ResearchBlogging.orgThe best way to prevent sexually transmitted infections is the proper use of condoms. That being said, it’s not the only way to prevent STI’s. Abstinence is one way, but it involves an amputation of sorts—the removal of a critical human behavior. Another amputation (of sorts) that prevents STIs is circumcision. Male circumcision has been found in several good studies to reduce the rate of HIV transmission, and now a study out of Uganda shows a significant decrease in rates of genital herpes infections (HSV-2), human papilloma virus (HPV) infection (the strains that cause penile, cervical, and anal cancer), but no decrease in syphilis infection.

This study complements the our knowledge on the benefits of circumcision to prevent disease. The authors emphasize that circumcision alone is not sufficient, but may be a useful adjunct to prevent serious STIs. In fact, STI’s tend to travel together, and ulcerative diseases such as herpes increase transmission of HIV.

Now people get a little touchy about male circumcision. Despite the lack of data to show negative effects, there is a reasonable question to be asked as to whether the removal of the foreskin, whatever benefit may accrue, is worth any loss of sexual pleasure that may result. This is a tough outcome to study. Most males are circumcised as infants and know no different. However, a small study was published in the Journal of Urology a few years back that asked an interesting question: if you circumcise an adult male, what differences will he report? In the study published, they found that men reported decreased erectile function, decreased penile sensitivity, but increased satisfaction.

The study has its limitations of course, but what it did not find was a group of terribly unhappy men.

The science is quite clear; circumcision effectively prevents the transmission of a number of important diseases, and used in congress with condoms has a great potential to reduce the plagues killing millions of people yearly. What has yet to be answered is whether the human cost of circumcision, whatever that may be, justifies its use.

References

Aaron A.R. Tobian, M.D., Ph.D., David Serwadda, M.Med., M.P.H., Thomas C. Quinn, M.D., M.Sc., Godfrey Kigozi, M.B., Ch.B., M.P.H., Patti E. Gravitt, Ph.D., Oliver Laeyendecker, M.S., M.B.A., Blake Charvat, M.Sc., Victor Ssempijja, B.Stat., Melissa Riedese (2009). Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis The New England Journal of Medicine, 360 (13), 1298-1309

FINK, K., CARSON, C., & DEVELLIS, R. (2002). Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction The Journal of Urology, 167 (5), 2113-2116 DOI: 10.1016/S0022-5347(05)65098-7

Posted by Peter Lipson

Peter A. Lipson, MD is a practicing internist and teaching physician in Southeast Michigan.  After graduating from Rush Medical College in Chicago, he completed his Internal Medicine residency at Northwestern Memorial Hospital. He currently maintains a private practice, and serves as a teaching physician at a large community hospital He also maintains appointments as a Clinical Assistant Professor of Medicine at Wayne State University School of Medicine and at Oakland University William Beaumont School of Medicine, the first being a large, established medical school, the latter being a newly-formed medical school which will soon be accepting its first class of students.  He blogs at White Coat Underground at the Scientopia blog network. A primary goal of his writing is to illuminate the differences between science-based medicine and everything else.  His perspective as a primary care physician and his daily interaction with real patients gives him what he hopes is special insight into the current "De-lightenment" in medicine.  As new media evolve, pseudo-scientific, deceptive, and immoral health practices become more and more available to patients, making his job all that much more difficult---and all that much more interesting. Disclaimer: The views in all of of Dr. Lipson's writing are his alone.  They do not represent in any way his practice, hospital, employers, or anyone else. Any medical information is general and should not be applied to specific personal medical decisions.  Any medical questions should be directed to your personal physician.  Dr. Lipson will not answer any specific medical questions, and any emails and comments should be assumed public. Dr. Lipson receives no compensation for his writing. Dr. Lipson's posts for Science-Based Medicine are archived here.