Adult male circumcision does not reduce the risk of incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis infection: results from a randomized, controlled trial in Kenya.
BACKGROUND
We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).


METHODS
We evaluated the incidence of STI among men aged 18-24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.


RESULTS
There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49-8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.


CONCLUSIONS
Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.
Mehta
Supriya D
SD
Department of Epidemiology, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA. supriyad@uic.edu
Moses
Stephen
S
Agot
Kawango
K
Parker
Corette
C
Ndinya-Achola
Jeckoniah O
JO
Maclean
Ian
I
Bailey
Robert C
RC
D000293:Adolescent; D000818:Animals; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D002692:Chlamydia trachomatis; D002944:Circumcision, Male; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009344:Neisseria gonorrhoeae; D016016:Proportional Hazards Models; D012307:Risk Factors; D014245:Trichomonas Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D014246:Trichomonas vaginalis; D055815:Young Adult