Effect of Circumcision of HIV-Negative Men on Transmission of Human Papillomavirus to HIV-Negative Women: A Randomized Trial in Rakai, Uganda

Wawer, M., Tobian, A., Kigozi, A., et al. Lancet (January 2011), 377:209–218, doi: 10.1016/S0140-6736(10)61967-8.

This article reported on the human papillomavirus (HPV) results of two medical male circumcision (MMC) trials in Rakai, Uganda. The trials assessed the efficacy of MMC in reducing the prevalence and incidence of HPV infection in female sexual partners of circumcised men as a secondary endpoint. HIV-negative female partners of trial participants were enrolled and followed for 24 months after their partners were circumcised. Self-administered vaginal swabs were used to measure prevalence of HPV genotypes, clearance of previously detected genotypes, and incidence of new infections (newly detected genotypes or ones previously cleared) at 12 and 24 months after MMC. Prevalence and incidence of low-risk and high-risk HPV infections were lower in women with circumcised partners than in women with uncircumcised partners. Over two years MMC reduced prevalence of high-risk HPV by 28 percent; clearance of high-risk HPV infection (except for HPV-16) was also higher in the MMC group. Results were consistent with observational studies showing lower rates of cervical cancer associated with male circumcision. The authors posited that reduced penile high-risk HPV could decrease incidence in females and increase clearance, decreasing re-infection. They concluded that MMC should be seen as effective for reducing prevalence and incidence of HPV in female partners. Because it was partly protective, interventions promoting safer sex should continue.