Reuters (10.10.03) - Friday, October 10, 2003
Circumcised male patients had an eight-fold reduction in HIV-1
risk compared to uncircumcised patients in a study of 2,302
men at three STD clinics in Pune, India, released on Thursday.
The incidence of diseases such as syphilis, gonorrhea and
genital herpes was slightly higher among uncircumcised men,
but the difference was not statistically significant.
The research, presented in San Diego at the 41st Annual
Meeting of the Infectious Diseases Society of America, was
part of a larger study investigating HIV infection risk at the
clinics from 1993 to 2000. Demographics, sexual risk behaviors
- including having sex with a prostitute - and condom use were
similar between both circumcised and uncircumcised patients,
said Dr. Steven Reynolds, one of the study's investigators.
Male circumcision - the removal of the foreskin that covers
the tip of the penis - is typically done shortly after birth.
Some two- thirds of US male infants are circumcised annually.
Worldwide, the rates vary greatly, depending on culture and
religion. In many countries, including India, circumcision is
rare. The American Academy of Pediatrics no longer recommends
routine circumcision because - despite some medical benefit -
there can be complications.
Reynolds suggested that the inner surface of the foreskin does
not have the same protective layer as the outside, and is
potentially more vulnerable to HIV. "It is important that we
offer measures to help curb the spread of AIDS, particularly
in developing countries, where it continues to grow at an
alarming rate," said Reynolds, a post-doctoral fellow at Johns
Hopkins University School of Medicine.
Methods that uncircumcised men may be able to use to protect
themselves against HIV include using condoms and, in the
future, a potential topical microbicide that might be applied
to the foreskin before sex, Reynolds said. "Circumcision as a
potential prevention strategy requires confirmation by
randomized clinical trials," Reynolds said. There are such
trials now underway in Kenya, Uganda and South Africa. The
presentation, LB-10, is titled "Male Circumcision Is
Protective Against HIV-1 But Not Other Common Sexually
Transmitted Infections in India."