Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis

Abstract

The claim that circumcision reduces the risk of sexually transmitted infections has been repeated so frequently that many believe it is true. A systematic review and meta-analyses were performed on studies of genital discharge syndrome versus genital ulcerative disease, genital discharge syndrome, nonspecific urethritis, gonorrhea, chlamydia, genital ulcerative disease, chancroid, syphilis, herpes simplex virus, human papillomavirus, and contracting a sexually transmitted infection of any type. Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.

High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea

“…Our finding that men with a dorsal slit had a significantly lower incidence of syphilis compared with men without a foreskin cut is consistent with earlier research suggesting that male circumcision may confer protection against syphilis (as well as HSV-2 and chancroid) in men, [32][33][34][35] but these associations are contentious. 36 The present study was underpowered to detect a difference in prevalent or incident HIV infection among men with and without a foreskin cut. Ongoing clinical epidemiological and immunohistological research by our group is investigating the association and mechanisms by which penile foreskin cutting may protect men against HIV infection.…”

The value of a multi-specialty service, including genitourinary medicine, dermatology and urology input, in the management of male genital dermatoses

“…16 Circumcision can be carried out for religious purposes, particularly amongst the Jewish and Muslim populations, 15,16 or for medical management of genital complaints such as phimosis and recurrent balanitis. 15,17 Research has intimated some interesting associations between circumcision status and genital pathology: it has been demonstrated that circumcision reduces the risk of some sexually transmitted infections (STIs), 15,18,19 in particular ulcerative STIs. 18 It is also recognised that the presence of a foreskin predisposes to penile carcinoma.…”

Common urological problems in children: prepuce, phimosis, and buried penis

“…Other cohorts also showed similar findings, with circumcised males having a decreased risk of syphilis, gonorrhoea, and human papillomavirus (HPV). [36][37][38][39] On the contrary, another systematic review by Van Howe 40 showed that most STDs are not impacted significantly by circumcision status. They included chlamydia, gonorrhoea, HSV, and HPV.…”