The medical advice given to parents about circumcision should be reassessed, argue U.S. experts, after a new study found the procedure significantly reduces the transmission of herpes and HPV.
Adult male circumcision has already been shown to sharply reduce the risk of HIV infection in African men -- by as much as 60 per cent, some studies suggest. Now, new data from Ugandan scientists and investigators at Johns Hopkins University suggest circumcision can also decrease the transmission of herpes and the human papillomavirus.
The study, featured this week in the New England Journal of Medicine, found that males who were circumcised as adults reduced their risk of infection with HPV by 35 per cent and their risk of herpes by 28 per cent. Circumcision had no effect on the transmission of syphilis.
In an accompanying editorial, "Prevention of Viral Sexually Transmitted Infections - Foreskin at the Forefront," two University of Washington researchers say the new findings provide compelling evidence that circumcision could decrease rates of incurable sexually transmitted infections (STIs).
"These new data should prompt a major reassessment of the role of male circumcision, not only in HIV prevention, but also in the prevention of other sexually transmitted infections," write authors Drs. Matthew R. Golden and Judith N. Wasserheit.
What's more, they add, all parents or guardians of newborn sons should be educated about the benefits and risks of circumcision, given these new findings.
"Male circumcision will remain a personal decision for patients and parents, and some unanswered questions persist. However, evidence now strongly suggests that circumcision offers an important prevention opportunity and should be widely available," they write.
Circumcision is a surgical procedure to remove the layer of skin called the foreskin or the prepuce that covers the head of the penis. It is most often done during the first few days after birth. This study focused only on circumcision performed on adults.
The Canadian Paediatric Society does not recommend routine circumcision for newborn boys. It says that after reviewing the scientific evidence for and against circumcision, it considers it a "non-therapeutic" procedure, which means not medically necessary.
The CPS tells Â鶹´«Ã½ that their Fetus and Newborn Committee has been reviewing recent studies about circumcision and their position on the procedure since early last year.
The latest research involved 3,393 HIV-negative heterosexual adolescent boys and men from Uganda who were part of an earlier HIV study. About half were randomly selected to undergo circumcision right away while the rest had the procedure two years later. All were offered voluntary HIV counseling and condoms.
After two years, the researchers found that the cumulative probability of herpes infection was significantly lower among those volunteers who received immediate circumcision (7.8 per cent) than among those who were circumcised at 24 months (10.3 per cent).
"The cumulative scientific evidence supporting the public health value of medically supervised male circumcision is now overwhelming," wrote study co-author Dr. Thomas C. Quinn.
"This new research confirms the substantial health benefits of male circumcision, including reduced acquisition of HIV, genital herpes, HPV and genital ulcer disease."
Why adult male circumcision may cut the risk of STIs is not known. But research has suggested that the foreskin allows the penis to remain damp. That might allow viruses to "stick" more easily to the penis, or create tiny ulcers on the surface of the penis through which a virus might enter.
Dr. Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, U.K., doesn't believe that circumcision is the answer to controlling sexually transmitted infections.
"It suggests that it is women who infect innocent men - let's protect the innocent men," he told BBC News.
"And it allows men who don't want to change their irresponsible behaviour to continue to sleep around and not even use a condom."
Researchers now plan to study whether adult male circumcision reduces the spread of HPV to female sex partners.
