|
Effect of male circumcision on human papilloma virus, neisseria gonorrhoeae and trichomonas vaginalis infections in men: results from a randomized controlled trial
Presented by Dirk Taljaard, South Africa.
B. Auvert1, J. Sobngwi –Tambekou1, A. Puren2, M. Nieuwoudt2, E. Cutler2, P. Lissouba1, D. Taljaard3
1INSERM, Paris, France, 2NICD, Johannesburg, South Africa, 3Progressus, Johannesburg, South Africa
Background: Male circumcision (MC) is an effective prevention approach to reduce the acquisitions of HIV and HSV-2 by men in Africa. The objective of this study was to assess the effect of MC on High-Risk Human Papilloma virus (HR-HPV), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) infections using data from a MC randomized controlled trial (RCT).
Methods: Data were collected during the MC trial conducted in Orange Farm (ANRS-1265, South Africa) among men aged 18 to 24. Urethral swabs and urine samples were collected among circumcised and uncircumcised participants reporting for the last follow-up visit. Samples were analyzed using PCR. HR-HPV, NG and TV prevalences were assessed using intention-to-treat (ITT) and as-treated (AT) analyses. Univariate and multivariate logistic regressions were conducted using ethnic group, age, education, sexual behavior, marital status, condom use and HIV status as covariates.
Results: The ITT and AT analyses demonstrated that MC had a protective effect on HR-HPV prevalence (OR:0.57; 95%CI:0.43-0.75; p<.001 and OR:0.52; 95%CI:0.39-0.69; p<.001, respectively). In the ITT analysis, MC had a borderline effect on TV infection (OR:0.54; 95%CI:0.29-1.03; p=.062). This effect became significant in the AT analysis (OR:0.49; 95%CI:0.25-0.93; p=.030). The OR and p-values given by the multivariate analyses were similar. There was no evidence of a protective effect of MC on NG infection.
Conclusions: This study demonstrated for the first time that MC reduces the heterosexual risk of HR-HPV and TV infections among men. This finding explains why women with circumcised partners are less at risk of HR-HPV and TV infections. This study reinforces the need to roll-out MC in Africa.
|