Male Foreskin Size Can Affect Risk of HIV Infection - Study finds larger foreskin surface area linked to higher risk of infection

Male Foreskin Size Can Affect Risk of HIV Infection - Study finds larger foreskin surface area linked to higher risk of infection - ModernMedicine

ModernMedicine ModernMedicine Community

HOT TOPICS: Cardiometabolic Disorders & Weight · Liability & Risk Management· Health Care IT

Godfrey Kigozi, M.D., from Rakai Health Sciences Program in Entebbe, Uganda, and colleagues examined the association between foreskin surface area and HIV acquisition among 965 initially HIV-negative men who were enrolled in randomized trials of male circumcision. Men were circumcised either immediately or after two years.

The researchers found that 48 men became infected with HIV before circumcision. The mean surface area was significantly larger for men who seroconverted (43.3 versus 36.8 cm²). HIV incidence increased with increasing foreskin surface area, from 0.80 per 100 person-years for the lowest quartile to 2.48 per 100 person-years for the highest quartile. After adjusting for age and other factors, the adjusted incidence rate ratio for HIV infection was 2.37 for the highest compared with the lowest quartile of foreskin surface area.

"A larger foreskin surface area was associated with an increased risk of HIV acquisition, which suggests that providers should avoid leaving excess residual foreskin tissue after circumcision," Kigozi and colleagues conclude. "These observations strongly suggest that larger foreskin size is a risk factor for HIV acquisition in uncircumcised men."

Abstract
Full Text (subscription or payment may be required)

Comments from our Readers

Mark Lyndon / Manchester, ZZ, UNITED KINGDOM
Posted 2009-10-29 15:16:27.0
So when will the studies start on the size of female genitalia with a view to cutting parts of them off? Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The one study into male-to-female transmission showed a 50% higher rate in the group where the men had been circumcised btw. ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

TLC Tugger / Chicago, IL, UNITED STATES
Posted 2009-10-30 13:50:57.0
Isn't foreskin size just a proxy for penis size? Isn't a large penis possibly correlated to the number of partners available or sought? How about the fact that large condoms may be hard to find? Most of the world does not circumcise. Most of the US men who have died of AIDS were circumcised at birth. HIV is more rare in non-cutting Sweden than in mostly-cut Israel.

Hugh7 / NEW ZEALAND
Posted 2009-10-30 18:13:54.0
As usual with studies promoting circumcision, there are problems: did they control for penis size? Unsurprisingly, bigger foreskins are usually found (or in this case, taken from) bigger penises. Do men with bigger penises have more trouble using condoms? Do they have more confidence and hence more sex? Either could account for the correlation Kigozi et al. found. Like the rest of the handful of researchers who have published most of the studies demonising the foreskin, Kigozi at al. apparently want to promote circumcision, but perhaps that tends to narrow their focus. For example they cut short their study about male transmission to women (Lancet 374;9685, pp 229-37) before it reached statistical significance. With 18% of the women with circumcised partners becoming HIV+ compared to only 12% of the partners of intact men, it looked as though it was going to show that circumcising men _increased_ the risk to women.

SITE TOOLS

Featured Jobs

Clinical Perspectives

Business Perspectives

Popular Topics