The prepuce: a mistake of nature?
Retrospective studies suggest that circumcision of newborn boys will reduce the frequency of male early infantile urinary tract infection (UTI) by about 90%. If they are correct, this will be the first known instance of a common potentially lethal disease being preventable by extirpation of a piece of normal tissue. To reconcile the phenomenon with existing views of evolution and biology, it is suggested that the effects of one unphysiological intervention are counterbalancing those of another--ie, colonisation of the baby's gastrointestinal tract and genitals in maternity units by Escherichia coli strains of non-maternal origin, to which the baby has no passive immunity. As an alternative to circumcision to prevent early infantile male UTI, more natural colonisation could be promoted by strict rooming-in of mother and baby or by active colonisation of the baby with his mother's anaerobic gut flora.
Winberg
J
J
Department of Paediatrics, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
Bollgren
I
I
Gothefors
L
L
Herthelius
M
M
Tullus
K
K
D002944:Circumcision, Male; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004927:Escherichia coli Infections / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010413:Penis / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*