title: Male circumcision reduces penile high-risk human papillomavirus viral load in a randomised clinical trial in Rakai, Uganda.
abstract: OBJECTIVE
  Male circumcision reduces penile high-risk human papillomavirus (HR-HPV) prevalence in randomised trials. The goal of this study was to examine the effect of circumcision on HPV viral load among HPV-infected men in a randomised trial of male circumcision.
  
  
  METHODS
  In a randomised trial to assess the efficacy of circumcision on HIV acquisition in Rakai, Uganda, HIV-negative men were randomised to immediate (intervention) or delayed (control) circumcision and followed over 24 months. We performed quantitative-PCR HPV viral load assays on penile swabs which tested positive by Linear Array (LA) for six HR-HPV genotypes and estimated viral load in the remaining types by LA signal strength.
  
  
  RESULTS
  At 24 months, circumcision intervention arm men infected with one of the six selected HR-HPV genotypes had a lower viral load and significantly reduced HR-HPV high LA band intensity (PRR=0.61, 95% CI 0.43 to 0.86) compared to infected men in the control arm of the trial. The decreased viral load associated with circumcision was seen among HPV infections acquired after enrolment but not among infections that persisted from trial enrolment to 24 months (p=0.80).
  
  
  CONCLUSIONS
  The decreased penile HR-HPV shedding observed among HPV-infected circumcised men may help to explain the protective association observed between circumcision and reduced acquisition of HR-HPV in female partners.
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. lawilson@jhsph.edu
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Wilson
authors.forename: Patti
authors.initials: P
authors.lastname: Gravitt
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Stephen
authors.initials: S
authors.lastname: Watya
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000821:virology*; D010409:Penile Diseases / Q000517:prevention & control* / Q000821:virology*; D060888:Real-Time Polymerase Chain Reaction; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult