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Mehta KS, Marfatia YS, Jain AP, Shah DJ, Baxi DS. Male circumcision and Sexually transmitted Infections - An update. Indian J Sex Transm Dis AIDS 2021; 42:1-6. [PMID: 34765930 PMCID: PMC8579597 DOI: 10.4103/ijstd.ijstd_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 11/04/2022] Open
Abstract
Role of male circumcision (MC) as a tool to prevent sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) was assessed. An attempt was made to search articles related to association between MC and STIs/HIV. A thorough search was carried out to find out quality articles published in indexed specialty journals. Centers for Disease Control and Prevention and World Health Organization (WHO) sites were also referred. Warm and moist environment of area under foreskin facilitates some pathogens to persist and replicate. Further, the thinness of foreskin predisposes it to minor trauma and abrasions that facilitate the entry of pathogens. MC reduces HIV infection risk by 50%–60% over time and reduces the risk of men acquiring herpes simplex virus-2 and human papillomavirus (HPV) that can cause penile and other anogenital cancers, by 30%. There is no significant reduction in risk of acquiring syphilis, but reduced risk of acquisition of Haemophilus ducreyi is reported. MC is reported to be beneficial in conditions such as traumatic injury, Balanitis Xerotica Obliterans, refractory balanoposthitis, and chronic, recurrent urinary tract infections. MC also reduces the chances of penile carcinoma by facilitating improved penile hygiene, lowering HPV/HIV transmission rates, and reducing chronic inflammatory conditions such as phimosis and balanitis. MC has been recommended by the WHO and UNAIDS in 2007 as an additional HIV prevention intervention in settings of high HIV prevalence. MC is an important adjunct to safe sex education, condom use, and vaccination (HPV) in reducing the global burden of HIV/STIs-related morbidity and mortality.
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Affiliation(s)
- Kajal S Mehta
- Consultant Dermatologist, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Yogesh S Marfatia
- Department of Skin and VD, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Apexa P Jain
- Department of Skin and VD, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Dhiral J Shah
- Department of Skin and VD, Baroda Medical College, Vadodara, Gujarat, India
| | - Disha S Baxi
- Department of Skin and VD, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India
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Nowak RG, Liska TA, Bentzen SM, Kim E, Chipato T, Salata RA, Celentano DD, Morrison CS, Gravitt PE. Brief Report: Herpes Simplex Virus Type-2 Shedding and Genital Ulcers During Early HIV in Zimbabwean Women. J Acquir Immune Defic Syndr 2021; 87:789-793. [PMID: 33587502 PMCID: PMC8131209 DOI: 10.1097/qai.0000000000002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Herpes simplex virus type-2 (HSV-2) seropositive persons have a 3- to 5-fold higher risk of acquiring HIV, possibly because of HSV-2-induced inflammation and recruitment of susceptible immune cells to exposure sites. We hypothesized that cervical HSV-2 activation (ie, viral DNA shedding and/or ulcers) preceded HIV acquisition in the hormonal contraception and HIV cohort. METHODS Zimbabwean women who acquired HIV were matched to HIV-negative women on visit, age, and bacterial sexually transmitted infections. Up to 5 cervical swabs bracketing first polymerase chain reaction detection of HIV DNA (the index visit) were selected (t-6months, t-3months, tindex, t+3months, t+6months). Women with HSV-2 immunoglobulin G+ before tindex were polymerase chain reaction tested for viral shedding. Self-reported and clinician-diagnosed ulcers were documented. Multivariable logistic regression, accounting for matching, estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) at each visit. RESULTS Of 387 HSV-2 seropositive women, most had prevalent as compared with incident HSV-2 (91% vs. 9%, respectively). HSV-2 viral shedding was more common among HIV seroconverters than HIV-negative women (26% vs. 14%, P < 0.01). Shedding occurred around HIV acquisition (t-3months aOR, 2.7; 95% CI, 0.8 to 8.8; tindex aOR, 2.6; 95% CI, 1.1 to 6.5; t+3months aOR, 2.6; 95% CI, 1.0 to 6.6). Genital ulcers were reported more often among HIV seroconverters than HIV-negative women (13% vs. 7%; P = 0.06) and detection was after HIV acquisition (t+6months aOR, 14.5; 95% CI, 1.6 to 133.9). CONCLUSIONS HSV-2 shedding appeared synergistic with HIV acquisition followed by presentation of ulcers. Evaluating all sexually transmitted infections rather than HSV-2 alone may clarify the relationship between inflammation and HIV acquisition.
