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PubMed2001

Gomco circumcision: When is it safe?

BACKGROUND/PURPOSE: The Gomco clamp is used most commonly for neonatal circumcisions in the United States with reported rates of complication as low as 0.2%. Often, however, circumcision is delayed beyond the neonatal period because of illness, parental concerns, or physician bias with patients presenting for elective circumcision in the first few years of life. In neonates and infants, the "bloodless" Gomco circumcision is cost effective, can be performed with minimal anesthesia and gives good cosmetic results. However, the optimal age at which to perform this procedure remains controversial. We reviewed the experience of one pediatric urologist with Gomco circumcision in neonates and infants to determine the optimal age at which this procedure should be performed. METHODS: One hundred thirty patients underwent Gomco circumcision by 1 pediatric urologist between 1996 and 1998. Ninety-eight patients underwent Gomco circumcision as neonates or during early infancy at a mean age of 17 days (range, 4 to 30 days). Thirty-two patients underwent circumcision after early infancy at a mean age of 6.5 months (range, 90 days to 8.5 months). All patients younger than 1 month of age underwent circumcision while fully awake using a dorsal penile nerve block. Patients greater than 3 months of age were circumcised under general anesthesia. Gomco circumcision was performed using 1.1- to 2.1-cm bells. Patients were assessed with regard to outcome. RESULTS: None of the 98 patients in the early infancy group had postcircumcision complications. Of the 32 patients in the older group, 12 (30%) had postoperative bleeding requiring suture repair or fulguration. The skin edges separated in 2 patients, 1 less than 1 month of age and 1 in the older group. Neither patient required further intervention, and both healed spontaneously. There was no correlation between size of clamp and development of complications. CONCLUSION: Although safe and effective for circumcision in the neonatal period and in early infancy, use of the Gomco clamp for circumcision beyond early infancy (3 months of age) has substantial morbidity, and alternative methods of circumcision should be sought.

Age Factors↗
PubMedDate not supplied

[Circumcision--criticism of the routine].

Circumcision is one of the most frequent operative procedures done in males. About 120 circumcisions are performed every 5 minutes over the world [14]. Three different reasons lead to circumcision: 1) Medical reasons in present of a pathologic phimosis. 2) Circumcisions done due to religious, social or cultural rea-reasons. 3) Finally in many countries circumcision is performed as "routine-circumcision" in the newborn period. While in the United States the number of routine-circumcisions decreases (about 60% of all male newborns) South-Korea has a rate near to 100%. Even with no religious or cultural background in Germany circumcision often is performed without scrutinizing medical indication. Circumcision is regarded as an procedure with no complications and no disadvantage for the patient. In general circumcision has no medical benefit neither in decreasing the incidence of urinary tract infections nor of sexual transmitted diseases nor of neoplasias. Medical indication for circumcision is given in present of pathologic phimosis in 4% of all males. Postoperative complications range up to 2% and "circumcision is the amputation of the prepuce from the rest of the penis, resulting in permanent alteration of the anatomy, histology and function of the penis...". There are many reports about having discomfort and disadvantages after circumcision as well to the males as to the sexual partners. This challenge the legality of neonatal involuntary circumcision because legality is based on saving the children's best interests.

Circumcision, Male↗
PubMed2001

Dynamics of male circumcision practices in northwest Tanzania.

BACKGROUND: Male circumcision status is considered an important cofactor in the spread of HIV and sexually transmitted disease. There is limited evidence that male circumcision practices in Africa may be changing. GOAL: To assess the determinants of male circumcision status in a traditionally noncircumcising ethnic group and to investigate the reasons for increasing acceptance of circumcision. METHODS: Data from a factory workers study and a rural cohort study in northwest Tanzania were used to analyze the levels and determinants of male circumcision status and assess the reliability of self-reported data. Qualitative data from focus group discussions and in-depth interviews were obtained to ascertain norms and values in relation to male circumcision. RESULTS: Male circumcision has become more popular in recent years, and 21% of 3,491 men reported themselves as circumcised. An increase in circumcision rates was observed in the rural cohort study during 1994 to 1997, though reporting inconsistencies are common. Circumcision rates were higher among men with higher levels of education and in Muslim men. Men are often circumcised in their late teens or twenties. The reasons for the increasing popularity of circumcision were investigated in group discussions and in-depth interviews. The most frequently mentioned reason was health-related; circumcision was thought to enhance penile hygiene, reduce sexually transmitted disease incidence, and improve sexually transmitted disease cure rates. CONCLUSION: Male circumcision is becoming more popular among a traditionally noncircumcising ethnic group in Tanzania, especially in urban areas and among boys who have attended secondary schools.

