Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa.
BACKGROUND
A causal association links high-risk human papillomavirus (HR-HPV) and cervical cancer, which is a major public health problem. The objective of the present study was to investigate the association between male circumcision (MC) and the prevalence of HR-HPV among young men.


METHODS
We used data from a MC trial conducted in Orange Farm, South Africa, among men aged 18-24 years. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios (PRRs) were assessed using univariate and multivariate log Poisson regression.


RESULTS
In an intention-to-treat analysis, the prevalences of HR-HPV among the intervention and control groups were 14.8% (94/637) and 22.3% (140/627), respectively, with a PRR of 0.66 (0.51-0.86) (P = .002). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results.


CONCLUSIONS
This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women.
Auvert
Bertran
B
Assistance Publique-Hôpitaux de Paris, University of Versailles, France. Bertran.auvert@uvsq.fr
Sobngwi-Tambekou
Joelle
J
Cutler
Ewalde
E
Nieuwoudt
Marthi
M
Lissouba
Pascale
P
Puren
Adrian
A
Taljaard
Dirk
D
D000293:Adolescent; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior / Q000502:physiology; D013019:South Africa / Q000453:epidemiology; D014521:Urethra / Q000821:virology; D055815:Young Adult