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Affiliation(s)
- Rebecca G Nowak
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Tobias A Liska
- Nathan Schnaper Internship Program in Translational Cancer Research, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Esther Kim
- Beth Israel Lahey Health Beverly Hospital, Beverly MA
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Faris R, Andersen SE, McCullough A, Gourronc F, Klingelhutz AJ, Weber MM. Chlamydia trachomatis Serovars Drive Differential Production of Proinflammatory Cytokines and Chemokines Depending on the Type of Cell Infected. Front Cell Infect Microbiol 2019; 9:399. [PMID: 32039039 PMCID: PMC6988789 DOI: 10.3389/fcimb.2019.00399] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
Chlamydia trachomatis serovars A-C infect conjunctival epithelial cells and untreated infection can lead to blindness. D-K infect genital tract epithelial cells resulting in pelvic inflammatory disease, ectopic pregnancy, and sterility while L1-L3 infect epithelial cells and macrophages, causing an invasive infection. Despite some strains of Chlamydia sharing high nucleotide sequence similarity, the bacterial and host factors that govern tissue and cellular tropism remain largely unknown. Following introduction of C. trachomatis via intercourse, epithelial cells of the vagina, foreskin, and ectocervix are exposed to large numbers of the pathogen, yet their response to infection and the dynamics of chlamydial growth in these cells has not been well-characterized compared to growth in more permissive cell types that harbor C. trachomatis. We compared intracellular replication and inclusion development of representative C. trachomatis serovars in immortalized human conjunctival epithelial, urogenital epithelial, PMA stimulated THP-1 (macrophages), and HeLa cells. We demonstrate that urogenital epithelial cells of the vagina, ectocervix, and foreskin restrict replication of serovar A while promoting robust replication and inclusion development of serovar D and L2. Macrophages restrict serovars D and A while L2 proliferates in these cells. Furthermore, we show that GM-CSF, RANTES, GROα, IL-1α, IL-1β, IP-10, IL-8, and IL-18 are produced in a cell-type and serovar-specific manner. Collectively we have established a series of human cell lines that represent some of the first cell types to encounter C. trachomatis following exposure and show that differential production of key cytokines early during infection could regulate serovar-host cell specificity.
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Affiliation(s)
- Robert Faris
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Shelby E Andersen
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Alix McCullough
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Françoise Gourronc
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Aloysius J Klingelhutz
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Mary M Weber
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
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4
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Morris BJ, Moreton S, Krieger JN. Critical evaluation of arguments opposing male circumcision: A systematic review. J Evid Based Med 2019; 12:263-290. [PMID: 31496128 PMCID: PMC6899915 DOI: 10.1111/jebm.12361] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/03/2019] [Accepted: 05/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically evaluate evidence against male circumcision (MC). METHODS We searched PubMed, Google Scholar, EMBASE and Cochrane databases. RESULTS Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high-quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high-quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk-benefit analyses reported that benefits exceed risks by 100-200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low-risk, high-benefit interventions such as MC for better health. Expert evaluations of case-law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost-saving to health systems. CONCLUSIONS Arguments opposing MC are supported mostly by low-quality evidence and opinion, and are contradicted by strong scientific evidence.