Adolescent↗
PubMed2002

A limited study on the perception and change in attitude about circumcision among health care professionals and their male family members.

OBJECTIVES: Millions of male children are circumcised throughout the world. We investigated the opinions and thoughts about the past and future aspects of circumcision by interviewing 100 male family members of the health care staff. METHODS: 100 male volunteers answered a questionnaire comprising questions about their personal observations, feelings, festivities and opinions about their own circumcisions as well as their views about the circumcision phenomenon as a parent, and the legality of circumcision. RESULTS: 81% of the volunteers in our study had been circumcised by traditional circumcisers. The rest had been circumcised by doctors (10%), barbers (7%) and sheikhs (2%). In 90% the circumcision took place at home, 7% in hospitals and in 3% in village squares. While 66% of the subjects do not remember anything, the remaining 33% reported some bad sensations like fear, pain and shame about their circumcisions, and 1 (1%) subject reported happiness. As a parent, they answered the questions on their preferences on the place and performer of the circumcision. 44% preferred to have circumcision performed in the hospital by a physician, 26% at home by a physician, and 30% at home by a circumciser. CONCLUSION: There are significant changes in the attitudes of people in Turkey on circumcision as a traditional culture, though its perception has remained unchanged.

Adolescent↗
PubMed2004

The effect of circumcision status on periurethral and glanular bacterial flora.

INTRODUCTION: Circumcision is a historical operation which is still performed for different purposes. The aim of this study is to investigate the changes in periurethral and glanular sulcus flora due to circumcision to determine the role of circumcision on urinary tract infections (UTIs). PATIENTS AND METHODS: Fifty patients who were circumcised for social-religious reasons between January 2000 and January 2001 were evaluated in this prospective study. Two swabs were taken from the periurethral and glanular sulcus regions both just before circumcision and 4 weeks after, and the bacteria cultured were recorded. RESULTS: We isolated pathogenic bacteria in the periurethral region of 32 (64%) patients (enterococci in 14 cases; Escherichia coli in 12 cases) before circumcision, and this number decreased to 5 (10%) after circumcision. Similarly, pathogenic bacteria were cultured from the glanular sulcus swabs of 33 (68%) patients (enterococci in 14 cases; E. coli in 10 cases), as well as coagulase-negative staphylococci in another 15 patients before circumcision. Following circumcision, we detected pathogenic bacteria in the glanular cultures of only 4 cases, whereas 40 children had non-pathogenic skin flora. Only 1 of 5 children with history of UTIs (n = 1) and retractable phimosis (n = 4) had periurethral pathogenic bacteria (Proteus spp.) in the post-circumcision period. The differences between pre- and post-circumcision values of the pathogenic bacterial colonizations were statistically significant in both groups sampled (p < 0.05). CONCLUSION: Non-circumcised patients have similar pathogenic bacterial colonizations in the periurethral and the inner preputial regions, although they have no phimosis. The origin of periurethral flora should be the deeper preputial regions. The flora greatly changed with skin commensals after circumcision. Circumcision might be beneficial from this point of view.

Bacteria↗
PubMed2005

Complications of circumcision in Israel: a one year multicenter survey.

BACKGROUND: In Israel, virtually all children undergo circumcision in the neonatal period. Traditionally, it is commonly performed by a "Mohel" (ritual circumciser) but lately there is an increasing tendency among the educated secular population to prefer a medical procedure performed by a physician and with local anesthetic injection. OBJECTIVES: To evaluate the outcome of this procedure and to compare the complication rate following circumcisions performed by ritual circumcisers and by physicians. METHODS: In 2001, of the 19,478 males born in four major medical centers in Israel 66 had circumcision-related complications. All the children were circumcised in non-medical settings within the community. The patients were medically evaluated either urgently due to immediate complications or electively in outpatient clinics later on. Upon the initial assessment a detailed questionnaire was filled to obtain data regarding the procedure, the performer, and the subsequent complications. RESULTS: All the circumcisions were performed during the early neonatal period, usually on day 8 of life (according to Jewish law). in 55 cases (83%) it was part of a ritual ceremony conducted by a ritual circumciser (Mohel), while in 11 babies (17%) physicians were involved. Acute bleeding after circumcision was encountered in 16 cases (24%), which required suturing in 8. In addition, we found two cases of wound infection and one case of partial amputation of glans penis in which the circumcision was performed by a ritual circumciser. Among the late complications, the most common was excess of skin in 38 cases (57%); 5 children (7.5%) had penile torsion and 4 children (6%) had shortages of skin, phimosis and inclusion cyst. The overall estimated complication rate of circumcision was 0.34%. CONCLUSIONS: Complications of circumcision are rare in Israel and in most cases are mild and correctable. There appears to be no significant difference in the type of complications between medical and ritual circumcisions.

