More compelling evidence on why circumcision should be routine

March 25, 2009

New data from Ugandan scientists and investigators at Johns Hopkins University find that adult male circumcision decreased rates of the two most common sexually transmitted infections - herpes and the human papillomavirus (HPV), the virus that causes cervical cancer and genital warts - according to a report issued in the New England Journal of Medicine March 26, 2009.

In an accompanying editorial, "Prevention of Viral Sexually Transmitted Infections - Foreskin at the Forefront," two local University of Washington researchers say these new findings provide compelling new evidence on circumcision's effect on decreasing currently incurable viral sexually transmitted infections.

"These new data should prompt a major reassessment of the role of male circumcision not only in HIV prevention but also in the prevention of other sexually transmitted infections," write authors Drs. Matthew R. Golden and Judith N. Wasserheit.

"We already knew that circumcision can decrease men's HIV risk by 60%," said Golden, who is also director of the STD Control Program for Public Health - Seattle & King County. "Now we know that male circumcision reduces men's risk of herpes by 25% and of human papillomavirus by a third."

The data could be a major game changer for how health providers counsel patients and parents on circumcision.

Circumcision rates have been declining in the United States and are lowest among black and Hispanic patients -- groups with the highest rates of HIV, herpes and cervical cancer.

"These new, compelling data mean that,all providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured," said Wasserheit, who is also the vice chair of the UW Department of Global Health.

Herpes and HPV infection are extremely common, can have severe consequences and are not curable.

In the United States alone, almost one in five Americans is infected with herpes simplex virus type 2 (HSV-2).Furthermore, roughly three quarters of sexually active Americans will have at least one human papillomavirus (HPV) infection and approximately 4,500 women die every year from cervical cancer.

In many low and middle income countries, these infections are even more common and more serious. Cervical cancer is the second most common cause of cancer deaths in women worldwide.

Golden and Wasserheit say these findings should prompt professional organizations to play a leadership role in sharing with their members and the public this new information about the benefits of circumcision in preventing all three of the major viral STIs -- not only HIV, but also herpes and HPV infection.

University of Washington Health Sciences/UW Medicine

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