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Affiliation(s)
- Brian J Morris
- School of Medical SciencesUniversity of SydneySydneyNew South WalesAustralia
| | | | - John N Krieger
- Department of UrologyUniversity of Washington School of MedicineSeattleWashington
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Morris BJ, Hankins CA, Banerjee J, Lumbers ER, Mindel A, Klausner JD, Krieger JN. Does Male Circumcision Reduce Women's Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions? Front Public Health 2019; 7:4. [PMID: 30766863 PMCID: PMC6365441 DOI: 10.3389/fpubh.2019.00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Male circumcision (MC) is proven to substantially reduce men's risk of a number of sexually transmitted infections (STIs). We conducted a detailed systematic review of the scientific literature to determine the relationship between MC and risk of STIs and associated conditions in women. Methods: Database searches by "circumcision women" and "circumcision female" identified 68 relevant articles for inclusion. Examination of bibliographies of these yielded 14 further publications. Each was rated for quality using a conventional rating system. Results: Evaluation of the data from the studies retrieved showed that MC is associated with a reduced risk in women of being infected by oncogenic human papillomavirus (HPV) genotypes and of contracting cervical cancer. Data from randomized controlled trials and other studies has confirmed that partner MC reduces women's risk not only of oncogenic HPV, but as well Trichomonas vaginalis, bacterial vaginosis and possibly genital ulcer disease. For herpes simplex virus type 2, Chlamydia trachomatis, Treponema pallidum, human immunodeficiency virus and candidiasis, the evidence is mixed. Male partner MC did not reduce risk of gonorrhea, Mycoplasma genitalium, dysuria or vaginal discharge in women. Conclusion: MC reduces risk of oncogenic HPV genotypes, cervical cancer, T. vaginalis, bacterial vaginosis and possibly genital ulcer disease in women. The reduction in risk of these STIs and cervical cancer adds to the data supporting global efforts to deploy MC as a health-promoting and life-saving public health measure and supplements other STI prevention strategies.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia
| | - Catherine A. Hankins
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | | | - Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine and Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Adrian Mindel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey D. Klausner
- Division of Infectious Diseases and the Program in Global Health, Fielding School of Public Health, University of California Los Angeles Care Center, Los Angeles, CA, United States
| | - John N. Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
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Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). Can Urol Assoc J 2018; 12:18-28. [PMID: 29381455 PMCID: PMC5937397 DOI: 10.5489/cuaj.5034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
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7
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Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J 2018; 12:E76-E99. [PMID: 29381458 PMCID: PMC5937400 DOI: 10.5489/cuaj.5033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
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Abstract
The last estimated annual incidence of Trichomonas vaginalis worldwide exceeds that of chlamydia and gonorrhea combined. This critical review updates the state of the art on advances in T. vaginalis diagnostics and strategies for treatment and prevention of trichomoniasis. In particular, new data on treatment outcomes for topical administration of formulations are reviewed and discussed.
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Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, Taliano J, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Pals S, Davis SM. Association between male circumcision and women's biomedical health outcomes: a systematic review. Lancet Glob Health 2017; 5:e1113-e1122. [PMID: 29025633 PMCID: PMC5728090 DOI: 10.1016/s2214-109x(17)30369-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/21/2017] [Accepted: 08/25/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Male circumcision reduces men's risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women's health outcomes to benefit women's health programmes. METHODS In this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women's health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency. FINDINGS 60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate. INTERPRETATION Scale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly consistent. Synergies between male circumcision and women's health programmes should be explored. FUNDING US Centers for Disease Control and Prevention and Jhpiego.
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Affiliation(s)
- Jonathan M Grund
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Naomi Bock
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Carlos Toledo
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Joanna Taliano
- LAC Group, Contractor to US Centers for Disease Control and Prevention, Library Science Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, USA
| | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sherri Pals
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Stephanie M Davis
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA.
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Bochner AF, Baeten JM, Rustagi AS, Nakku-Joloba E, Lingappa JR, Mugo NR, Bukusi EA, Kapiga S, Delany-Moretlwe S, Celum C, Barnabas RV. A cross-sectional analysis of Trichomonas vaginalis infection among heterosexual HIV-1 serodiscordant African couples. Sex Transm Infect 2017; 93:520-529. [PMID: 28377421 DOI: 10.1136/sextrans-2016-053034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/16/2017] [Accepted: 03/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Trichomonas vaginalis is the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and female T. vaginalis infection. METHODS African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials. T. vaginalis testing was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis. RESULTS Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms of T. vaginalis. Exploring concordance of T. vaginalis status within sexual partnerships, we observed that 61% (195/319) of T. vaginalis-positive men and 23% (195/857) of T. vaginalis-positive women had a concurrently infected partner. In multivariable analysis, having a T. vaginalis-positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis. CONCLUSIONS We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalis transmission.
