According to Anna R. Giuliano, Ph.D., program leader in cancer epidemiology at Moffitt Cancer Center in Tampa, Fla., and colleagues in the Netherlands, earlier circumcision of males in South Africa may be a positive step in slowing the spread of both HIV and the human papillomavirus (HPV). Their commentary and data were published in a recent issue of the British medical journal The Lancet Infectious Diseases (Vol. 11) 581-582.
"Countries with high incidences of HIV also have high incidences of cancer-related HPV," said Giuliano. "This is especially true in South Africa."
Commenting on a study related to circumcision and HIV and HPV transmission, Giuliano and her colleagues note that studies have shown that circumcision of HIV-infected men does not reduce HPV transmission to their female partners. Many factors may account for this lack of efficacy. However, Giuliano and colleagues suggest that the high prevalence of HPV among the HIV-infected men (73 percent in the intervention group and 69 percent in the control group) and the high prevalence of HIV among the female partners of greater than 60 percent, relates to the lack of efficacy of male circumcision. In that study, it was pointed out that the high and sustained prevalence of HPV among the HIV-infected individuals is "likely to overwhelm any preventative effect of circumcision."
"Male circumcision is important for reduction of not only HIV infection but also HPV infection in HIV-negative men and their female partners," said Giuliano. "However, its efficacy seems limited to HIV-negative men. These results suggest the need for early circumcision to achieve maximum effectiveness in populations with a high incidence of HIV and cervical cancer."
For maximum reductions in HIV and HPV infections and related diseases in women, such as cervical cancer, the researchers recommend that both circumcision and HPV vaccination of the male population should be delivered prior to sexual debut.
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