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MALE CIRCUMCISION AND HPV IN MEN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Monday, 3rd of October 2011

• MALE CIRCUMCISION AND HUMAN PAPILLOMAVIRUS INFECTION IN MEN: A SYSTEMATIC REVIEW AND META-ANALYSIS 

‘Several countries are expanding access to voluntary medical male circumcision to reduce HIV prevalence. This could provide additional benefit in reducing HPV prevalence.’

 Journal of Infectious Diseasesjid.oxfordjournals.org

J Infect Dis. (2011) 204 (9): 1375-1390. doi: 10.1093/infdis/jir523

Abstract below; full text to journal subscribers available online at http://jid.oxfordjournals.org/content/204/9/1375.abstract?etoc

 

1. 1.   Natasha Larke1,2,
2. 2.   Sara L. Thomas2,
3. 3.   Isabel dos Santos Silva3 and
4. 4.   Helen A. Weiss1,2

+ Author Affiliations

1. 1.    ¹Medical Research Council Tropical Epidemiology Group
2. 2.    ²Department of Infectious Disease Epidemiology
3. 3.    ³Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
4. Correspondence: Natasha Larke, DPhil, MRC Tropical Epidemiology Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom (natasha.larke@lshtm.ac.uk).

Abstract

Background. We systematically reviewed the evidence for an association between male circumcision and Human Papillomavirus (HPV) infection and genital warts in men.

Methods. PubMed and Embase were searched to 15 September 2010. The measure of effect was the adjusted odds ratio (OR) or rate ratio (RR) when present and the crude estimate otherwise. Random effects meta-analyses were used to calculate summary measures of effect.

Results. We identified 23 papers about the association between circumcision and HPV DNA. Circumcised men were less likely to have prevalent genital HPV infection than uncircumcised men (summary OR, 0.57, 95% confidence interval [CI], 0.45–0.71) with between-study heterogeneity (P-heterogeneity = 0.006; I² = 50.5%; 19 studies). Similar summary associations were seen in clinical and methodological subgroups. The effect of circumcision was stronger at the glans/corona (OR, 0.47; 95% CI, 0.37–0.60) and urethra (OR, 0.35; 95% CI, 0.12–1.05) compared with sites more distal to the foreskin. There was weak evidence that circumcision was associated with decreased HPV incidence (summary RR, 0.75, 95% CI, 0.57–0.99; 3 studies) and increased HPV clearance (summary RR, 1.33; 95% CI, 0.89–1.98; 3 studies) but no evidence of an association with prevalent genital warts (OR, 0.93, 95% CI, 0.65–1.33; 15 studies).

Conclusions. Several countries are expanding access to voluntary medical male circumcision to reduce HIV prevalence. This could provide additional benefit in reducing HPV prevalence.

       Received January 8, 2011.

       Accepted July 26, 2011.