Ceremonial Behavior↗
PubMed1987

Circumcision decision: prominence of social concerns.

Despite policy statements against routine circumcision of newborns by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology more than 10 years ago, there has been virtually no change in circumcision practices in the United States. In addition, controlled trials of programs to educate parents about the lack of medical indications for routine newborn circumcision have shown that parental education has little impact on the circumcision decision. We hypothesized that parents based their circumcision decision predominantly on social concerns rather than on medical ones. We prospectively surveyed parents of 124 newborns soon after they made the circumcision decision to learn their reasons for the decision. The strongest factor associated with the circumcision decision was whether or not the father was circumcised (P less than .0001). The survey also showed that concerns about the attitudes of peers and their sons' self concept in the future were prominent among parents deciding to circumcise. The circumcision decision in the United States is emerging as a cultural ritual rather than the result of medical misunderstanding among parents. In counseling parents making the circumcision decision, the health care provider should provide a knowledgeable and honest discussion of the medical aspects of circumcision. Until information is available that addresses parents' social concerns about circumcision, it is unreasonable to expect a significant change in circumcision customs in the United States.

Adult↗
PubMed2003

Carbon dioxide laser circumcisions for children.

The carbon dioxide laser for circumcision was introduced by our department in 1989. This study aims to review our experience with laser circumcision for children and to evaluate its cost effectiveness as compared to conventional methods. A retrospective study of 30 patients who underwent conventional circumcision in 1985 and another 30 patients who underwent laser circumcision in 1995 was undertaken. The operating times in both groups were compared. The total cost of use of the laser machine was calculated, taking into account maintenance costs, estimated life span of laser machines (10 years) and costs of disposables used during each circumcision. This was weighed against the cost savings from shorter operating times and reduced operating theatre facility charges. Also, morbidity data from 2781 laser circumcisions done between May 1997 and April 2000 was collected. There was a significant decrease of 5 minutes in operating time for the group of patients who underwent laser circumcision. Calculated cost savings per laser circumcision from the reduced operating theatre time was S dollars 31/-. Of the 2781 cases of laser circumcision performed, there was an overall complication rate of 1.15%. Twenty-nine cases (1.04%) had post circumcision bleeding, of which 10 cases (0.36%) required unplanned return to operating theatre for hemostasis. Three cases (0.11%) had wound infection, requiring admission to hospital. Laser circumcision is a simple method with reduced operative time translating into cost effectiveness. Morbidity rates of laser circumcision compare favourably to those of conventional circumcision based on reports from other institutions.

Carbon Dioxide↗
PubMed2004

Knowledge of and attitude towards circumcision of adult Korean males by age.

AIM: Circumcision is widely practised in Korea, but little is known regarding the public's attitude towards circumcision. This study was designed to evaluate the knowledge and the general opinion of Korean adult males towards circumcision. METHODS: Fifteen hundred self-completion questionnaires were distributed to adult males in five decadal age groups ranging from 10 to 59 y old. Questions concerning opinions regarding the necessity, reasons, potential benefits and disadvantages of circumcision, as well as the role of peer pressure upon the decision to circumcise were included. Completed questionnaires were collected and analysed statistically. RESULTS: The achieved response rate was 62.7%. 73.1% believed that circumcision is necessary, while 7.1% believed it is not necessary. The principal reason for circumcision was to improve penile hygiene (77.9%). 68.7% did not prefer neonatal circumcision regardless of the respondent's age. The major reason was fear of pain (36.9%). Peer pressure was one of the most influential factors when deciding upon circumcision: 60.8% believed that they might be ridiculed by their peer group unless circumcised, and the younger the age of the respondent, the more frequently this opinion was held (p < 0.05). 62.7% thought that circumcision would prevent genital tract infection of the sexual partner. Respondents with older age tended to emphasize improved sexual potency (p < 0.05). CONCLUSIONS: This study indicates that common beliefs of adult males about circumcision in Korea are relatively homogeneous. Tailored education about circumcision is needed.

