title: Male circumcision for the prevention of HSV-2 and HPV infections and syphilis.
abstract: BACKGROUND
  Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men.
  
  
  METHODS
  We enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2-seronegative at enrollment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, we tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months.
  
  
  RESULTS
  At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P=0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P=0.44).
  
  
  CONCLUSIONS
  In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure. (ClinicalTrials.gov numbers, NCT00425984 and NCT00124878.)
authors.affiliation: Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Godfrey
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authors.lastname: Kigozi
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.forename: Blake
authors.initials: B
authors.lastname: Charvat
authors.forename: Victor
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authors.lastname: Ssempijja
authors.forename: Melissa
authors.initials: M
authors.lastname: Riedesel
authors.forename: Amy E
authors.initials: AE
authors.lastname: Oliver
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Nowak
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Chen
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray