Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Protection for women A study in Uganda observed lower rates of male-to-female transmission of HIV if the man was circumcised. 13 Among 47 couples in which the circumcised male partner was infected with HIV and whose viral load was below 50 000 copies per ml, none of the female partners became infected in two years. By contrast, 26 of the 147 women whose HIV-infected partners were not circumcised became infected. A subsequent randomized controlled trial of circumcision among men with HIV infection did not confirm this result. It showed there might be a higher risk of HIV transmission to women in the first two years after the operation. 22 A further observational study has shown a 40% lower risk of HIV infection in couples where the male partner was infected and the female partner not infected with HIV, but the reduction in risk was not significant. 23 Other health benefits of circumcision A multicountry study 24 found a lower prevalence of human papillomavirus (HPV) infection in circumcised men than in uncircumcised men. HPV infection is a necessary causal factor for cervical cancer and is associated with an increased risk of cancer of the vulva, vagina and anus in women, and of the penis and anus in men. Prospective studies have shown that circumcised men are less likely to have HPV infection. 25,26,27 The incidence of invasive penile cancer is significantly lower in circumcised men than in uncircumcised men, though this condition is extremely rare. 28,10 Acceptability of circumcision among African men Surveys and qualitative studies among young as well as older men in six African countries have found that a considerable proportion expressed interest in circumcision, ranging from 45% in Harare, Zimbabwe, to over 80% in a large survey in Botswana. 29 These studies indicate that many men would willingly undergo circumcision if it could be performed safely and at reasonable cost. In the surveys, the men reported that their main interest in circumcision was related to hygiene, infection control and, for some, a belief that condom use is easier for men who are circumcised. Male circumcision and HIV infection Chapter 1-6
Male circumcision under local anaesthesia Version 3.1 (Dec09) REFERENCES 1 Wiswell TE, Hachey WE. Urinary tract infections and the uncircumcised state. Clin Pediatr 1993; 32: 130-4. 2 Nasio JM et al. Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status. Int J STD AIDS 1996; 7: 410-414. 3 Cook LS, Koutsky LA, Holmes KK. Circumcision and sexually transmitted diseases. Am J Public Health 1994; 84: 197-201. 4 Krieger J et al. Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. BJU International 2005; 96: 1109-1113. 5 Weiss H, Quigley M, Hayes R. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000; 14: 2361-2370. 6 Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Medicine 2005;2(11):e298. 7 Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007;369:643- 656. 8 Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007; 369: 657-666. 9 American Academy of Pediatrics. Report of the task force on circumcision. Pediatrics 1989; 84: 388-391. 10 Dodge OG, Kaviti JN. Male circumcision among the peoples of East Africa and the incidence of genital cancer. East Afr Med J 1965; 42: 98-105. 11 Agarwal SS et al. Role of male behavior in cervical carcinogenesis among women with one lifetime sexual partner. Cancer 1993; 72: 166-169. 12 World Health Organization and Joint United Nations Programme on AIDS. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. World Health Organization, Geneva, 2007 (http://www.who.int/hiv/mediacentre/news68/en/index.html) 13 Gray RH, Kiwanuka N, Quinn TC et al. Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda. Rakai Project Team. AIDS 2000;14:2371-81. 14 Auvert B, Buve A, Ferry B, Carael M, Morison L, Lagarde E et al. Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection. AIDS 2001;15:S15-30. 15 Halperin DT, Bailey RC. Male circumcision and HIV infection: 10 years and counting. Lancet 1999;354:1813-1815. 16 2006 Report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2006. 17 Reynolds SJ et al. Male circumcision and risk of HIV-1 and other sexually transmitted infections in India. Lancet 2004; 363(9414):1039-40. 18 Soilleux EJ, Coleman N. Expression of DC-SIGN in human foreskin may facilitate sexual transmission of HIV. J Clin Pathol 2004; 57: 77-78. 19 Hussain LA, Lehner T. Comparative investigation of Langerhans cells and potential receptors for HIV in oral, genitourinary and rectal epithelia. Immunology 1995; 85: 475-484. 20 Estrada CR et al. Biologic mechanisms of HIV infection of human foreskin: Implications for transmission. J Urol 2002; 147 (Suppl 4). 21 Patterson BK et al. Susceptibility to human immunodeficiency virus-1 infection of human foreskin and cervical tissue grown in explant culture. Am J. Path. 2002; 161: 876-873. 22 Wawer MJ, Makumbi F, Kigozi G, et al. ircumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009; 374(9685): 229-237. 23 Baeten JM, Donnell D, Kapiga SH, et al. Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples. AIDS 2010;24(5):737-744. 24 Travis JW. Male circumcision, penile human papillomavirus infection, and cervical cancer [letter]. New Engl. J Med 2002;346:1105-12. 25 Serwadda D, Wawer MJ, Makumbi F, et al. Circumcision of HIV-infected men: Effects on high-risk human papillomavirus infections in a randomized trial in Rakai, Uganda. Journal of Infectious Diseases 2010;201. 26 Smith JS, Moses S, Hudgens MG, et al. Increased risk of HIV acquisition among Kenyan men with human papillomavirus infection. JID 2010;201(11). 27 Gray RH, Serwadda D, Kong X, et al. Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: A randomized trial in Rakai, Uganda. Journal of Infectious Diseases 2010;201. Male circumcision and HIV infection Chapter 1-7
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