title: Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis.
abstract: BACKGROUND
  We systematically reviewed the evidence for an association between male circumcision and Human Papillomavirus (HPV) infection and genital warts in men.
  
  
  METHODS
  PubMed and Embase were searched to 15 September 2010. The measure of effect was the adjusted odds ratio (OR) or rate ratio (RR) when present and the crude estimate otherwise. Random effects meta-analyses were used to calculate summary measures of effect.
  
  
  RESULTS
  We identified 23 papers about the association between circumcision and HPV DNA. Circumcised men were less likely to have prevalent genital HPV infection than uncircumcised men (summary OR, 0.57, 95% confidence interval [CI], 0.45-0.71) with between-study heterogeneity (P-heterogeneity = 0.006; I(2) = 50.5%; 19 studies). Similar summary associations were seen in clinical and methodological subgroups. The effect of circumcision was stronger at the glans/corona (OR, 0.47; 95% CI, 0.37-0.60) and urethra (OR, 0.35; 95% CI, 0.12-1.05) compared with sites more distal to the foreskin. There was weak evidence that circumcision was associated with decreased HPV incidence (summary RR, 0.75, 95% CI, 0.57-0.99; 3 studies) and increased HPV clearance (summary RR, 1.33; 95% CI, 0.89-1.98; 3 studies) but no evidence of an association with prevalent genital warts (OR, 0.93, 95% CI, 0.65-1.33; 15 studies).
  
  
  CONCLUSIONS
  Several countries are expanding access to voluntary medical male circumcision to reduce HIV prevalence. This could provide additional benefit in reducing HPV prevalence.
authors.affiliation: Medical Research Council Tropical Epidemiology Group, United Kingdom. natasha.larke@lshtm.ac.uk
authors.forename: Natasha
authors.initials: N
authors.lastname: Larke
authors.forename: Sara L
authors.initials: SL
authors.lastname: Thomas
authors.forename: Isabel
authors.initials: I
authors.lastname: Dos Santos Silva
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
mesh_terms: D002944:Circumcision, Male; D003218:Condylomata Acuminata / Q000453:epidemiology* / Q000517:prevention & control*; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D004279:DNA, Viral