Call for higher circumcision rate

Circumcision should be routinely considered as a way to reduce the risk of sexually transmitted infections, argue US experts.

They spoke out after research found circumcision significantly cut the risk of infection with herpes and the cancer-causing human papillomavirus.

Circumcision is known to sharply reduce the risk of HIV infection.

But the study, featured in the New England Journal of Medicine, failed to convince UK experts.

"All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons"
Dr Judith Wasserheit
University of Washington

The research, carried out by scientists in Uganda, involved nearly 3,500 men and monitored their sexual activity over a period of up to two years.

The researchers, from Johns Hopkins University, found circumcision reduced the risk of herpes by 25%, and human papillomavirus (HPV) by a third.

HPV causes cervical cancer in women, and genital warts in both sexes.

Circumcision rates have been declining in the US and are lowest among black and Hispanic patients - the groups with the highest rates of HIV, herpes and cervical cancer.

Writing in the journal, Dr Matthew Golden and Dr Judith Wasserheit, from the University of Washington, said: "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."

Dr Wasserheit went on to say: "All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured."

UK scepticism

The reason why a foreskin might increase the risk of infection with various viruses is unclear.

However, research has suggested that a man with a damp penis has a greater risk of being infected by HIV.

Various reasons for this have been put forward, including wetness allowing viruses to stick more easily to the penis, or creating 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, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections.

He said: "Sure, a dry skinned penis is a bit less likely to contract HIV, herpes and possibly genital warts but it will get infected eventually."

Dr O'Mahony also said pushing circumcision as a solution sent the wrong message.

"It suggests that it is women who infect innocent men - let's protect the innocent men.

"And it allows men who don't want to change their irresponsible behaviour to continue to sleep around and not even use a condom."

Keith Alcorn, from the HIV information service NAM, also warned against a knee jerk reaction.

He said: "We have to be careful not to take evidence from one part of the world and apply it uncritically to others.

"Male circumcision will have little impact on HIV risk for boys born in the UK, where the risk of acquiring HIV heterosexually is very low.

"Girls can be vaccinated against HPV and so protected from cervical cancer, and condoms protect against herpes."

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University of Washington
New England Journal of Medicine
Johns Hopkins University
Health Protection Agency
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