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Affiliation(s)
- Aaron F Bochner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,School of Medicine, University of Washington, Seattle, Washington, USA
| | - Alison S Rustagi
- Department of Medicine, University of California, San Francisco, California, USA
| | | | - Jairam R Lingappa
- Department of Global Health, University of Washington, Seattle, Washington, USA.,School of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Saidi Kapiga
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ruanne V Barnabas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,School of Medicine, University of Washington, Seattle, Washington, USA
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11
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Park K. Medical perspectives on the clinical value of male circumcision. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.10.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kwanjin Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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12
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Kakaire O, Byamugisha JK, Tumwesigye NM, Gamzell-Danielsson K. Prevalence and factors associated with sexually transmitted infections among HIV positive women opting for intrauterine contraception. PLoS One 2015; 10:e0122400. [PMID: 25859659 PMCID: PMC4393084 DOI: 10.1371/journal.pone.0122400] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Women living with HIV/AIDS (WLHA) are a high risk group for sexually transmitted infections (STIs). However, the majority of women with STIs are asymptomatic. Data on prevalence of STIs among WLHA in Uganda are limited. The objective of the study was to determine prevalence and factors associated with STIs among WLHA opting for intrauterine contraceptive device (IUD). Methods Three hundred fifty one WLHA deemed free of STIs using a syndromic logarithm were enrolled into the study. Endo-cervical swabs were taken before IUD insertion and PCR test for Nisseria gonorrhea (NG), Trichomonas vaginalis (TV) and Chlamydia trachomatis (CT) infections conducted. Results Participants’ mean age was 29.4 ± 6.2 years, 83% were under 35years, 50% had secondary education and 73% were married. The majority (69%) had disclosed their HIV sero status to their spouses, 82% used Cotrimoxazole prophylaxis, 70% were on antiretroviral therapy, 90% had CD4 count greater than 350, about 60% reported condoms use and 70% were of parity 2-4. Over 50% of the participants’ spouses were older than 35 years and 72% had attained secondary education. STIs prevalence was 11.1%, (95% CI 7.8-14.4) and individual prevalence for TV, NG, and CT was 5.9%, 5.4% and 0.9% respectively. Factors independently associated with STI were having primary or less education (OR= 2.3, 95% CI: 1.09 - 4.85) having a spouse of primary or less education (OR= 3.3, 95% CI: 1.6 - 6.78) and muslim faith (OR= 0.2, 95% CI: 0.04 - 0.78). Conclusion STI prevalence was 11.1%. TV and NG were the commonest STIs in this population. Having primary or less education for both participant and spouse was associated with increased risk while being of muslim faith was associated with reduced risk of STI.
