Decline in circumcision rate could cost billions

[angelatc]

Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis.

This first systematic review of male circumcision and ulcerative STI strongly indicates that circumcised men are at lower risk of chancroid and syphilis. There is less association with HSV-2. Potential male circumcision interventions to reduce HIV in high risk populations may provide additional benefit by protecting against other STI.

(Note the language here. One study does not science make, and the author is careful to limit his conclusion as such.)

 

[heavenlyboy34]

angela, I don't know why you bother posting all those studies, considering that the same argument can be used to cut the entire penis.

You must spread some Reputation around before giving it to low preference guy again.

I'll +rep ya later if I find the time.

 

[angelatc]

Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.

Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.

...

 

[Dr.3D]

Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis.



(Note the language here. One study does not science make, and the author is careful to limit his conclusion as such.)

Last time I read a study like that one was when someone had taken the data from countries that didn't circumcise, aka Africa and others where people had a propensity to have unprotected sex, versus those who were circumcised and had protected sex.

Saying circumcision has something to do with the the difference in disease rates, seems disingenuous to say the least.

 

[Brian4Liberty]

Multiple studies prove this:

No they don't. Usually these are statistical studies, with no controls whatsoever. They are not scientific, and often do not take into account the most obvious of outside factors. And even at that, when these biased studies do find small statistical differences, that is not enough to warrant performing unnecessary surgery. The crux of the whole bean-counting economic argument here in the OP revolves around the expense of the very small amount of people who will contract AIDS.

And the exact same argument being used here will be used for a whole host of other procedures, not the least of which is a whole host of vaccines and drugs, all potentially to be government mandated.

 

[Brian4Liberty]

Last time I read a study like that one was when someone had taken the data from countries that didn't circumcise, aka Africa and others where people had a propensity to have unprotected sex, versus those who were circumcised and had protected sex.

Saying circumcision has something to do with the the difference in disease rates, seems disingenuous to say the least.

Exactly. Ignore obvious factors which effect results.

 

[NorfolkPCSolutions]

Thanks for adding nothing at all to the conversation. But you're wrong. Multiple clinical studies have clearly shown that the little flap of skin can indeed impact the rate of transmission of STDs.

No, not using a condom can indeed impact the rate of transmission of STDs.

Sure you guys came that way. And there is a reason that ancient cultures began circumcising their infants. They did not know the science behind it, but the risk of infections increased dramatically, and before antibiotics, caused death. The rationale came later, but the practice didn't just show up because somebody decided it was a cool way to make a living.

No, the practice showed up because a group of somebodies who dwelt in the cradle of civilization (ie Mesopotamia, also known as a big frickin' desert) realized about 3,000 years ago that it was easier to keep sand, sweat, and smegma out of your wiener by "trimming the tree" a little bit. This was accomplished through the creation of religion. Also, it is one of the first examples of social engineering...first by Judaism, then by Christianity, and on and on...it's much easier to change the behavior of great masses of men and women by telling them that their God said so.

Nowadays, we place more esteem on the opinions of doctors who - gasp - would rather not see a billable procedure fall by the wayside. Society evolves in much the same way as animals and plants, you see. Just look at the progress Ron Paul has made just since 2007!

You're right - I really don't care what other people do to their kids, but putting this emotion-driven drivel crap out to a young audience unchallenged is dangerous. They would happily support laws against circumcision, freedom lovers that they are.

Grand. Stop caring, then - I'm not going to change your mind, you're not going to change anyone's mind; this thread is about an ongoing paradigm shift among new parents over the last 30-40 years or so, and the perceived "negative impact" this has had on the health care industry.

This is not a thread about your misguided, ill-conceived, and just plain goofy obsession with male mutilation. Start another thread about that in the Health Freedom forum. Trim your son's weenie if you want to. Just recognize that there comes a point where we must respectfully agree to peacefully disagree, and this thread passed that point about ten posts back.

I ate my Cheerios with sugar and milk. No, it wasn't my preferred evening meal, but hey - in this economy, we all have to make sacrifices, right? It was tasty, anyway. Sorry it took so long for me to reply, but I wanted to feed myself before I fed the troll.

*duck, dodge*

 

[angelatc]

Male circumcision for prevention of heterosexual acquisition of HIV in men.

We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV.

Real science doesn't always find what it hoped to find.

 

[angelatc]

Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda

Interpretation: Prepubertal circumcision may reduce male HIV acquisition in a general population, but the protective effects are confounded by cultural and behavioral factors in Muslims. In discordant couples, circumcision reduces HIV acquisition and transmission. The assessment of circumcision for HIV prevention is complex and requires randomized trials.

...

This is especially interesting. They found that unless the circumcision is done before puberty, it has very little effect on disease transmission.

 

[angelatc]

Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

Conclusion
Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.

 

[heavenlyboy34]

[h=3]SOUTH AFRICAN MEDICAL JOURNAL, Volume 98, Number 10: Pages 781-782,
October 2008.[/h]

[h=2]Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable[/h]Two articles[SUP]1,2[/SUP] published in this issue address male circumcision (MC).Connolly et al.[SUP]1[/SUP] show in a national survey that MC, whether pre-pubertal or post-pubertal, has no protective effect on acquisition by males of HIV infection as measured by prevalence.Sidler et al.[SUP]2[/SUP] state that neonatal MC continues to be promoted without adequate justification as a medicalised ritual, via an HIV prevention rationale. They caution that for MC to be a therapeutic as opposed to a non-therapeutic procedure, it is necessary to gather more corroborative and consistent evidence of its benefit, consider the potential harms (psychological, sexual, surgical and behavioural/disinhibition), examine the ethical implications, and examine effectiveness and efficiency (costs and benefits) at the population and societal levels. They point out that MC is not just a technical surgical intervention – it takes place in a social context that can radically alter the anticipated outcome. At the 2008 International AIDS Conference[SUP]3[/SUP] in Mexico cultural, political and educational issues raised by the intervention, such as decreased condom use and marginalisation of women, were hotly debated. Some cultural interpretations may view MC as a licence to have unprotected sex. A case in point is Swaziland, where men are flocking to be circumcised with the understanding that this means they no longer need to use other preventive methods (e.g. wear condoms or limit the number of sexual partners).[SUP]4[/SUP]The 2003 Cochrane review[SUP]5[/SUP] of observational studies of MC effectiveness concluded that there was insufficient evidence to support it as an anti-HIV intervention. Three randomised controlled trials (RCTs) from South Africa, Kenya and Uganda in 2006 - 2007 show a protective effect of MC. However, Garenne[SUP]6[/SUP] has subsequently shown from observational data that there is considerable heterogeneity of the effect of MC across 14 African countries. Despite the South African RCT showing a protective effect, he reports for the nine South African provinces that ‘there is no evidence that HIV transmission over the period 1994 - 2004 was slower in those provinces with higher levels of circumcision’. Interestingly, in both Kenya and Uganda, where two of the RCTs were done, a protective effect of MC was observed, but a harmful effect was observed in Cameroon, Lesotho and Malawi. The other eight countries showed no significant effect of MC.These somewhat discordant findings are difficult to interpret. While RCTs are theoretically strong designs, it is conceivable that their findings are not generalisable beyond their settings. Furthermore, there have been no trials of neonatal MC. Study flaws such as inability to obtain double blinding, and loss to follow-up in RCTs, may effectively degrade their quality to that of observational studies. Meanwhile other disturbing findings referred to by Sidler et al. are emerging, including the reported higher risk for women partners of circumcised HIV positive men, disinhibition, urological complications, relatively small effect sizes of MC at the population level, and relative cost-inefficiency of MC.Not all objections to MC as an HIV intervention have to do with evidence of effectiveness or cost. Sidler et al. raise ethical objections. Owing to the current climate of desperation with regard to the HIV epidemic, evidence in favour of MC frequently seems overstated. This reduces the scope for informed consent and autonomy for adult men considering the procedure. Further problems arise in the case of neonates whose parents may be considering the procedure. Whereas informed consent is at least possible for adult men, it is clearly not possible for neonates. Parents can only guess what the child’s wishes would be if he were presented with the information they have at their disposal. If it could be shown that circumcision was necessary in the neonatal period, parental consent on behalf of the neonate would be justified. But since no valid surgical indications for circumcision exist in this period, and the future benefit to the child in respect of HIV avoidance is not relevant before sexual debut, the duty of parents may well be to err on the side of caution, and defer the procedure until the child can make an autonomous decision. In the absence of compelling indications, a procedure such as circumcision could also be seen as a violation of the child’s right to bodily integrity. Furthermore, the ethical principle of non-maleficence cannot be upheld as there are clear harms attached to this practice, to which Sidler et al. refer in their article. Lastly, at a societal level MC may be unjust insofar as it could compete for resources with more effective and less costly interventions[SUP]7[/SUP] and disadvantage women.Despite a strong pro-circumcision lobby driven by enthusiasts who have been promoting MC as an (HIV) intervention for many years, and impatience expressed by protagonists about the long delay after the 2006 - 2007 RCT results and the UNAIDS/WHO policy recommendations[SUP]8[/SUP] of March 2007, few mass campaigns have been launched in African countries.Given the epidemiological uncertainties and the economic, cultural, ethical and logistical barriers, it seems neither justified nor practicable to roll out MC as a mass anti-HIV/AIDS intervention.A Myers
Humanities student, University of Cape Town
J Myers
School of Public Health and Family Medicine
University of Cape Town
Corresponding author: J Myers ([email protected])
References

1. Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: Results from a national survey in 2002.S Afr Med J 2008; 98: 789-794.
2. Sidler D, Smith J, Rode H. Neonatal circumcision does not reduce HIV infection rates. S Afr Med J 2008; 98: 764-766.
3. Male Circumcision: To Cut or Not to Cut (dedicated session, 7 August). AIDS 2008 – Mexico City 3-8 August 2008 – XVII International AIDS Conference.http://www.aids2008.org/Pag/ PSession.aspx?s=41 (last accessed 8 August 2008).
4. Swaziland: Circumcision gives men an excuse not to use condoms. http://www.irinnews. org/Report.aspx?ReportId=79557 (last accessed 7 August 2008).
5. Siegfried N, Muller M, Volmink J, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003362. DOI: 10.1002/14651858.CD003362.
6. Garenne M. Long-term population effect of male circumcision in generalised HIV epidemics in sub-Saharan Africa. African Journal of AIDS Research 2008; 7(1): 1-8.
7. New study shows condoms 95 times more cost-effective than circumcision in HIV battle. http://www.prweb.com/releases/2008/08/prweb1151894.htm (last accessed 7 August 2008).
8. WHO/UNAIDS Technical Consultation Male Circumcision and HIV Prevention: Research Implications for Policy and Programming. Montreux, 6 - 8 March 2007. Conclusions and Recommendations. http://data.unaids.org/pub/Report/2007/mc_recommendations_en.pdf (accessed 25 August 2008).

 

[angelatc]

Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.

The trial was stopped early on December 12, 2006, after a third interim analysis reviewed by the data and safety monitoring board. The median length of follow-up was 24 months. Follow-up for HIV status was incomplete for 240 (8.6%) participants. 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped. The 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72). Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrollment, the protective effect of circumcision was 60% (32-77). Adverse events related to the intervention (21 events in 1.5% of those circumcised) resolved quickly. No behavioural risk compensation after circumcision was observed.

INTERPRETATION:
Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa. Where appropriate, voluntary, safe, and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible.

 

[angelatc]

Risks from circumcision during the first month of life compared with those for uncircumcised boys.

The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life. For 100,157 circumcised boys, there were 193 complications (0.19%). These included 62 local infections, eight cases of bacteremia, 83 incidences of hemorrhage (31 requiring ligature and three requiring transfusion), 25 instances of surgical trauma, and 20 urinary tract infections. There were no deaths or reported losses of the glans or entire penis. By contrast, the complications in the 35,929 uncircumcised infants were all related to urinary tract infections. Of the 88 boys with such infections (0.24%), 32 had concomitant bacteremia, three had meningitis, two had renal failure, and two died. The frequencies of urinary tract infection (P less than .0001) and bacteremia (P less than .0002) were significantly higher in the uncircumcised boys. Serious complications from routine prepuce removal are rare and relatively minor. Circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.

 

[angelatc]

LPG - this is for you. I think you should volunteer your dick for the next trade-off analysis study. The world would be a better place.

A trade-off analysis of routine newborn circumcision.

