title: Longer-Term Follow-Up of Kenyan Men Circumcised Using the ShangRing Device.
abstract: OBJECTIVE
  To ascertain clinical sequelae, client satisfaction and sexual behavior 2+ years after male circumcision using the ShangRing device.
  
  
  METHODS
  We enrolled 199 men from the Kenya sites (Homa Bay district) participating in a 2012 study of the ShangRing device used in routine male circumcision services (N = 552). We enrolled men who had had the ShangRing placed successfully, and over-sampled men who had had an adverse event and/or were HIV-positive during the field study. In the present study, each participant was examined and interviewed by a study clinician, and penile photographs were taken to document longer-term cosmetic results and any abnormal findings.
  
  
  RESULTS
  194 men were included in the analysis. The mean and median times between circumcision and the longer-term follow-up visit in this study were 31.8 and 32 months, respectively. Four men (2.1%) had signs/symptoms of a sexually transmitted infection (STI). Virtually all (99.5%) of the men were very satisfied with the appearance of their circumcised penis, and all would recommend a ShangRing circumcision to friends or family members. The most prevalent reported advantage of the circumcision was the ease of bathing and enhanced cleanliness of the penis (75.8%). 94.3% of the men did not cite a single negative feature of their circumcision. 87.5% of men reported more sexual pleasure post-MC, the most common reason being more prolonged intercourse. The majority of men (52.6%) reported one sexual partner post-MC, but more than a quarter of the men (28.1%) reported an increased number of partners post-MC. Less than half of the men (44.3%) reported using condoms half of the time or more, but the great majority of condom users stated that condom use was much easier post-MC, and 76.9% of users said they used condoms more after circumcision than before.
  
  
  CONCLUSIONS
  This study supports the safety and acceptability of ShangRing male circumcision during 2-3 years of follow-up. It should allay worries that the ShangRing procedure could lead to delayed complications later than the observation period of most clinical studies.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01567436.
authors.affiliation: FHI 360, Durham, North Carolina, United States of America.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Feldblum
authors.affiliation: Homa Bay District Hospital, Homa Bay, Kenya.
authors.forename: Jairus
authors.initials: J
authors.lastname: Okech
authors.affiliation: Homa Bay District Hospital, Homa Bay, Kenya.
authors.forename: Rolex
authors.initials: R
authors.lastname: Ochieng
authors.affiliation: FHI 360, Durham, North Carolina, United States of America.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hart
authors.affiliation: Homa Bay District Hospital, Homa Bay, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Kiyuka
authors.affiliation: FHI 360, Durham, North Carolina, United States of America.
authors.forename: Jaim Jou
authors.initials: JJ
authors.lastname: Lai
authors.affiliation: FHI 360, Nairobi, Kenya.
authors.forename: Valentine
authors.initials: V
authors.lastname: Veena
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007630:Kenya; D008297:Male; D017060:Patient Satisfaction; D010413:Penis / Q000033:anatomy & histology / Q000601:surgery*; D010549:Personal Satisfaction; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control