Human papillomavirus and circumcision: A meta-analysis
Introduction
A decreased risk for sexually transmitted infections in circumcised adult males has long been used as a justification for neonatal circumcision.1, 2, 3 Other than general review articles and opinion pieces, the association between circumcision status and sexually transmitted infections has not been subjected to systematic review or analysis until recently.4, 5 In 1999, the American Academy of Pediatrics Task Force on Circumcision concluded, “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.” In addressing sexually transmitted infections other than HIV, they merely stated, “Evidence regarding the relationship of circumcision to STD in general is complex and conflicting.”6
Human papillomavirus (HPV) is believed to be responsible for cervical cancer in women and penile cancer in men. In an effort to clarify the impact of circumcision status on sexually transmitted HPV infections and indirectly on the female partner's risk of cervical cancer, the medical literature addressing the impact of circumcision status on sexually transmitted HPV infections was reviewed and analyzed.
Section snippets
Methods
The recommendations of Stroup et al. for the meta-analysis of observational studies were followed.7 Inclusion criteria included publication of a cohort, cross-sectional, and case-control study in a peer-reviewed journal, the presence of data on the circumcision status of males both with and without genital HPV infections, diagnosis by culture, biopsy, or HPV DNA detection using PCR or Hybrid capture 2, determination of circumcision status by physical examination, and multiple site sampling
Results
Characteristics of the studies with data on the circumcision status of males both with and without genital HPV infections are shown in Table 1. Table 2 shows the raw data from the sixteen studies comparing HPV infections by circumcision status. Table 3 shows the results of the meta-analyses. The random-effects summary effect odds ratio of the three studies meeting the inclusion criteria was 1.20 (95%CI = 0.80–1.79). There was no evidence of significant between-study heterogeneity.
In our attempt
Discussion
This is the first systematic review of the medical literature looking at the risk of genital HPV infections based on circumcision status. Using strict criteria to include multiple genital sites for sampling, including detection of HPV on the penile shaft the analysis failed to show a significant association between genital HPV infection and circumcision status.
The limitations of the meta-analysis when applied to observational studies, the role of between-study heterogeneity, the role of
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Cited by (48)
Evaluation of the optimal sampling approach for HPV genotyping in circumcised heterosexual men with genital warts
2023, Journal of Infection and ChemotherapyActual controversies about circumcision
2014, Presse MedicaleRisk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer
2013, Journal of InfectionCitation Excerpt :Due to the cross-sectional design of this study, it is possible that the association observed was due to women using condoms as a protective measure after contracting genital warts. There is an ongoing debate on the role of male circumcision in reducing the risk for HPV infection, mainly due to how studies ascertain circumcision status (physical examination vs. self-report), the HPV-related outcomes selected, and the procedures used for sample collection and HPV detection.94–96 Castellsagué et al.97 suggest that compared to uncircumcised males, circumcised males are less likely to harbor HPV, which results in a reduced risk for both HPV DNA genital prevalence in males and cervical cancer in their female partners.
Not a surgical vaccine: There is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia
2011, Australian and New Zealand Journal of Public HealthFactors affecting transmission of mucosal human papillomavirus
2010, The Lancet Infectious DiseasesCitation Excerpt :A protective effect of male circumcision on male HPV prevalence was reported in two randomised controlled trials.105,128 These findings added valuable knowledge to the inconclusive results from observational studies.105,128,129 Both trials were designed to study the association between male circumcision and HIV acquisition in men and showed a reduced risk of HIV acquisition in circumcised men.59,105,132