Male circumcision and women's risk of incident chlamydial, gonococcal, and trichomonal infections.
BACKGROUND
Male circumcision (MC) decreases the risk of human immunodeficiency virus (HIV) acquisition in men. We explored associations between MC of the primary sex partner and women's risk of acquisition of chlamydial (Ct), gonococcal (GC), or trichomonal (Tv) infections.


METHODS
We analyzed data from a prospective study on hormonal contraception and incident human immunodeficiency virus/sexually transmitted infection (STI) among women from Uganda, Zimbabwe, and Thailand. At enrollment and each follow-up visit, we collected endocervical swabs for polymerase chain reaction identification of Ct and GC; Tv was diagnosed by wet mount. Using Cox proportional hazards models, we compared time to STI acquisition for women according to their partner's MC status.


RESULTS
Among 5925 women (2180 from Uganda, 2228 from Zimbabwe, and 1517 from Thailand), 18.6% reported a circumcised primary partner at baseline, 70.8% reported an uncircumcised partner, and 9.7% did not know their partner's circumcision status. During follow-up, 408, 305, and 362 participants had a first incident Ct, GC, or Tv infection, respectively. In multivariate analysis, after controlling for contraceptive method, age, age at coital debut, and country, the adjusted hazard ratio (HR) comparing women with circumcised partners with those with uncircumcised partners for Ct was 1.25 [95% confidence interval (CI) 0.96-1.63]; for GC, adjusted HR 0.99 (95% CI 0.74-1.31); for Tv, adjusted HR 1.05 (95% CI 0.80-1.36), and for the 3 STIs combined, adjusted HR 1.02 (95% CI 0.85-1.21).


CONCLUSIONS
MC was not associated with women's risk of acquisition of Ct, GC, or Tv infection in this cohort.
Turner
Abigail Norris
AN
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC 27599-7435, USA. ant@unc.edu
Morrison
Charles S
CS
Padian
Nancy S
NS
Kaufman
Jay S
JS
Behets
Frieda M
FM
Salata
Robert A
RA
Mmiro
Francis A
FA
Chipato
Tsungai
T
Celentano
David D
DD
Rugpao
Sungwal
S
Miller
William C
WC
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002692:Chlamydia trachomatis; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D013785:Thailand / Q000453:epidemiology; D014245:Trichomonas Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D014454:Uganda / Q000453:epidemiology; D016387:Women's Health; D015030:Zimbabwe / Q000453:epidemiology