title: Male circumcision and risk of HIV-1 and other sexually transmitted infections in India.
abstract: Circumcised men have a lower risk of HIV-1 infection than uncircumcised men. Laboratory findings suggest that the foreskin is enriched with HIV-1 target cells. However, some data suggest that circumcision could simply be a marker for low-risk behaviours. In a prospective study of 2298 HIV-uninfected men attending sexually transmitted infection clinics in India, we noted that circumcision was strongly protective against HIV-1 infection (adjusted relative risk 0.15; 95% CI 0.04-0.62; p=0.0089); however, we noted no protective effect against herpes simplex virus type 2, syphilis, or gonorrhoea. The specificity of this relation suggests a biological rather than behavioural explanation for the protective effect of male circumcision against HIV-1.
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University Medical School, Ross 1150, 720 Rutland Avenue, Baltimore, Maryland 21205, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Mary E
authors.initials: ME
authors.lastname: Shepherd
authors.forename: Arun R
authors.initials: AR
authors.lastname: Risbud
authors.forename: Raman R
authors.initials: RR
authors.lastname: Gangakhedkar
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Brookmeyer
authors.forename: Anand D
authors.initials: AD
authors.lastname: Divekar
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mehendale
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D002944:Circumcision, Male / Q000706:statistics & numerical data; D015331:Cohort Studies; D006069:Gonorrhea / Q000453:epidemiology; D006558:Herpes Genitalis / Q000453:epidemiology / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1; D007194:India / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D013587:Syphilis / Q000453:epidemiology