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Women Benefit from Male Circumcision, Too

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Women Benefit From Male Circumcision,Too

Rakai researchers may make new breakthroughs in prevention by drawing on what is possibly the world’s largest foreskin collection.

Women in the developing world looking for protection from cervical cancer have another reinforcement to add to their arsenal: male circumcision. Bloomberg School researchers Maria Wawer, MD, MHSc, and Aaron Tobian, MD, PhD, have finished a multiyear study that shows the efficacy of male circumcision as a means of reducing the rate of HPV infection among women.

Human papillomavirus (HPV) can cause genital warts and cervical cancer. In the developing world, where 85 percent of infections occur, the situation is dire: WHO estimates that about 33 percent of East African women are harboring HPV. Cervical cancer is the leading cause of cancer death among women in Uganda, where the study took place.

Rakai researchers may make new breakthroughs in prevention by drawing on what is possibly the world’s largest foreskin collection.

Women partnered to circumcised men have a 25 to 30 percent reduction over time in the number of HPV infections, according to Wawer, a professor of Population, Family and Reproductive Health, and Tobian, an assistant professor of Pathology at the School of Medicine. Though encouraged by the finding, Wawer cautions that couples should still practice other forms of safe sex. “Don’t think of this as a magic bullet,” she says. “It’s part of a program of protection.”

In the study, 5,000 uncircumcised HIV-negative men enrolled, together with their HIV-negative female partners. Then researchers randomly assigned men to be circumcised, either immediately or at the end of two years. Everyone was tested for infections at the beginning, middle and end of the study. Circumcised males had lower rates of HPV infection, likely because the procedure makes carrying the disease more difficult, says Wawer. And, as suspected, so did their female partners. 

The parallel effect occurred because male circumcision both reduced the number of new male infections and increased the proportion of men with HPV at the time of enrollment who subsequently cleared the virus. “We hypothesize that the foreskin mucosa is an important site for infection,” notes Wawer. “Without this focal site, there is higher clearance at other sites along the male genital tract and less reinfection of other sites by the virus when it is no longer shed by [cells within] the foreskin mucosa.”

Since fewer men were infected, fewer transmitted HPV to their partners. A bonus: Wawer says that about 40 percent of women in the study reported being more sexually satisfied after the man’s circumcision, mainly because of better hygiene. 

She and her colleagues have been studying a broad range of HIV-related matters since the late 1980s in the Rakai region of Uganda, where they founded the Rakai Health Sciences Program. The researchers made headlines several years ago with a study showing that circumcision dramatically reduced men’s chances of contracting HIV from infected female partners.

The Program provides thousands of circumcisions at no cost to men through PEPFAR funding. As a result, the site has what is possibly the world’s largest collection of foreskins, which are “immediately whisked away,” says Wawer, “because we do have a real kick-ass lab right there in rural Uganda.” The Rakai researchers are using the tissues to study how immune defenses in the mucous membranes protect the body from infections. Inadvertently, they are also discovering hundreds of new bacteria under the foreskins—enough that “everybody working on the project could probably have a bacterium named after them,” Wawer says.

Comments

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  • Rachel Weisberger

    United States 02/16/2012 01:10:40 AM

    A simple question for you all really. How much medical evidence would be needed to make female circumcision of the prepuce fund-able through tax dollars? After all, it serves nearly the same purpose and gathers just as much debris as the male prepuce. In the honesty of not being sexist, it seems like the only fair solution. You can't simply force one gender to deny themselves a piece of their sexual organ for the sake of the other... that's sexism in a nutshell.