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Affiliation(s)
- Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala, Uganda
- * E-mail:
| | - Josaphat Kayogoza Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- School of Public Health, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala Uganda
| | - Kristina Gamzell-Danielsson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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13
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Pintye J, Baeten JM, Manhart LE, Celum C, Ronald A, Mugo N, Mujugira A, Cohen C, Were E, Bukusi E, Kiarie J, Heffron R. Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples. LANCET GLOBAL HEALTH 2014; 2:e664-71. [PMID: 25442691 DOI: 10.1016/s2214-109x(14)70315-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Male circumcision is a primary HIV-1 prevention intervention for men, but whether the procedure reduces the risk of syphilis among men and their female partners is uncertain. We aimed to assess whether male circumcision was associated with incident syphilis in men and in their female partners. METHODS In this large prospective cohort study, participants were members of Kenyan and Ugandan HIV-1 serodiscordant heterosexual couples enrolled in a randomised safety and efficacy clinical trial of pre-exposure prophylaxis for HIV-1 prevention (the Partners PrEP Study). Participants attended monthly or quarterly follow-up visits for up to 36 months. Annually, syphilis serology testing was done and male circumcision status was assessed. We used multivariate Andersen-Gill survival methods, adjusted for age, sexual behaviour, and plasma HIV RNA levels of the HIV-infected partner. FINDINGS 4716 HIV-1 serodiscordant couples (38%) with a man with HIV were followed for a median of 2·75 years. At enrolment, 1575 (53%) men with HIV and 560 (32%) men without HIV were circumcised; an additional 69 (4%) men with HIV and 132 (5%) men without HIV were circumcised during study follow-up. 221 incident syphilis infections were reported: 46 (21%) in men with HIV (incidence 1·10 per 100 person-years), 76 (34%) in men without HIV (1·09), 54 (24%) in women with HIV (0·77), and 45 (24%) in women without HIV (1·11). Male circumcision was associated with a 42% reduction in incident syphilis in men (adjusted hazard ratio [aHR] 0·58, 95% CI 0·37-0·91) including a 62% reduction in men with HIV (0·38, 0·18-0·81), and a non-significant reduction in incident syphilis in men without HIV (0·64, 0·36-1·11). In women, circumcision of their male partners was associated with a 59% reduction in incident syphilis (aHR 0·41, 95% CI 0·25-0·69), including a 75% reduction in women without HIV (0·25, 0·08-0·76) and a 48% reduction in women with HIV (0·52, 0·27-0·97). INTERPRETATION Male circumcision was associated with decreased risk of incident syphilis in men and women. If confirmed, these results suggest that medical male circumcision could substantially reduce incidence of syphilis and its sequelae. FUNDING Bill & Melinda Gates Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Nursing, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lisa E Manhart
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Allan Ronald
- Departments of Medicine and Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA; Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Craig Cohen
- Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Obstetrics, Gynecology and Reproductive Sciences University of California-San Francisco, San Francisco, CA, USA
| | - Edwin Were
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Obstetrics, Gynecology and Reproductive Sciences University of California-San Francisco, San Francisco, CA, USA
| | - James Kiarie
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA.
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14
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Abstract
The American Academy of Pediatrics recently issued a statement that the health benefits of newborn male circumcision exceed the risks and therefore justify access to the procedure for families who choose it. Further, clinicians are charged with providing factually correct information that communicates the risks and benefits of elective newborn male circumcision in a nonbiased manner. However, many clinicians lack adequate information to discuss the risks and benefits of male circumcision. The purpose of this review is to highlight evidence on the risks and benefits of newborn male circumcision and provide clinicians with counseling points that can be used to guide discussion with parents considering newborn male circumcision.
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15
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Abstract
Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP's 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association's template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners' competency in discussing circumcision's benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it. Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child. Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure. Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families. Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not. Elective circumcision should be performed only if the infant's condition is stable and healthy. Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management. Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision. If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns. Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing; Teach the procedure and analgesic techniques during postgraduate training programs; Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents; Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises. The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.
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16
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Heiman JR, Long JS, Smith SN, Fisher WA, Sand MS, Rosen RC. Sexual satisfaction and relationship happiness in midlife and older couples in five countries. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:741-53. [PMID: 21267644 DOI: 10.1007/s10508-010-9703-3] [Citation(s) in RCA: 214] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 10/19/2010] [Accepted: 10/19/2010] [Indexed: 05/23/2023]
Abstract
Sexuality research focuses almost exclusively on individuals rather than couples, though ongoing relationships are very important for most people and cultures. The present study was the first to examine sexual and relationship parameters of middle-aged and older couples in committed relationships of 1-51 years duration. Survey research was conducted in Brazil, Germany, Japan, Spain, and the U.S. targeting 200 men aged 40-70 and their female partners in each country, with 1,009 couples in the final sample. Key demographic, health, physical intimacy, sexual behavior, sexual function, and sexual history variables were used to model relationship happiness and sexual satisfaction. The median ages were 55 for men and 52 for women; median relationship duration was 25 years. Relationship satisfaction in men depended on health, physical intimacy, and sexual functioning, while in women only sexual functioning predicted relationship satisfaction. Models predicting sexual satisfaction included significant physical intimacy and sexual functioning for both genders and, for men, more frequent recent sexual activity and fewer lifetime partners. Longer relationship duration predicted greater relationship happiness and sexual satisfaction for men. However, women in relationships of 20 to 40 years were significantly less likely than men to report relationship happiness. Compared to men, women showed lower sexual satisfaction early in the relationship and greater sexual satisfaction later. Within the long-term committed relationship context, there were significant gender differences in correlates of sexual and relationship satisfaction, with sexual functioning a common predictor of both types of satisfaction and physical intimacy a more consistent and salient predictor for men.
