence in the foreskins of infants and children. Eight studies, with a total of 556 infants and children with phimosis, were eligible for the meta-analysis. The pooled overall prevalence of general HPV, high-risk HPV, low-risk HPV, HPV 16/18, HPV 16, and HPV 18 were 17.3 (95%CI: 0.8-46.3), 12.1 (95% CI: 0.9-31.5), 2.4 (95% CI: 0.0-11.2), 4.8 (95% CI: 0.0-16.8), 1.7 (95% CI: 0.0-5.1), and 0 (95% CI: 0-0.5), respectively. The estimated HPV prevalence in foreskins was not zero among infants and children, which implies HPV transmission other than by sexual contact. Considering that high-risk HPV is detected in asymptomatic infants and children, future studies are warranted to determine whether preventive treatments in asymptomatic infants and children could be effective in preventing persistence or transmission of high-risk HPV.
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Affiliation(s)
- Bora Lee
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, Korea
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchuhyang University Medical College, Bucheon, Korea
| | - Dae In Kim
- Department of Pharmaceutical engineering, Soonchunhyang University, Asan, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea.
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Morris BJ, Krieger JN. Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision. Int J Prev Med 2017; 8:32. [PMID: 28567234 PMCID: PMC5439293 DOI: 10.4103/ijpvm.ijpvm_377_16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/07/2017] [Indexed: 01/12/2023] Open
Abstract
Penile inflammatory skin conditions such as balanitis and posthitis are common, especially in uncircumcised males, and feature prominently in medical consultations. We conducted a systematic review of the medical literature on PubMed, EMBASE, and Cohrane databases using keywords "balanitis," "posthitis," "balanoposthitis," "lichen sclerosus," "penile inflammation," and "inflammation penis," along with "circumcision," "circumcised," and "uncircumcised." Balanitis is the most common inflammatory disease of the penis. The accumulation of yeasts and other microorganisms under the foreskin contributes to inflammation of the surrounding penile tissue. The clinical presentation of inflammatory penile conditions includes itching, tenderness, and pain. Penile inflammation is responsible for significant morbidity, including acquired phimosis, balanoposthitis, and lichen sclerosus. Medical treatment can be challenging and a cost burden to the health system. Reducing prevalence is therefore important. While topical antifungal creams can be used, usually accompanied by advice on hygiene, the definitive treatment is circumcision. Data from meta-analyses showed that circumcised males have a 68% lower prevalence of balanitis than uncircumcised males and that balanitis is accompanied by a 3.8-fold increase in risk of penile cancer. Because of the high prevalence and morbidity of penile inflammation, especially in immunocompromised and diabetic patients, circumcision should be more widely adopted globally and is best performed early in infancy.
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Affiliation(s)
- Brian J. Morris
- Department of Physiology, School of Medical Sciences and Bosch Institute, University of Sydney, New South Wales 2006, Australia
| | - John N. Krieger
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Section of Urology, Seattle, Washington 98108, USA
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Morris BJ, Krieger JN, Klausner JD. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy. World J Clin Pediatr 2016; 5:251-261. [PMID: 27610340 PMCID: PMC4978617 DOI: 10.5409/wjcp.v5.i3.251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/11/2016] [Accepted: 04/22/2016] [Indexed: 02/06/2023] Open
Abstract
We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.
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