Circumcision Shown to Reduce Risk of Herpes and HPV

Parents welcoming their newborn son into the world have an important decision to make before they can take their little guy home: whether or not to circumcise him. Parents who choose to have the procedure done often do so because of religious beliefs, hygienic concerns, or cultural or social reasons, such as the wish to have their son look like other men in the family, but there are also potential health benefits. In children, circumcision can reduce the chance of urinary tract infections and phimosis, a problem with the foreskin. For teens and adults, the operation has been shown to significantly reduce the risk of HIV transmission. Now related research shows it may also limit the spread of two other incurable sexually transmitted diseases—genital herpes and human papillomavirus (HPV).

A team, which included researchers from Johns Hopkins University in the U.S. and Makerere University in Uganda, conducted two parallel clinical trials involving more than 5,000 uncircumcised Ugandan males ages 15 to 49 that initially tested negative for both HIV and herpes simplex virus type 2, which causes genital herpes. A portion of the men underwent circumcision before the study began while members of the control group were circumcised after a delay of 24 months.

During the two-year follow-up, the circumcised participants were 28 percent less likely to contract herpes and 35 percent less likely to catch HPV, compared to their uncircumcised counterparts. But circumcision had no effect on the incidence of syphilis. “Medically supervised adult male circumcision is a scientifically proven method for reducing a man’s risk of acquiring HIV infection through heterosexual intercourse,” said Anthony Fauci of the National Institutes of Health in the United States, which funded the study. “This new research provides compelling evidence that circumcision can provide some protection against genital herpes and human papillomavirus infections as well.”

HPV is the most common sexually transmitted infection in the world. It causes genital warts as well as anal, penile and cervical (women) cancers. Genital herpes has been associated with an increased risk of HIV. The researchers are unsure why circumcision may lower a man’s chance of developing these diseases, but one reason may be because the foreskin of the penis has more receptors for the viruses. When that skin is removed during circumcision, the body is less susceptible to the diseases.

Currently in the United States, approximately 55 to 65 percent of all newborn boys are circumcised each year, down from more than 90 percent in the 1970s. In Asia, South America, Central America, and most of Europe, the procedure is uncommon. The study authors say that efforts to increase male circumcision in areas with high rates of sexually transmitted infections, especially Africa where HIV and HPV are widespread, could have a tremendous benefit. Since 2007, the World Health Organization and the United Nations’ program on HIV/AIDS have promoted circumcision for reducing the risk of AIDS in areas where heterosexual transmission is high.

In an editorial that accompanied the study, Dr. Matthew Golden of the University of Washington called for circumcision to be made widely available in North America. “For most parents, the default should be circumcision,” he said. “Obviously, these are complex decisions, and parents have to do what they think is right for their children, but there are significant health benefits.”

However, despite the growing evidence of its benefits, some opponents say the removal of the foreskin is an unnecessary surgical procedure that may reduce sexual sensitivity in adulthood. Neither the American Academy of Pediatrics (AAP) nor the American Academy of Family Physicians (AAFP) endorse the procedure as a way to prevent the medical conditions mentioned previously and the AAP said previously that there was insufficient evidence to warrant recommending routine circumcision of infants. The group is now reviewing its position in light of recent studies.

“We hope these data will ultimately result in policy changes in recommending circumcision for young boys or adult men to decrease the rates of infection with HIV, HPV and herpes,” said lead author Dr. Thomas Quinn, a senior investigator in infectious diseases at the National Institute for Allergy and Infectious Diseases (NIAID) and a professor of medicine at Johns Hopkins School of Medicine in Baltimore. “The cumulative scientific evidence supporting the public health value of medically supervised male circumcision is now overwhelming.”

They also note, however, that male circumcision is not completely effective in preventing sexually transmitted infections. Safe sex practices, including consistent condom use, are still necessary to provide the best protection, circumcised or not.

The new study findings appear in the March 26 issue of the New England Journal of Medicine.