Adolescent↗
PubMed2002

The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya.

Compelling epidemiological evidence showing a significant association between lack of male circumcision and HIV infection has prompted calls for consideration of male circumcision interventions as a strategy for reducing HIV prevalence in highly affected areas where circumcision is little practiced and transmission is predominantly heterosexual. Little is known about whether male circumcision interventions would be acceptable or feasible in traditionally non-circumcisng areas of Africa. This study assesses the acceptability of male circumcision in the Luo, a large, traditionally non-circumcising ethnic group in western Kenya. Separate focused group discussions with adult Luo men and women and semi-structured interviews with clinicians were conducted in Nyanza Province, Kenya. The primary barriers to acceptance of male circumcision were cultural identification, fear of pain and excessive bleeding and cost. The main facilitators were association of male circumcision with better hygiene and reduced risk of infection. Both men and women were eager for promotion of genital hygiene and male circumcision, and they desired availability of circumcision clinical services in the Province's health facilities. Clinicians lacked the knowledge and resources to offer safe circumcision counselling and services. If results from this study are valid for other areas of sub-Saharan Africa, acceptability of male circumcision as a means to reduce STDs and HIV is higher than previously suspected. Further studies are needed in other regions to assess the feasibility of introducing acceptable male circumcision information and services to reduce HIV transmission.

Adolescent↗
PubMed2005

The acceptability of male circumcision as an HIV intervention among a rural Zulu population, Kwazulu-Natal, South Africa.

Epidemiological and biological studies provide compelling evidence for the protective effect of male circumcision against the acquisition of HIV. Three randomized controlled trials are currently underway to assess the impact of male circumcision as an HIV intervention in traditionally non-circumcising areas with high levels of heterosexually-transmitted infection. This study explores the acceptability of male circumcision among the rural Zulu around Hlabisa and Mtubatuba, KwaZulu-Natal, South Africa. A cross-sectional convenience sample of 100 men and 44 women was surveyed, and two male focus groups held, to ascertain circumcision preferences within the population. Four in-depth interviews with service providers assessed the feasibility of promoting male circumcision. Fifty-one per cent of uncircumcised men and 68% of women favoured male circumcision of themselves or their partners; while 50% of men and 73% of women would circumcise their sons. For men, the main predictors of circumcision preference pertained to beliefs surrounding sexual pain and pleasure; for women, knowledge about the relationship between male circumcision status and STI acquisition was the key indicator for circumcision preference. Among both sexes the main barrier to circumcision was fear of pain and death. The greatest logistical barrier was that circumcision can presently only be carried out by trained hospital doctors.

Adolescent↗
PubMed2006

The effect of male circumcision on sexuality.

OBJECTIVE: To prospectively study, using a questionnaire, the sexuality of men circumcised as adults compared to uncircumcised men, and to compare their sex lives before and after circumcision. SUBJECTS AND METHODS: The study included 373 sexually active men, of whom 255 were circumcised and 118 were not. Of the 255 circumcised men, 138 had been sexually active before circumcision, and all were circumcised at >20 years of age. As the Brief Male Sexual Function Inventory does not specifically address the quality of sex life, questions were added to compare sexual and masturbatory pleasure before and after circumcision. RESULTS: There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision. CONCLUSION: There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.

Adult↗
PubMed2003

Male circumcision: an acceptable strategy for HIV prevention in Botswana.

BACKGROUND: Male circumcision is known to reduce the risk of acquiring HIV, but few studies have been performed to assess its acceptability among either children or adults in sub-Saharan Africa. METHODS: We conducted a cross sectional survey in nine geographically representative locations in Botswana to determine the acceptability of male circumcision in the country, as well as the preferred age and setting for male circumcision. Interviews were conducted using standardised questionnaires both before and after an informational session outlining the risks and benefits of male circumcision. RESULTS: Among 605 people surveyed, the median age was 29 years (range 18-74 years), 52% were male, and >15 ethnicities were represented. Before the informational session, 408 (68%) responded that they would definitely or probably circumcise a male child if circumcision was offered free of charge in a hospital setting; this number increased to 542 (89%) after the informational session. Among 238 uncircumcised men, 145 (61%) stated that they would definitely or probably get circumcised themselves if it were offered free of charge in a hospital setting; this increased to 192 (81%) after the informational session. In a multivariate analysis of all participants, people with children were more likely to favour circumcision than people without children (adjusted odds ratio 1.8, 95% CI 1.0 to 3.4). Most participants (55%) felt that the ideal age for circumcision is before 6 years, and 90% of participants felt that circumcision should be performed in the hospital setting. CONCLUSIONS: Male circumcision appears to be highly acceptable in Botswana. The option for safe circumcision should be made available to parents in Botswana for their male children. Circumcision might also be an acceptable option for adults and adolescents, if its efficacy as an HIV prevention strategy among sexually active people is supported by clinical trials.

