title: Male Circumcision and STI Acquisition in Britain: Evidence from a National Probability Sample Survey.
abstract: BACKGROUND
  It is well-established that male circumcision reduces acquisition of HIV, herpes simplex virus 2, chancroid, and syphilis. However, the effect on the acquisition of non-ulcerative sexually transmitted infections (STIs) remains unclear. We examined the relationship between circumcision and biological measures of three STIs: human papillomavirus (HPV), Chlamydia trachomatis and Mycoplasma genitalium.
  
  
  METHODS
  A probability sample survey of 15,162 men and women aged 16-74 years (including 4,060 men aged 16-44 years) was carried out in Britain between 2010 and 2012. Participants completed a computer-assisted personal interview, including a computer-assisted self-interview, which asked about experience of STI diagnoses, and circumcision. Additionally, 1,850 urine samples from sexually-experienced men aged 16-44 years were collected and tested for STIs. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR) to quantify associations between circumcision and i) self-reporting any STI diagnosis and ii) presence of STIs in urine, in men aged 16-44 years, adjusting for key socio-demographic and sexual behavioural factors.
  
  
  RESULTS
  The prevalence of circumcision in sexually-experienced men aged 16-44 years was 17.4% (95%CI 16.0-19.0). There was no association between circumcision and reporting any previous STI diagnoses, and specifically previous chlamydia or genital warts. However, circumcised men were less likely to have any HPV type (AOR 0.26, 95% confidence interval (CI) 0.13-0.50) including high-risk HPV types (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and/or 68) (AOR 0.14, 95% CI 0.05-0.40) detected in urine.
  
  
  CONCLUSIONS
  Circumcised men had reduced odds of HPV detection in urine. These findings have implications for improving the precision of models of STI transmission in populations with different circumcision prevalence and in designing interventions to reduce STI acquisition.
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Virginia
authors.initials: V
authors.lastname: Homfray
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Miller
authors.affiliation: Virus Reference Department, Public Health England, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Beddows
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Field
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Kaye
authors.initials: K
authors.lastname: Wellings
authors.affiliation: Virus Reference Department, Public Health England, London, United Kingdom.
authors.forename: Kavita
authors.initials: K
authors.lastname: Panwar
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012494:Sampling Studies; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult