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Circumcision and Risk for STIs: No Evidence of Major Protective Effect
Early childhood circumcision did not lower risk for STIs.
Circumcision protects against acquisition of HIV infection (Journal Watch Mar 13 2007), but only some studies have shown that it protects against other sexually transmitted infections. In a New Zealand birth cohort of 499 sexually experienced men, investigators prospectively assessed self-reported rates of STIs at ages 21, 26, and 32; 201 men had been circumcised by age 3.
At age 32, the percentage of men who reported ever having STIs was virtually identical among circumcised and uncircumcised men (23.4% and 23.5%). STI incidence rates for all STIs, bacterial STIs, and viral STIs were similar among circumcised and uncircumcised men at all three ages. Adjustment for socioeconomic or sexual behavior characteristics and other confounding factors did not significantly alter the results.
Comment: In contrast with the results of this study, a previous study conducted in another New Zealand cohort showed that circumcision lowered risk for STIs (Journal Watch Pediatrics and Adolescent Medicine Dec 6 2006). Although that study’s sample size was similar to the current study’s, the proportion of circumcised men was lower, and only 7% of the men overall reported STIs (vs. 23% in the current study). These differences might account for the discrepant findings. Because a randomized study is not possible, defining the true difference in STI risk between circumcised and uncircumcised men might not be possible. Circumcision lowers risk for urinary tract infections, penile cancer (quite rare), phimosis, and HIV infection. Although circumcision often is a religious or cultural decision, clinicians should be aware of this information when advising families about risks and benefits.
Published in Journal Watch General Medicine March 18, 2008
Citation(s):
Dickson NP et al. Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr 2008 Mar; 152:383.
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