%0 Journal Article
%T Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis
%A Robert S. Van Howe
%J ISRN Urology
%D 2013
%R 10.1155/2013/109846
%X 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. 1. Background The earliest report of circumcision status as potential risk factor for sexually transmitted infections (STIs) was published in 1855 by Hutchinson, who noted that in men who were treated for STIs (primarily gonorrhea and syphilis), Jews were less likely to have syphilis [1]. This report is still referenced by circumcision proponents as a validation of their claim that circumcision prevents STIs, but the converse of Hutchinson¡¯s finding, namely that when compared to Gentiles, Jews were at greater risk for gonorrhea, is typically ignored. The claim of reduction of the risk of STIs to justify neonatal circumcision continues today, often supported by selective bibliographies [2¨C12]. When the entire medical literature is reviewed, these claims become difficult to substantiate. The American Academy of Pediatrics, 1999, Task Force on Circumcision concluded that ¡°evidence regarding the relationship of circumcision to STD in general is complex and conflicting.¡± [13] In 2012, using a selective bibliography, consistent with the practices of circumcision proponents, the American Academy of Pediatrics concluded that ¡°evaluation of current evidence
%U http://www.hindawi.com/journals/isrn.urology/2013/109846/