Human Papillomavirus

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The human papillomavirus (HPV) is the most common STD in the U.S. It is known to cause genital warts, and it has been implicated as the cause of cervical cancer in women.

Prevention

Two vaccines have recently been developed to prevent HPV acquisition. In the past, circumcision was assumed to prevent the acquisition of HPV, thus reducing the risk of cervical cancer, but this was supported by dubious studies as outlined below.

Circumcision and HPV

The association of HPV transmission with circumcision has been a heavily debated topic for many years. As more recent studies enact more rigorous controls and use larger study groups, the association between circumcision and HPV has become more clear.

A classic 1993 study on HPV came up with the following conclusions:

"Uncircumcised men had a lower prevalence of genital warts than circumcised men... The presence of the foreskin may confer non specific protection of the proximal penis from acquisition of HPV infection." [1]

A meta-analysis Performed by D.r. Robert Van Howe in 2006 found no significant association between circumcision status and HPV infection.

"The medical literature does not support the claim that circumcision reduces the risk for genital HPV infection" [2]

Most studies on HPV performed before 2006 had poor controls and relatively small study groups. In order to clear up this confusion, a recent 2008 study on HPV had an enormous study group of almost nine thousand men in the United States. This is currently the largest study on circumcision and HPV ever performed in the U.S. And since the study was performed in the U.S., the results are directly applicable to people who live in the U.S. The study concluded:

"The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%)". [3]

A 2011 study on University of Washington students found no correlation between circumcision and HPV.[4] This study tested for HPV at three sites: the scrotum/shaft skin, the glans, and in urine samples. The authors of this study found that in circumcised men, the scrotum/shaft skin contained was most often the site of HPV infection. The authors also note that many large-scale studies fail to test for HPV on scrotum/shaft skin.

References

  1. Cook LS, Koutsky LA. Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993 Aug;69(4): 262-4 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195083/
  2. Van Howe, Robert S. (May 2007). "Human papillomavirus and circumcision: A meta-analysis". Journal of Infection 54 (5): 490–496.http://www.cirp.org/library/disease/cancer/vanhowe2006b/. Retrieved 2008-09-18.
  3. Dinh, T.H.; M. Sternberg, E.F. Dunne and L.E. Markowitz (April 2008). "Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999–2004". Sexually Transmitted Diseases 35 (4): 357–360.http://journals.lww.com/stdjournal/Fulltext/2008/04000/Seroepidemiology_of_Human_Papillomavirus_Type_11.8.aspx Retrieved 2011-03-5
  4. VanBuskirk, Kelley PhD; Winer, Rachel L. PhD; Hughes, James P. PhD; Feng, Qinghua PhD; Arima, Yuzo PhD; Lee, Shu-Kuang MS; Stern, Michael E. MN, ARNP; O'Reilly, Sandra F. BS; Koutsky, Laura A. PhD (December 2011). "Circumcision and Acquisition of Human Papillomavirus Infection in Young Men". Sexually Transmitted Diseases 38 (12). doi: 10.1097/OLQ.0b013e31822e60cb. "rates of acquiring clinically relevant HPV types... did not differ significantly by circumcision status". 

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