  • Daniel Seely

    Alexandria, VA 03/02/2012 01:04:19 AM

    If you are using culled foreskins from genital mutilations to study how immune defenses in the mucous membranes protect the body from infections, why did you take them away in the first place as your research buttresses the fact that G*d put them there for a reason. JHU should be as ashamed of this work that Wawer et. al are doing. It is about as biased and un-scientific as the work of Dr. Money in touting the success of poor David Reimer's sex change operation when it was indeed a failure. Almost 50 years later, we find JHU trying to validate Male Genital Mutilations with an equal level of gaul. More disturbing is that Gray and Tobian lend there names to articles written by persons whose motives for supporting circumcision warrant much scrutiny such as Brian Morris and Jake Waskett who have little to no authority to write credibly on such matters in an unbiased manner. To learn more about these atrocities check out www.circleaks.org. Shame on you JHU!

  • Paul Sandz

    UK 03/04/2012 03:29:16 PM

    All the evidence that the John Hopkins School can present for a health benefit associated with circumcsion comes from THIRD-WORLD countries! How can the circumcision of U.S, boys be encouraged based upon study findings from the Sub-Sahara?! If circumcision offered significant protection against STDs, there should be evidence of this from developed nations too. Instead, we find that the USA, the great majority of whose men are circumcised, fares POORLY in terms of STDs by comparison with European (and other) nations, where circumcision is uncommon.

  • Marius from SA

    South Africa 06/06/2012 06:51:46 AM

    There was many studies done, only 3 in Africa showed a improved result.

    The studies was done by circumcising men, teaching them about HIV, teach them about condom usage and the result was positive. Was this because of circumcision or education?

    They campaign insist that men must still use condoms. What is the purpose of circumcision if you will always use a condom then?

    If a man have 60% less chance of contracting the virus and he sleep regularly with his new HIV positive girl friend. The circumcision might help that he do not get infected tonight but he will get infected tomorrow night. This means 60% less risk in reality is like a one week delay at most for most situation where men get infected.

    They say it is receptors on the foreskin that contracts the virus and by removing it reduce HIV risk, still they say circumcision does not help for gay people, don’t the HIV enter the penis the same way for gay and heterosexuals, or do gay HIV viruses prefer to go in the other hole?

    There is a reason Brazil, China and Europe is not buying into it. They claim their studies prove differently.

    Circumcision is Africa is under US pressure, the same purple that pressured mass circumcision in S. Korea and Philippines. Where ever US go they want to circumcise.

    African countries risk loosing funding for HIV if they do not implement circumcision. This is why I believe Malawi was denied access to the Global Fund, since they didn’t want to circumcise as required by the UN. Men are not undergoing circumcision to reduce risk of AIDS, they do it so that African countries can continue to get funding for AIDS.

    This is also why governments are pushing men to have it done despite the fact that the evidence is very sketchy. Its about the US forcing their culture down on Africa and for Africa it is about money and global politics.

    We must also consider that NIAID in the US was behind the two trial in Kenya and Uganda

    From: http://en.wikipedia.org/wiki/Circumcision_and_HIV In 1989 Cameron found uncircumcised men 8.2 times more likely to have HIV.[27] Since then over 40 epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection.[28] In 1994, de Vincenzi and Mertens surveyed previous studies that had links between circumcision status and HIV; they surveyed 23 in total. They criticised the Cameron study saying that it may have suffered from selection bias.[29] In 1995 Ntozi noted: "There are now two schools of thought about the link between lack of circumcision and HIV infection in Africa. One school is that of Bongaarts et al. (1989), Moses et al. (n.d.) and Caldwell and Caldwell (1994) who use geographical distribution evidence to argue that the association between lack of circumcision and a high level of HIV infection in Africa is so convincing that the likelihood of a link should be recognized and taken into account where possible in the battle against AIDS. Moses et al. (n.d.) have gone further to recommend circumcision interventions for Africa. In contrast, De Vincenzi and Mertens (1994) argue that the evidence for an association, at least from small-scale surveys, is doubtful and hence not conclusive enough to qualify circumcision as an intervention.[30] Van Howe conducted a meta-analysis in 1999 and found circumcised men at a greater risk for HIV infection.[2] He further speculated that circumcision may be responsible for the increased number of partners, and therefore, the increased risk.

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