Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection.
Open accessAbstract
OBJECTIVE: We assessed the protective effect of medical male circumcision (MMC) against HIV, herpes simplex virus type 2 (HSV-2), and genital ulcer disease (GUD) incidence. DESIGN: Two thousand, seven hundred and eighty-seven men aged 18-24 years living in Kisumu, Kenya were randomly assigned to circumcision (n=1391) or delayed circumcision (n=1393) and assessed by HIV and HSV-2 testing and medical examinations during follow-ups at 1, 3, 6, 12, 18, and 24 months. METHODS: Cox regression estimated the risk ratio of each outcome (incident HIV, GUD, HSV-2) for circumcision status and multivariable models estimated HIV risk associated with HSV-2, GUD, and circumcision status as time-varying covariates. RESULTS: HIV incidence was 1.42 per 100 person-years. Circumcision was 62% protective against HIV [risk ratio=0.38; 95% confidence interval (CI) 0.22-0.67] and did not change when controlling for HSV-2 and GUD (risk ratio=0.39; 95% CI 0.23-0.69). GUD incidence was halved among circumcised men (risk ratio=0.52; 95% CI 0.37-0.73). HSV-2 incidence did not differ by circumcision status (risk ratio=0.94; 95% CI 0.70-1.25). In the multivariable model, HIV seroconversions were tripled (risk ratio=3.44; 95% CI 1.52-7.80) among men with incident HSV-2 and seven times greater (risk ratio=6.98; 95% CI 3.50-13.9) for men with GUD. CONCLUSION: Contrary to findings from the South African and Ugandan trials, the protective effect of MMC against HIV was independent of GUD and HSV-2, and MMC had no effect on HSV-2 incidence. Determining the causes of GUD is necessary to reduce associated HIV risk and to understand how circumcision confers protection against GUD and HIV.
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The effect of male circumcision on HIV prevention is not mediated solely through a reduction in HSV-2 infection or genital ulcer disease.
“Follow-up studies have demonstrated sustained benefit of circumcision for HIV prevention (69) and that the effect is not mediated solely through a reduction in HSV-2 infection or genital ulcer disease (GUD) (70).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [70]
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- Authors
- Mehta, S. D., Moses, S., Parker, C. B., Agot, K., Maclean, I., & Bailey, R. C.
- Affiliations
- University of Illinois Chicago (US)
- University of Manitoba (CA)
- RTI International (US)
- Corresponding author
- Mehta, Supriya D.
- Venue
- AIDS
- Published
- 2012-06-01
- Volume
- 26
- Issue
- 9
- Pages
- 1141-1149
- ISSN
- 0269-9370 (ISSN-L)
- PMC
- PMC3668787
- OpenAlex
- W2029479564
- Cited by
- 69
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 6 · 2021: 8 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 7 · 2016: 4 · 2015: 7 · 2014: 10 · 2013: 8 · 2012: 3
- FWCI
- 9.14
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- AIDS (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Canadian Institutes of Health Research (HCT 44180)
- National Institute of Allergy and Infectious Diseases (U01AI050440, AI50440, P30AI082151)
- Topics
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- medical male circumcision, HIV incidence, herpes simplex virus type 2, genital ulcer disease, HIV prevention, young men, HIV risk factors
- MeSH terms
- Adolescent, Circumcision, Male, Herpes Genitalis, Humans, Kenya, Male, Risk Factors, Ulcer, HIV Infections, Incidence, Herpesvirus 2, Human, Young Adult
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