title: A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa.
abstract: OBJECTIVE
  Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa.
  
  
  METHODS
  This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities.
  
  
  RESULTS
  During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8-13 year olds. Median age was 15 years (IQR: 12-23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8-13, 14-18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8-13 years (OR = 5.9; 95% CI = 4.8-7.1) and 14-18 years (OR = 1.9; 95% CI = 1.5-2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4-2.7).
  
  
  CONCLUSIONS
  The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries.
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Hillary
authors.initials: H
authors.lastname: Mukudu
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Otwombe
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Fatima
authors.initials: F
authors.lastname: Laher
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Erica
authors.initials: E
authors.lastname: Lazarus
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Mmatsie
authors.initials: M
authors.lastname: Manentsa
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Limakatso
authors.initials: L
authors.lastname: Lebina
authors.affiliation: School of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Victor
authors.initials: V
authors.lastname: Mapulanga
authors.affiliation: School of Medicine, Copperbelt University, Ndola, Zambia.
authors.forename: Kasonde
authors.initials: K
authors.lastname: Bowa
authors.affiliation: Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Neil
authors.initials: N
authors.lastname: Martinson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002944:Circumcision, Male; D003430:Cross-Sectional Studies; D052816:Foreskin / Q000503:physiopathology / Q000601:surgery*; D005832:Genital Diseases, Male / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006678:HIV / Q000472:pathogenicity; D006801:Humans; D008297:Male; D010413:Penis / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult