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Shang Ring Versus Forceps-Guided Adult Male Circumcision: A Randomized, Controlled Effectiveness Study in Southwestern Uganda

Kanyago, Samuel MBChB, MMed*,†; Riding, David M. MSc, MBChB, MRCS‡,§; Mutakooha, Elichum MMed, FCS*; Lopez de la O, Alcides MD*; Siedner, Mark J. MD, MPH*,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2013 - Volume 64 - Issue 2 - p 130–133
doi: 10.1097/QAI.0b013e3182965d67
Rapid Communication

Abstract: Adult male circumcision (AMC) reduces HIV transmission, but uptake is limited in part by current surgical methods. We randomized HIV-uninfected men (n = 138) to receive Shang Ring (SR)– or forceps-guided AMC from a locally trained surgeon. In as-treated analyses, more SR procedures were completed within 10 minutes (79% versus 0%, P < 0.01) and more subjects reported high satisfaction (77% versus 58%, P = 0.03). Healing time and pain scores were similar, though minor complication rates were higher in SR subjects (56% versus 24%, P < 0.01). SR circumcision is a rapid and acceptable method of AMC and should be further evaluated to increase uptake of AMC.

*Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;

Good Shepherd Hospital, Siteki, Swaziland;

North West Deanery, Manchester, UK;

§Mbarara Regional Referral Hospital, Mbarara, Uganda; and

Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA.

Correspondence to: Dr. Samuel Kanyago, MBChB, MMed, Good Shepherd Hospital, 3 Km, Siteki-Maphungwane Road, Siteki, Swaziland (e-mail:

M.J.S. received salary support from the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (R24 TW007988), and NIH (T32 AI007433).

The authors have no conflicts of interest to disclose.

Received January 09, 2013

Accepted April 09, 2013

© 2013 by Lippincott Williams & Wilkins