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Wednesday, June 17, 2009

Circumcision

Published Online First: 15 December 2008. doi:10.1136/sti.2008.032334
Sexually Transmitted Infections 2009;85:116-120
Copyright © 2009 by the BMJ Publishing Group Ltd.

EPIDEMIOLOGY

Male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis: observations after a randomised controlled trial for HIV prevention

J Sobngwi–Tambekou1, D Taljaard2, M Nieuwoudt3, P Lissouba1, A Puren3 and B Auvert4

1 INSERM U687, Hôpital Paul Brousse, Villejuif, France
2 Progressus, Johannesburg, South Africa
3 National Institute for Communicable Diseases, Johannesburg, South Africa
4 INSERM U687, Assistance Publique-Hôpitaux de Paris, University of Versailles, France

Correspondence to:
Dr Bertran Auvert, INSERM U687, 12 avenue Paul Vaillant-Couturier, 94804 Villejuif Cedex, France; bertran.auvert@uvsq.fr

Objective: To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial.

Methods: We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18–24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression.

Results: In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030).

Conclusions: This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.

Trial registration number: NCT00122525.

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