title: Male circumcision and anatomic sites of penile high-risk human papillomavirus in Rakai, Uganda.
abstract: Male circumcision (MC) reduces penile high-risk human papillomavirus (HR-HPV) on the coronal sulcus and urethra. HR-HPV varies by anatomic site, and it is unknown whether MC decreases HR-HPV on the penile shaft. We assessed the efficacy of MC to reduce HR-HPV on the penile shaft and compared it to known efficacy of MC to reduce HR-HPV on the coronal sulcus. HIV-negative men randomized to receive immediate circumcision (intervention) or circumcision delayed for 24 months (control) were evaluated for HR-HPV at 12 months postenrollment using the Roche HPV Linear Array assay. Among swabs with detectable β-globin or HPV, year 1 HR-HPV prevalence on the coronal sulcus was 21.5% in the intervention arm and 36.3% in the control arm men [adjusted prevalence risk ratios (PRRs) = 0.57, 95% CI 0.39-0.84, p = 0.005]. On the shaft, year 1 HR-HPV prevalence was 15.5% in the intervention and 23.8% in the control arm (adjusted PRR = 0.66, 95% CI 0.39-1.12, p = 0.12). Efficacy of MC to reduce HR-HPV on the shaft was similar to efficacy on the coronal sulcus (p = 0.52). In a sensitivity analysis in which swabs without detectable β-globin or HPV were included as HPV negative, prevalence of HR-HPV on the shaft was lower in the intervention arm (7.8%) than control arm (13.6%; PRR 0.57, 95% CI 0.33-0.99, p < 0.05). HR-HPV was more frequently detected on the coronal sulcus than penile shaft among uncircumcised men (36.3% vs. 23.8%, respectively, p = 0.02) and circumcised men (21.5% vs. 15.5%, respectively, p = 0.24). MC reduced HR-HPV prevalence on both the coronal sulcus and shaft.
authors.affiliation: Department of Pathology, Johns Hopkins University, Baltimore, MD, USA. atobian1@jhmi.edu
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Kong
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Eaton
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Amy E
authors.initials: AE
authors.lastname: Oliver
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Frederick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Chen
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology*; D010413:Penis / Q000033:anatomy & histology* / Q000821:virology*; D015995:Prevalence; D014454:Uganda