By: Dr. Geoffrey Modest
The CDC just came out with final recommendations targeting provider counseling regarding male circumcision (not yet available on the CDC website). The focus of these recommendations is to help with prevention of HIV, sexually transmitted infections (STIs), etc.
They note the following:
–The final decision about male circumcision is not only based on health considerations, but includes a variety of social, cultural, ethical and religious considerations
–3 African studies (with very high baseline prevalence of HIV) have shown a 50-60% decreased risk of HIV transmission with circumcision of men engaged in penile-vaginal sex. Additionally, there was a 30% decreased transmission of HSV-2 (herpes simplex virus type-2) and HPV (human papilloma virus). Note: most new HIV infections in the US occur in men who have sex with men (MSM), for which there are no data that circumcision is effective.
Their formal recommendations:
–HIV risk assessment should be done on all who are at risk of acquiring HIV from heterosexual sex (though seems to me that this should include homosexual sex……)
–Adolescents and men having heterosexual sex should be informed that circumcision reduces but does not eliminate potential transmission of HIV and other STIs, though there are no data for oral or anal sex. Also no data that circumcision reduces risk of transmission to women (though in the US, 10% of new HIV infections are from women to men, so the data suggest these men may benefit)
–After circumcision, avoid sex until the wound is healed
–Although some epidemiologic data suggest protection by circumcision for MSM who have insertive rectal sex, there are no convincing data to confirm this, and it is biologically unlikely that there is any protection for the anal-receptive partner
–Risks and benefits of circumcision should be reviewed with patient
–In terms of neonatal circumcision, parents should know that circumcised males are less likely to get urinary tract infections (which are pretty uncommon, anyway), balanitis, HIV/STIs as above, penile cancer (also uncommon) and possibly prostate cancer
–Timing of neonatal circumcision: parents should know that neonatal circumcision is safer and heals more rapidly than when done in older boys and men, and costs less. though most of benefits are after the male is sexually active
–Complications: in newborns up to age 9, <0.5% and mostly bleeding/inflammation/need for corrective procedures. In those >10yo, 5% with complications as above and penile wounds. The American Academy of Pediatrics taskforce states that benefits outweigh risks for families who desire it.
