title: Male circumcision and the incidence and clearance of genital human papillomavirus (HPV) infection in men: the HPV Infection in men (HIM) cohort study.
abstract: BACKGROUND
  Reported associations of male circumcision (MC) with human papillomavirus (HPV) infection in men have been inconsistent.
  
  
  METHODS
  4,033 healthy men were examined every six months for a median of 17.5 months. In each study visit, exfoliated cell specimens from the coronal sulcus/glans penis, penile shaft, and scrotum were collected and combined into one sample per person for HPV DNA detection. Samples were tested for 37 HPV types. Cox proportional hazards models were used to evaluate the association between MC and the incidence and clearance of HPV infections and specific genotypes.
  
  
  RESULTS
  The overall incidence of new HPV infections did not differ by MC status (for any HPV, adjusted hazard ratio (aHR) 1.08, 95% confidence interval (CI) 0.91-1.27). However, incidence was significantly lower among circumcised versus uncircumcised men for HPV types 58 (p = 0.01), 68 (p < 0.001), 42 (p = 0.01), 61 (p < 0.001), 71 (p < 0.001), 81 (p = 0.04), and IS39 (p = 0.01), and higher for HPV types 39 (p = 0.01) and 51 (p = 0.02). Despite the lack of an overall association in the risk of HPV clearance by MC (for any HPV, aHR 0.95, 95% CI 0.88-1.02), median times to clearance were significantly shorter among circumcised than uncircumcised men for HPV types 33 (p = 0.02) and 64 (p = 0.04), and longer for HPV types 6 (p < 0.001), 16 (p < 0.001), and 51 (p = 0.02).
  
  
  CONCLUSIONS
  MC is not associated with the incidence and clearance of genital HPV detection, except for certain HPV types. The use of a single combined sample from the penis and scrotum for HPV DNA detection likely limited our ability to identify a true effect of MC at the distal penis.
authors: Ginesa
authors: G
authors: Albero
authors: Xavier
authors: X
authors: Castellsagué
authors: Hui-Yi
authors: HY
authors: Lin
authors: William
authors: W
authors: Fulp
authors: Luisa L
authors: LL
authors: Villa
authors: Eduardo
authors: E
authors: Lazcano-Ponce
authors: Mary
authors: M
authors: Papenfuss
authors: Martha
authors: M
authors: Abrahamsen
authors: Jorge
authors: J
authors: Salmerón
authors: Manuel
authors: M
authors: Quiterio
authors: Alan G
authors: AG
authors: Nyitray
authors: Beibei
authors: B
authors: Lu
authors: F Xavier
authors: FX
authors: Bosch
authors: H, Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. Anna.Giuliano@moffitt.org.
authors: Anna R
authors: AR
authors: Giuliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002944:Circumcision, Male; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis*; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D010413:Penis / Q000821:virology*; D016016:Proportional Hazards Models; D012611:Scrotum / Q000821:virology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D004279:DNA, Viral