Adolescent↗
PubMed1998

Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block.

OBJECTIVE: To compare the efficacy of the dorsal penile nerve block (DPNB) with a less invasive form of local anesthesia, eutectic mixture of local anesthetic (EMLA) cream, for reduction of pain during neonatal circumcision. DESIGN: Prospective, blinded, randomized, controlled trial. SETTING: Tertiary referral, neonatal intensive care nursery in a university teaching hospital. PATIENTS: Fifty infants >/=341/2 weeks postmenstrual age and stable for discharge at time of circumcision; gestational age at birth 25 to 41 weeks; birth weight 600 to 4390 g; age at study 3 to 105 days. An additional cohort of term newborns (n = 20), who were not randomized, were circumcised without anesthesia. INTERVENTIONS: Administration of either EMLA cream (0.5 g topically 1 hour before circumcision) or 1% lidocaine (0.7-1.0 mL subcutaneously 3 minutes before circumcision). OUTCOME MEASURES: Primary: Neonatal Infant Pain Scale (NIPS) score; secondary: heart rate, respiratory rate. All outcome measures were assessed by an individual who was blinded to the group assignment and did not perform the circumcision. RESULTS: NIPS scores were significantly lower in the DPNB infants (2.3 +/- 1.8) compared with the EMLA infants (4.8 +/- 0.7). NIPS scores in patients circumcised without anesthesia indicated severe pain. There was a significantly greater increase in heart rate over the duration of the circumcision in the EMLA group than in the DPNB group (49 vs 9 beats per minute). Adverse effects included small hematomas at the site of injection in DPNB infants (10/23), mild erythema at 1 and/or 24 hours after circumcision in the EMLA infants (3/21), and penile edema noted 5 days after circumcision requiring removal of the circumcision bell in 1 DPNB infant. CONCLUSIONS: DPNB provides better pain reduction during neonatal circumcision than EMLA cream. EMLA cream may provide pain reduction compared with no anesthesia during neonatal circumcision.

Anesthesia, Local↗
PubMed2003

Parental concerns on the circumcision for elementary school boys: a questionnaire study.

To evaluate the parental concerns for elementary school boys (7-12 yr) on the circumcision, a randomly selected cross-sectional survey was performed in each elementary school from 16 urban wards in Busan. We asked 10,861 parents to answer the questionnaires on the circumcision such as the benefits and fallbacks of circumcision, proper time and knowledge of the surgery, and neonatal circumcision. The overall response rate to the questionnaire was 38.9%. The overall circumcision rate of elementary school boys was 43.2%, which increased from 18.7% at 7 yr old to 64.8% at 12 yr old. The significant reason for and against circumcision was "hygiene benefits (88.1%)" and "unreliable medical benefits (38.5%)", respectively. 74.9% of parents thought that elementary school age is the optimal time of circumcision. Only 11.2% of boys were circumcised during neonatal period. The main reason for parents to oppose neonatal circumcision was "their babies feel pain (35.8%)". About 50% of parents thought that circumcision will prevent medical diseases. Besides the medical basis, the circumcision is emerging as a kind of social custom in Busan. For parents making the decisions on the circumcision of their boys, physician or health care providers should provide helpful and honest facts about circumcision.

Attitude to Health↗
PubMedDate not supplied

A study on female circumcision in Nigeria.

