Vitals Spotlight - We Give the Doctor an Exam

circumcision procedure (nzherald.co.nz)

In the late 19th Century, Victorian era doctors described the male foreskin as “a source of mischief”, according to the Sunday New York Times. Now in the 21st century studies are showing that cells in the foreskin act as a magnet for HIV, Herpes and other STD’s. Health officials are now considering whether they should offer circumcision as a voluntary option for infants and even adult men who are at risk for HIV.

The Centers for Disease Control and Prevention has estimated that at least 45 million people in the United States aged 12 and older have had herpes or HSV-2 and about 20 million are currently infected with human papillomavirus, HPV. Research has indicated that male circumcision reduces the risk of sexually transmitted disease and even certain types of cancer. It is already known that it can decrease the risk of penile cancer, a relatively rare disease.

In a study of more than 5,000 uncircumcised adult Ugandan males, researchers found that after circumcision the rates of infection with the virus that causes herpes went down by 28 percent and the transmission of HPV was reduced by 35 percent. In another study circumcision reduced infection with the HIV virus by 60 percent.  The procedure did not protect against syphilis and safe sex practices, such as condoms, are still necessary to provide the best protection.

Asked about the applicability of the African results to men in the United States, Dr. Ronald H. Gray, a professor of reproductive epidemiology at John Hopkins and co- principal investigator, said:

“There is no reason to believe that this is in any way unique to Africa.”

Dr. Thomas Quinn

Dr. Thomas Quinn, senior investigator in infectious diseases at the National Institute for Allergy and Infectious diseases explained why removing the foreskin helps reduce the transmission of certain infections.

“The foreskin has two different sides. The outside is much like regular skin cells. However the inside is mucosal, similar to a woman’s vagina… It’s likely that there are vital receptors on that mucosal side that makes it easier for a virus to get into the cells.”

According to Vitals.com, Dr. Quinn received his medical degree at Northwestern University and completed his residency in internal medicine at Albany Medical Center.

Circumcision may be especially important for minority US populations, including Hispanic and African American males, since they are most at risk from HIV infections to date. Unfortunately Medicaid, which insures many low income patients, doesn’t pay for even routine infant circumcision in 16 states. Hopefully the growing evidence will persuade lawmakers in the United States and other countries to officially recommend the procedure. This would make patient education and insurance coverage more likely.

“The findings suggest that there are important lifetime health benefits to the procedure. I think it’s important that pediatricians consider the lifelong benefits that might accrue from circumcision when they are advising parents on whether the procedure should be performed on baby boys,” says Dr. Gray.

Their next focus will be to ascertain whether male circumcision can reduce transmission of HPV to female sexual partners. This would be hugely significant since HPV causes cervical cancer.