title: Male circumcision decreases high-risk human papillomavirus viral load in female partners: a randomized trial in Rakai, Uganda.
abstract: Male circumcision (MC) reduces high-risk human papillomavirus (HR-HPV) infection in female partners. We evaluated the intensity of HR-HPV viral DNA load in HIV-negative, HR-HPV-positive female partners of circumcised and uncircumcised men. HIV-negative men and their female partners were enrolled in randomized trials of MC in Rakai, Uganda. Vaginal swabs were tested for HR-HPV genotypes by Roche HPV Linear Array which provides a semi-quantitative measure of HPV DNA by the intensity of genotype-specific bands (graded:1-4). We assessed the effects of MC on female HR-HPV DNA load by comparing high intensity linear array bands (3-4) to low intensity bands (1-2) using an intention-to-treat analysis. Prevalence risk ratios (PRR) of high intensity bands in partners of intervention versus control arm men were estimated using log-binomial regression with robust variance. The trial included 335 women with male partners in the intervention arm and 340 in the control arm. At enrollment, the frequency of HR-HPV high intensity linear array bands was similar in both study arms. At 24 months follow-up, the prevalence of high intensity bands among women with detectable HR-HPV was significantly lower in partners of intervention arm (42.7%) than control arm men (55.1%, PRR = 0.78, 95% CI 0.65-0.94, p = 0.02), primarily among incident HR-HPV infections (PRR = 0.66, 95% CI 0.50-0.87, p = 0.003), but not persistent infections (PRR = 1.02, 95% CI 0.83-1.24). Genotypes with high HR-HPV band intensity were more likely to persist (adjHR = 1.27 95% CI 1.07-1.50), irrespective of male partner circumcision status. MC reduces HR-HPV DNA load in newly infected female partners.
authors: Department of Gynecology Oncology, Moores Cancer Center, UCSD, La Jolla, CA, USA.
authors: Mitzie-Ann
authors: MA
authors: Davis
authors: Ronald H
authors: RH
authors: Gray
authors: Mary K
authors: MK
authors: Grabowski
authors: David
authors: D
authors: Serwadda
authors: Godfrey
authors: G
authors: Kigozi
authors: Patti E
authors: PE
authors: Gravitt
authors: Fred
authors: F
authors: Nalugoda
authors: Stephen
authors: S
authors: Watya
authors: Maria J
authors: MJ
authors: Wawer
authors: Thomas C
authors: TC
authors: Quinn
authors: Aaron A R
authors: AA
authors: Tobian
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D012306:Risk; D014454:Uganda; D019562:Viral Load
keywords: HIV; Uganda; cervical cancer; human papillomavirus; linear array band intensity; male circumcision; sexually transmitted infections; viral load; viral shedding
references: JAMA. 2011 Oct 5;306(13):1479-80
references: 21972310
references: J Infect Dis. 2010 May 15;201(10):1455-62
references: 20370483
references: N Engl J Med. 2002 Apr 11;346(15):1105-12
references: 11948269
references: J Infect Dis. 2009 Dec 1;200(11):1789-97
references: 19848609
references: Lancet. 2007 Feb 24;369(9562):657-66
references: 17321311
references: Int J Cancer. 2009 Mar 15;124(6):1251-7
references: 19089913
references: Int J Cancer. 2012 Apr 15;130(8):1888-97
references: 21618520
references: J Clin Invest. 2011 Dec;121(12):4593-9
references: 22133884
references: Sex Transm Infect. 2013 May;89(3):262-6
references: 23112341
references: J Infect Dis. 1999 Oct;180(4):1316-9
references: 10479163
references: Lancet. 2011 Jan 15;377(9761):209-18
references: 21216000
references: Int J Cancer. 2011 Dec 15;129(12):2970-5
references: 21462185
references: AIDS. 2012 Jul 31;26(12):1555-65
references: 22441255
references: Future Microbiol. 2011 Jul;6(7):739-45
references: 21797689
references: Lancet. 2000 Jun 24;355(9222):2194-8
references: 10881892
references: N Engl J Med. 2009 Mar 26;360(13):1298-309
references: 19321868
references: Lancet Infect Dis. 2007 Jul;7(7):453-9
references: 17597569
references: Int J Cancer. 2003 Sep 1;106(3):396-403
references: 12845680
references: J Infect Dis. 2004 Jul 1;190(1):37-45
references: 15195241
references: Int J Cancer. 2010 Dec 15;127(12):2893-917
references: 21351269
references: Clin Infect Dis. 2005 Sep 1;41(5):612-20
references: 16080082
references: N Engl J Med. 2003 Feb 6;348(6):518-27
references: 12571259
references: J Infect Dis. 2009 Jan 1;199(1):14-9
references: 19086814
references: J Clin Microbiol. 2012 May;50(5):1564-70
references: 22337992
references: Lancet Oncol. 2005 Apr;6(4):204
references: 15830458