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Cited by 512Genital Health and DiseaseHerpesvirus Infections and TreatmentsCervical Cancer and HPV Research

Male circumcision for the prevention of HSV-2 and HPV infections and syphilis.

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Tobian, Aaron A.R., Serwadda, David, Quinn, Thomas C., Kigozi, Godfrey, Gravitt, Patti E., Laeyendecker, Oliver, Charvat, Blake, Ssempijja, Victor +8 more·2009·New England Journal of Medicine
DOI 10.1056/nejmoa0802556PMC PMC2676895
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Abstract

BACKGROUND: Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men. METHODS: We enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2-seronegative at enrollment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, we tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months. RESULTS: At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P=0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P=0.44). CONCLUSIONS: In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure. (ClinicalTrials.gov numbers, NCT00425984 and NCT00124878.)

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  • MMC can be associated with decreased risk for HSV-2 acquisition among adult heterosexual men and with decreased risk for HSV-2 transmission from male to female partners.

    “These data indicate that MMC can be associated with decreased risk for HSV-2 acquisition among adult heterosexual men and with decreased risk for HSV-2 transmission from male to female partners.”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [66]

    The Abstract and ‘Male Circumcision and HSV-2 Acquisition’ section report lower HSV-2 acquisition among circumcised male participants. The Discussion describes reduced HSV-2 infection in men, but identifies trichomoniasis and bacterial vaginosis—not HSV-2—as infections reduced in female partners. Our copy does not establish decreased male-to-female HSV-2 transmission. (LLM, conf=0.88)

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  • In those trials, circumcision also was protective against other STIs, including high-risk genital HPV infection and genital herpes.

    “In those trials, circumcision also was protective against other STIs, including high-risk genital HPV infection and genital herpes (66–68).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [66]

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Research works printed but not linked: 4

  1. [1]1. Whitley RJ, Roizman B. Herpes sim- plex virus infections. Lancet 2001;357: 1513-8.
  2. [17]17. Cook LS, Koutsky LA, Holmes KK. Cir- cumcision and sexually transmitted dis- eases. Am J Public Health 1994;84:197-201.
  3. [24]24. Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV+ men, Rakai, Uganda: effects in HIV+ men and in women partners. In: Proceedings of the 15th Conference on Retroviruses and Op- portunistic Infections, Boston, February 3-6, 2008. abstract.
  4. [29]29. Cogliano V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F. Carcinogenic- ity of human papillomaviruses. Lancet On- col 2005;6:204.

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Authors
Tobian, A. A. R., Serwadda, D., Quinn, T. C., Kigozi, G., Gravitt, P. E., Laeyendecker, O., Charvat, B., Ssempijja, V., Riedesel, M., Oliver, A. E., Nowak, R. G., Moulton, L. H., Chen, M. Z., Reynolds, S. J., Wawer, M. J., & Gray, R. H.
Affiliations
  • Johns Hopkins University (US)
  • Makerere University (UG)
  • National Institutes of Health (US)
  • Rakai Health Sciences Program (UG)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2009-03-26
Volume
360
Issue
13
Pages
1298-1309
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa0802556
PMC
PMC2676895
OpenAlex
W2170949839
Cited by
512
References
41
Citations by year
2026: 6 · 2025: 9 · 2024: 12 · 2023: 11 · 2022: 20 · 2021: 21 · 2020: 22 · 2019: 21 · 2018: 6 · 2017: 29 · 2016: 25 · 2015: 30 · 2014: 34 · 2013: 45 · 2012: 55
FWCI
74.16
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • Bill and Melinda Gates Foundation (22006.02, 22006)
  • National Institutes of Health (Z99 AI999999)
  • National Institute of Allergy and Infectious Diseases (U01AI51171, U01AI051171, Z01AI000361)
  • Fogarty International Center (#D43TW00015, D43TW001508, T22TW000015)
Topics
  • Health Sciences › Medicine › Surgery › Genital Health and Disease
  • Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Keywords
male circumcision, herpes simplex virus type 2, human papillomavirus, syphilis, sexually transmitted infections, HPV prevalence, HIV prevention, HIV-negative men, adolescent boys, high-risk HPV genotypes, HIV prevention trials
MeSH terms
Adolescent, Adult, Circumcision, Male, Genotype, Herpes Genitalis, Humans, Male, Sexual Behavior, Syphilis, Treponema pallidum, Confounding Factors, Epidemiologic, Incidence, Prevalence, Condoms, Herpesvirus 2, Human, Papillomaviridae, Papillomavirus Infections, Kaplan-Meier Estimate, Young Adult

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