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Affiliation(s)
- Julia R Heiman
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN 47405, USA.
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17
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Macneily AE, Afshar K. Circumcision and non-HIV sexually transmitted infections. Can Urol Assoc J 2011; 5:58-9. [PMID: 21470518 DOI: 10.5489/cuaj.11009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew E Macneily
- Department of Urologic Sciences, University of British Columbia, Vancouver BC
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18
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Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, Hankins CA. The Strong Protective Effect of Circumcision against Cancer of the Penis. Adv Urol 2011; 2011:812368. [PMID: 21687572 PMCID: PMC3113366 DOI: 10.1155/2011/812368] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/09/2011] [Indexed: 01/30/2023] Open
Abstract
Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening impeding the passage of urine) is confined to uncircumcised men, in whom balanitis (affecting 10%) is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer. Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners. Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV. Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ronald H. Gray
- Population and Family Planning, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Xavier Castellsague
- Institut Català d'Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L'Hospitalet de Llobregat, Catalonia, Spain
| | - F. Xavier Bosch
- Institut Català d'Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L'Hospitalet de Llobregat, Catalonia, Spain
| | - Daniel T. Halperin
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA
| | - Jake H. Waskett
- Circumcision Independent Reference and Commentary Service, Radcliffe, Manchester M261JR, UK
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19
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Veldhuijzen NJ, Snijders PJ, Reiss P, Meijer CJ, van de Wijgert JH. Factors affecting transmission of mucosal human papillomavirus. THE LANCET. INFECTIOUS DISEASES 2010; 10:862-74. [PMID: 21075056 DOI: 10.1016/s1473-3099(10)70190-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection. The effect of HPV on public health is especially related to the burden of anogenital cancers, most notably cervical cancer. Determinants of exposure to HPV are similar to those for most sexually transmitted infections, but determinants of susceptibility and infectivity are much less well established. Gaps exist in understanding of interactions between HPV, HIV, and other sexually transmitted infections. The roles of mucosal immunology, human microbiota at mucosal surfaces, host genetic factors and hormonal concentrations on HPV susceptibility and infectivity are poorly understood, as are the level of effectiveness of some primary or secondary preventive measures other than HPV vaccination (such as condoms, male circumcision, and combination antiretroviral therapy for HIV). Prospective couples studies, studies focusing on mucosal immunology, and in-vitro raft culture studies mimicking HPV infection might increase understanding of the dynamics of HPV transmission.
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Affiliation(s)
- Nienke J Veldhuijzen
- Academic Medical Center of the University of Amsterdam, Department of Internal Medicine, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.
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20
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Lemmermen KA, Van Wingen TF, Spencer CM, Scott PJ, Sienko KH. Adult Male Circumcision Tool for Use in Traditional Ceremonies. J Med Device 2010. [DOI: 10.1115/1.4002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Public health officials are currently supporting adult male circumcision to minimize the transmission of HIV during intercourse. Estimates indicate that more than 3 million lives could be saved in sub-Saharan Africa alone if the procedure were widely adopted. Complications including infection and accidental cutting/amputation of the glans during traditional circumcision ceremonies can lead to permanent injury or death. A low cost, adjustable (one-size-fits-most), culturally appropriate adult male circumcision tool was designed for use in traditional circumcision ceremonies to increase the likelihood of safe outcomes.
