Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya.
OBJECTIVE
To develop a standard procedure for male circumcision in a resource-poor medical setting and prospectively evaluate the outcome in a randomized, controlled trial with the incidence of human immunodeficiency virus (HIV) as the main outcome, as studies suggest that circumcision is associated with a lower incidence of HIV and other sexually transmitted infections in high-risk populations.


METHODS
Healthy, uncircumcised, HIV-seronegative men aged 18-24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on "usual" medical procedures in Western Kenya. The follow-up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomization.


RESULTS
Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events judged definitely, probably or possibly related to the procedure. The most common adverse events were wound infections (1.3%), bleeding (0.8%), and delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of participants reported being very satisfied with the procedure; approximately 23% reported having had sex and 15% reported that their partners had expressed an opinion, all of whom were very satisfied with the outcome. About 96% of the men resumed normal general activities within the first week after the procedure.


CONCLUSIONS
Safe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public-health measure.
Krieger
John N
JN
Department of Urology, University of Washington, Box 356510, Seattle, WA 98195, USA. jkrieger@u.washington.edu
Bailey
Robert C
RC
Opeya
John
J
Ayieko
Benard
B
Opiyo
Felix
F
Agot
Kawango
K
Parker
Corette
C
Ndinya-Achola
Jeckoniah O
JO
Magoha
George A O
GA
Moses
Stephen
S
D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000379:methods*; D003906:Developing Countries; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007630:Kenya; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D013530:Surgical Wound Infection; D016896:Treatment Outcome