Of 354, 297 male infants born during the study period, 130,475 (37%) were circumcised during their newborn stay. Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis. Based on our findings, a complication can be expected in 1 out every 476 circumcisions. Six urinary tract infections can be prevented for every complication endured and almost 2 complications can be expected for every case of penile cancer prevented.

OMG - decisions, decisions. Should we reduce the odds that our sons will get cancer at the expense of the possibility of minor complications? Or should we make circumcisions illegal, because it's better to have children die than permit their parents to engage in behaviors that the liberals find "unethical."

 

[angelatc]

The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention,

There were no differences between the study arms at enrollment and problems with sexual satisfaction and function were reported by <2% of participants in both study arms at all time points. At 6 months, no difficulty with penetration was reported by 98.6% of circumcised men and 99.4% of controls (P = 0.02), and no pain on intercourse was reported by 99.4% circumcised and 98.8% of uncircumcised men (P = 0.05). There were no differences between the study arms in penetration or dyspareunia at later visits. Sexual satisfaction increased from 98.0% at enrollment to 99.9% at 2 years among the controls (P < 0.001), but there was no trend in satisfaction among circumcised men (enrollment 98.5%, 2 years 98.4%, P = 0.8).

CONCLUSION:
Adult male circumcision does not adversely affect sexual satisfaction or clinically significant function in men.

 

[angelatc]

Look HB - this is hosted on the "Doctors Against Circ" site you provided:

Risk factors for neonatal methicillinresistant Staphylococcus aureus infection in a well-infant nursery.


Results. Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and
outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin.
Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak
1, case infants ( ) had a significantly higher mean length of stay than np6 control infants (3.7 vs 2.5 days; Pp.01). In outbreak 2, case
infants (np5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received
lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been
circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were
indistinguishable from a community-associated MRSA strain (USA300-0114).

Conclusions. Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing
length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.

 

[specsaregood]

Sure, but am I the only one here who was young and stupid? Imagine telling a horny 17 year old kid, ready to wet his wick, that it's not worth the risk since he accidentally tore the condom. Of course, perhaps there are some parents who think that kids deserve to get AIDs because they didn't use the best judgement, but I'm not one of them.

I can't look over their shoulders constantly (nor would I want to - ick!) so as a parent it's my opinion that I should do everything I can to minimize the long term risk.

I was once that kid and I didn't do it. But you are right, STD's were not my main concern, not by a long shot. But rather I was instilled (probably by my parents) with the fear of knocking up a girl. The fear of getting a girl pregnant kept me wearing condoms well into adulthood, stds were just a passing thought. I always figured, if I get aids the worst that would happen is I would die. (oh to be young). But If I had a kid, i'd be on the hook for a long life.

 

[angelatc]

Effects of circumcision on male sexual function: debunking a myth?

Conclusions: Circumcision does not appear to have adverse, clinically important effects on male sexual function in sexually active adults who undergo the procedure.

 

[Brian4Liberty]

Breasts begin to form during fetal development, with a thickening in the chest area called the mammary ridge or milk line. By the time a female infant is born, a nipple and the beginnings of the milk-duct system have formed.

Breast changes continue to occur over the lifespan, with lobes, or small subdivisions of breast tissue, developing first. Mammary glands develop next and consist of 15-24 lobes.

Obviously the mammary ridge, milk-duct system and lobes can be removed from infant females, thus nearly eliminating the potential medical cost of breast cancer. This will result in quite a government budget savings in the future.

 

[angelatc]

The association between circumcision status and human immunodeficiency virus infection among homosexual men.

To evaluate whether uncircumcised status is correlated with acquisition of human immunodeficiency virus (HIV), 502 homosexual men were surveyed; 85% were circumcised. HIV infection was significantly associated with uncircumcised status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2, 3.8), nonwhite race, intravenous drug use, sexual contact with an intravenous drug user, number of male partners, frequency of unprotected receptive anal intercourse, and with history of genital herpes, anal herpes, or syphilis. Uncircumcised status was significantly associated with older age, nonwhite race, and history of syphilis; it was inversely associated with intravenous drug use. Using logistic regression analysis, the adjusted OR for the association between HIV infection and uncircumcised status was 2.0 (95% CI, 1.0, 4.0). Uncircumcised homosexual men had 2-fold increased risk of HIV infection. The role of circumcision as an intervention strategy to reduce sexual transmission of HIV warrants consideration.