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Affiliation(s)
- Kyle A. Lemmermen
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Tom F. Van Wingen
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Craig M. Spencer
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Phil J. Scott
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
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21
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Abstract
Circumcision is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal among Muslim and Jewish men. Most medical institutions in various countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children. It should be performed only for established medical reasons and should not be universally recommended. There are modern techniques that provide safer, simpler, quicker, and cheaper alternatives to the traditional means of circumcision with good functional and cosmetic results. Female genital mutilation (FGM) includes procedure that alters or injures female genital organs for nonmedical reasons. Various degrees of FGM are prevalent, the most mutilating one being infibulation. There are numerous gynecologic and obstetrical complications with infibulation. FGM also plays a significant role in facilitating the transmission of HIV infection through numerous mechanisms. Health care providers have an important role to play in the eradication of this practice. Increased professional and public awareness about such a practice is required.
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Affiliation(s)
- Poonam Puri
- Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India
| | - Joginder Kumar
- Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India
| | - V. Ramesh
- Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India
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22
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de Bruyn G, Martinson NA, Gray GE. Male circumcision for HIV prevention: developments from sub-Saharan Africa. Expert Rev Anti Infect Ther 2010; 8:23-31. [PMID: 20014899 DOI: 10.1586/eri.09.120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The demonstration of a strong effect of male circumcision on reducing HIV acquisition has provided impetus for this intervention to be adopted more widely in areas of the world where HIV prevalence is high and rates of male circumcision are low. This perspective reviews recent research findings and provides a summary of progress in various countries.
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Affiliation(s)
- Guy de Bruyn
- Perinatal HIV Research Unit, New Nurses Home, Chris Hani Baragwanath Hospital, Chris Hani Road, Johannesburg, South Africa.
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23
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Puri P, Kumar J, Ramesh V. Circumcision. Indian J Sex Transm Dis AIDS 2010. [PMID: 21716785 PMCID: PMC3122584 DOI: 10.4103/2589-0557.74967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Circumcision is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal among Muslim and Jewish men. Most medical institutions in various countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children. It should be performed only for established medical reasons and should not be universally recommended. There are modern techniques that provide safer, simpler, quicker, and cheaper alternatives to the traditional means of circumcision with good functional and cosmetic results. Female genital mutilation (FGM) includes procedure that alters or injures female genital organs for nonmedical reasons. Various degrees of FGM are prevalent, the most mutilating one being infibulation. There are numerous gynecologic and obstetrical complications with infibulation. FGM also plays a significant role in facilitating the transmission of HIV infection through numerous mechanisms. Health care providers have an important role to play in the eradication of this practice. Increased professional and public awareness about such a practice is required.
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Affiliation(s)
- Poonam Puri
- Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India,Address for correspondence: Dr. Poonam Puri, Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India. E-mail:
| | - Joginder Kumar
- Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India
| | - V. Ramesh
- Department of Dermatology, Venereology and Leprosy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India
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Mehta SD, Moses S, Agot K, Parker C, Ndinya-Achola JO, Maclean I, Bailey RC. Adult male circumcision does not reduce the risk of incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis infection: results from a randomized, controlled trial in Kenya. J Infect Dis 2009; 200:370-8. [PMID: 19545209 DOI: 10.1086/600074] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs). METHODS We evaluated the incidence of STI among men aged 18-24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection. RESULTS There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49-8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective. CONCLUSIONS Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.
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Affiliation(s)
- Supriya D Mehta
- Department of Epidemiology, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA.
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25
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Sobngwi-Tambekou J, Taljaard D, Nieuwoudt M, Lissouba P, Puren A, Auvert B. Male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis: observations after a randomised controlled trial for HIV prevention. Sex Transm Infect 2009; 85:116-20. [PMID: 19074928 PMCID: PMC2652030 DOI: 10.1136/sti.2008.032334] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2008] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial. METHODS We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18-24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression. RESULTS In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030). CONCLUSIONS This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.
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