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. Author manuscript; available in PMC: 2013 Oct 4.
Published in final edited form as: Lancet. 2011 Jul 23;378(9788):314–315. doi: 10.1016/S0140-6736(11)61162-8

Male Circumcision for HR-HPV Prevention

Aaron A R Tobian 1,2,*, Thomas C Quinn 3,4, Ronald H Gray 2
PMCID: PMC3790321  NIHMSID: NIHMS514469  PMID: 21784258

In a Comment, Dr. Monsonego states “circumcision and condom use have not been shown to fully protect against either human papillomavirus (HPV) acquisition or clearance in male genital sites, which questions their value in preventing infection in men and transmission to female partners.” The statement is based on older observational studies, but ignores evidence from recent observational studies and two randomized trials of male circumcision that circumcision reduces penile HR-HPV prevalence.1 In addition, observational studies and one randomized trial showed that male circumcision reduces female partner HR-HPV prevalence.1–2 In both men and their female partners, male circumcision reduces HR-HPV prevalence by reducing acquisition and increasing clearance of the virus.2–3 Dr. Giuliano and colleagues have previously shown that male circumcision reduces penile HR-HPV prevalence.4 Unfortunately, little data are presented in her current study on the impact of male circumcision on HR-HPV acquisition or clearance.4

Currently there are no fully protective measures for HR-HPV prevention in men. The quadrivalent HPV vaccine only reduces external genital lesions in men by 60.2% and persistent infection with any HPV genotype by 27.1%.5 Therefore, multiple interventions may be required to significantly reduce HR-HPV infection in men and women, and the potential, albeit incomplete, protection afforded by male circumcision cannot be ignored.

References

  • 1.Tobian AA, Gray RH, Quinn TC. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision. Arch Pediatr Adolesc Med. 2010 Jan;164(1):78–84. doi: 10.1001/archpediatrics.2009.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Wawer MJ, Tobian AA, Kigozi G, Kong X, Gravitt PE, Serwadda D, et al. Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. Lancet. 2011;277(9761):209–218. doi: 10.1016/S0140-6736(10)61967-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Gray RH, Serwadda D, Kong X, Makumbi F, Kigozi G, Gravitt PE, et al. Male Circumcision Decreases Acquisition and Increases Clearance of High-Risk Human Papillomavirus in HIV-Negative Men: A Randomized Trial in Rakai, Uganda. J Infect Dis. 2010 Apr 6;201(10):1455–1462. doi: 10.1086/652184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Giuliano AR, Lazcano E, Villa LL, Flores R, Salmeron J, Lee JH, et al. Circumcision and sexual behavior: factors independently associated with human papillomavirus detection among men in the HIM study. Int J Cancer. 2009 Mar 15;124(6):1251–1257. doi: 10.1002/ijc.24097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Giuliano AR, Palefsky JM, Goldstone S, Moreira ED, Jr, Penny ME, Aranda C, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011 Feb 3;364(5):401–411. doi: 10.1056/NEJMoa0909537. [DOI] [PMC free article] [PubMed] [Google Scholar]

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