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【medical-news】Lancet 2010: Circumcision reduces HPV risk
Monday, 10 January 2011- Male circumcision can reduce the risk that female partners will acquire human papillomavirus (HPV), according to researchers.
Women in two large trials of circumcision had a lower incidence and prevalence of HPV if their partners got the procedure, according to said Dr. Aaron Tobian of Johns Hopkins University, and colleagues.
But protection was only partial so other safe sex practices remain important, Tobian and colleagues reported online in The Lancet.
The findings come from two parallel but independent trials in Rakai, Uganda, whose main purposes were to establish the effect of circumcision on the risk of men catching HIV in one case and the risk of transmitting the virus to their partners in the other.
The researchers separately contacted partners of trial participants who were married or in a long-term relationship and asked them to take part in a follow-up study looking at the effect of circumcision on the prevalence and incidence of high-risk strains of HPV.
Earlier studies had shown that the procedure reduces both prevalence and incidence in men, and observations had suggested it might have a beneficial effect in women, Tobian and colleagues noted.
To find out, they enrolled 648 partners of men in the circumcision group, and 597 partners of men in the control group between 2003 and 2006. The women were asked to provide vaginal swabs for HPV testing at baseline, 12 months, and 24 months. At the two-year follow-up, data were available for 544 women in the intervention group and 488 in the control group.
Of those, 151 women in the intervention group (27.8%) had a high-risk HPV infection, defined as one or more of the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. In comparison, 189 women in the control group (38.7%) had a high-risk HPV infection, leading to a prevalence risk ratio of 0.72 (95% CI 0.60 to 0.85, P=0.001).
Incidence of high-risk HPV infection during the trial was also lower in the intervention group than in the control group -- 20.7 infections per 100 person-years versus 26.9, yielding an incidence rate ratio of 0.77 (95% CI 0.63 to 0.93, P=0.008).
Given that persistent high-risk HPV infection is a recognized cause of cervical malignancies, the finding "accords with observational studies that show lower rates of cervical cancer associated with male circumcision," the researchers argued. But the study did not assess cervical neoplasia directly, they noted.
Tobian and colleagues cautioned that men and women in the study were in stable relationships and did not have HIV at baseline, so the results may not apply to other populations. The analysis may also have underestimated incidence, they cautioned, because infections acquired and cleared between the yearly follow-up points would have been missed.
An estimate of protection against cervical disease as a result of circumcision can't be made, according to Dr. Anna Giuliano of the H. Lee Moffitt Cancer Center in Tampa, Fla., and colleagues.
But the results do add weight to programs that promote circumcision in countries without cervical screening programs, Giuliano and colleagues argued in an accompanying commentary.
The procedure offers limited protection against most high-risk types, they noted, while the HPV vaccine is highly effective, but only against a limited number of genotypes. "The two interventions are likely to have important synergistic effects," they concluded.
Source: M.J. Wawer, et al., "Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda," Lancet 2010; DOI:10.1016/S0140-6736(10)61967-8.
http://www.urosource.com/home/todays-key-article/key-articles/view/article/circumcision-reduces-hpv-risk-for-both-sexes/?tx_ttnews%5BbackPid%5D=30&cHash=f7bb1de6cb009f0a6607ed3a76d10022
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61967-8/abstract Circumcision Facts* The current rationales/rationalizations for infant circumcision developed after the ... not by genital smegma (which both sexes produce), but by HPV (Human Papilloma ...www.circumcisionfacts.com/-2010-09-19-快照-Circumcision Facts" www.med.unc.edu/wrkunits/2depts/medicine/web/NeurosarcoidosiMale circumcision was associated with a reduced risk of penile HPV. In the case ... substantial impact on the individual and family. It can affect both sexes, and a wide...www.disease-disorder.com/...t/-2006-12-05-快照-Final Scientific Programme _revised_ Disease and disorder - Male circumcision was associated with a reduced risk of penile HPV. In the case ... substantial impact on the individual and family. It can affect both sexes, and a wide...www.disease-disorder.com/...d/-2008-08-07-快照-[标签:content2]
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作者:admin@医学,生命科学 2011-01-11 00:45
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