A total of 181 women were randomly chosen from the women attending the family planning clinic of the Department of Community Health, College of Medicine, University of Lagos, from February 1984 to September 1984. Of these, 84.7% were aged between 25 and 44 years and most of them are Yorubas (70.7%). A high proportion (56.4%) claimed to have been circumcised but examination revealed that 24.5% had no clinical evidence of circumcision. The Edo tribe had the highest proportion circumcised amongst the respondents, 76.7%, followed by the Ibos, 61%, and least of all the Efiks, 20%. Age at circumcision revealed that most had their circumcision as infants (78.8%) and only 5.9% had theirs as adults, however, the Ibos and Yorubas had high rates of infant circumcision. Some of the respondents were aware of the associated side effects and it was found that the more educated women were less likely to circumcise their daughters. All circumcised daughters were from circumcised mothers except one and she had to circumcise her daughter in conformity with her husband's tribal practice. Accurate statistics of morbidity and mortality from female circumcision will be difficult to gather as circumcision is performed mostly in the houses, nevertheless, the complications are severe enough to merit authoritative intervention. It is recommended that public awareness of female circumcision, its complications and other attendant health hazards should be embarked upon by health authorities especially amongst the tribes practising it.

Circumcision, Male↗
PubMed2004

How experiences and attitudes relating to female circumcision vary according to age on arrival in Britain: a study among young Somalis in London.

OBJECTIVE: To examine the association between age on arrival in Britain and experiences and attitudes relating to female circumcision among young, single Somalis living in London. DESIGN: The study population consisted of single male and female Somalis aged 16-22 years living in the Greater London area. Quantitative data were collected using a cross-sectional survey based on snowball sampling aiming to obtain data on 100 males and 100 females. Qualitative data were collected from 10 males and 10 infibulated females. RESULTS: Quantitative data were obtained for 94 females and 80 males. Living in Britain from a younger age was associated with increased assimilation in terms of language, dress and socialising. Seventy per cent of the females reported being circumcised with two-thirds of operations being infibulation. Those who were living in Britain before the usual age range for circumcision (before age six) were less likely to be circumcised (42%) than those who arrived after the usual age range for circumcision (11 or older) (91%). During in-depth interviews, health and sexual problems due to female circumcision were described with great emotion and interviewees acknowledged the association between the importance of virginity for marriage and circumcision. Half of males who arrived aged 11 or older wanted a circumcised wife compared with less than a quarter of those who arrived at a younger age. Eighteen per cent of female respondents and 43% of males intended to circumcise any daughters. Females were less likely than males to agree with the assumptions about sexuality and religion that underpin the practice. Substantial proportions of respondents perceived that their parents' expectations in terms of marriage and circumcision were more traditional than their own. CONCLUSION: Living in Britain from a younger age appears to be associated with abandonment of female circumcision and with changes in the underlying beliefs on sexuality, marriage and religion that underpin it. Groups identified with more traditional views towards female circumcision include males, older generations, new arrivals and those who show few signs of social assimilation.

Acculturation↗
PubMed1997

Male circumcision and susceptibility to HIV infection among men in Tanzania.

BACKGROUND: Evidence from ecological studies and from studies of and sexually transmitted disease (STD) patients in sub-Saharan Africa suggests that there is a protective effect of male circumcision against HIV infection. There are, however, few population-based studies that have controlled adequately for potential confounding factors. METHODS: Data from five population-based studies in north-western Tanzania were used to investigate the association between male circumcision and the risk of HIV infection and STD. The effects of circumcision on HIV prevalence, syphilis (positive Treponema pallidum haemagglutination; TPHA) and self-reported STD were analysed, controlling for a range of demographic and sociocultural variables, and indicators of sexual behaviour. RESULTS: In north-western Tanzania, circumcision was previously restricted to Muslims and specific ethnic groups, but is now more widespread, particularly in urban areas and among more educated men. Assessment of the reliability and validity of self-reported circumcision status showed that these data could be considered fairly accurate, although there was some tendency for circumcision to be over-reported. On univariate analysis, circumcision status was unrelated to HIV prevalence in most studies. After controlling for confounding variables, however, there was a modest but significant reduction of the HIV prevalence among circumcised men [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.48-0.81]. This effect appeared stronger in urban areas (OR, 0.46; 95% CI, 0.32-0.68) and roadside villages (OR, 0.65; 95% CI, 0.42-1.01) than in rural areas and islands (OR, 1.00 and 1.01 respectively). There was no association between circumcision status and syphilis serology (TPHA), but there was a positive association between circumcision and self-reported STD, although this was not significant after adjustment for confounding variables. CONCLUSION: Male circumcision has a protective effect against HIV infection in this population, which may be stronger in urban areas and roadside settlements than in the rural areas. Ethnic group and religious denomination are no longer the sole determinants of male circumcision.

Adolescent↗