November 7, 2006

Circumcised males are less likely than their uncircumcised peers to acquire a sexually transmitted infection, the findings of a 25-year New Zealand study suggest.

According to the report in the November issue of Paediatrics, circumcision may reduce the risk of acquiring and spreading such infections by up to 50%, which suggests "substantial benefits" for routine neonatal circumcision.

The current study is just one of many that have looked at this controversial topic. While most research has found that circumcision reduces the rates of HIV (the virus that causes AIDS), syphilis and genital ulcers, the results are more mixed for other STDs.

The American Academy of Paediatrics has called the evidence "complex and conflicting," and therefore concludes that, at present, the evidence is insufficient to support routine neonatal circumcision.

In the current study, the researchers analysed data collected for the Christchurch Health and Development Study, which included a large birth cohort of children from New Zealand. Males were divided into two groups based on circumcision status before 15 years of age. The presence of a sexually transmitted infection between 18 and 25 years of age was determined by questionnaire.

The 356 uncircumcised boys had a 2.66-fold increased risk of sexually transmitted infection compared with the 154 circumcised boys, lead author Dr David M Fergusson and colleagues, from the Christchurch School of Medicine and Health Sciences report.

Moreover, this elevated risk was largely unchanged after accounting for potential confounders, such as number of sexual partners and unprotected sex.

The authors estimate that had routine neonatal circumcision been in place, the rate of sexually transmitted infections in the current cohort would have been reduced by roughly 48%.

This analysis shows that the benefits of circumcision for reducing the risk of sexually transmitted infection "may be substantial," the authors conclude. "The public health issues raised by these findings clearly involve weighing the longer-term benefits of routine neonatal circumcision in terms of reducing risks of infection within the population, against the perceived costs of the procedure," they add.