Male circumcision and STI acquisition in Britain: Evidence from a national probability sample survey

Virginia Homfray, Clare Tanton, Robert F. Miller, Simon Beddows, Nigel Field, Pam Sonnenberg, Kaye Wellings, Kavita Panwar, Anne M. Johnson, Catherine H. Mercer

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)

Abstract

Background It is well-established that male circumcision reduces acquisition of HIV, herpes simplex virus 2, chancroid, and syphilis. However, the effect on the acquisition of non-ulcerative sexually transmitted infections (STIs) remains unclear. We examined the relationship between circumcision and biological measures of three STIs: Human papillomavirus (HPV), Chlamydia trachomatis and Mycoplasma genitalium. Methods A probability sample survey of 15,162 men and women aged 16-74 years (including 4,060 men aged 16-44 years) was carried out in Britain between 2010 and 2012. Participants completed a computer-assisted personal interview, including a computer-assisted selfinterview, which asked about experience of STI diagnoses, and circumcision. Additionally, 1,850 urine samples from sexually-experienced men aged 16-44 years were collected and tested for STIs. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR) to quantify associations between circumcision and i) self-reporting any STI diagnosis and ii) presence of STIs in urine, in men aged 16-44 years, adjusting for key socio-demographic and sexual behavioural factors. Results The prevalence of circumcision in sexually-experienced men aged 16-44 years was 17.4% (95%CI 16.0-19.0). There was no association between circumcision and reporting any previous STI diagnoses, and specifically previous chlamydia or genital warts. However, circumcised men were less likely to have any HPV type (AOR 0.26, 95% confidence interval (CI) 0.13-0.50) including high-risk HPV types (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and/or 68) (AOR 0.14, 95% CI 0.05-0.40) detected in urine. Conclusions Circumcised men had reduced odds of HPV detection in urine. These findings have implications for improving the precision of models of STI transmission in populations with different circumcision prevalence and in designing interventions to reduce STI acquisition.

Original languageEnglish
Article numbere0130396
JournalPLoS ONE
Volume10
Issue number6
DOIs
Publication statusPublished - 17 Jun 2015

Bibliographical note

Funding Information:
Natsal-3 is a collaboration between University College London (London, UK), the London School of Hygiene and Tropical Medicine (London, UK), NatCen Social Research, Public Health England (formerly the Health Protection Agency), and the University of Manchester (Manchester, UK). Natsal-3 was supported by grants to AMJ from the Medical Research Council ( www.mrc.ac.uk ; G0701757) and the Wellcome Trust ( www.wellcome.ac.uk ; 084840), with contributions from the Economic and Social Research Council and Department of Health. NF is supported by a National Institute for Health Research Academic Clinical Lectureship ( www.nihr.ac.uk ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the study participants; the team of interviewers from NatCen Social Research; and operations and computing staff from NatCen Social Research; staff from the Department of HIV and Sexually Transmitted Infections, Public Health England for data linkage, anonymisation, and data entry; and laboratory staff from the Virus Reference Department and the Sexually Transmitted Bacteria Reference Unit, Public Health England for their contributions to development of protocols and testing.

Publisher Copyright:
© 2015 Homfray et al.

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