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Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis

Albero, Ginesa MPH*,†,‡; Castellsagué, Xavier PhD*,†; Giuliano, Anna R. PhD§; Bosch, Francesc Xavier PhD

doi: 10.1097/OLQ.0b013e3182387abd
Review

Background: Human papillomavirus (HPV) infection is the principal cause of invasive cervical cancer. There is some evidence that male circumcision (MC) may protect against HPV infection and related disease in both men and women. The purpose of this study was to conduct a systematic review of the literature to assess the association between MC and genital HPV infection indicators including genital warts.

Methods: A systematic search of Medline was conducted to identify all relevant studies from February 1971 to August 2010. Effect estimates were included in random effects models.

Results: A total of 21 studies with 8046 circumcised and 6336 uncircumcised men were included in the meta-analysis. MC was associated with a statistically significant reduced odds of genital HPV prevalence (odds ratio = 0.57, 95% confidence interval: 0.42–0.77). This association was also observed for genital high-risk HPV prevalence in 2 randomized controlled trials (odds ratio = 0.67, 95% confidence interval: 0.54–0.82). No associations were found between MC and genital HPV acquisition of new infections, genital HPV clearance, or genital warts.

Conclusions: This meta-analysis shows a robust inverse association between MC and genital HPV prevalence in men. However, more studies are needed to adequately assess the effect of MC on the acquisition and clearance of HPV infections. MC could be considered as an additional one-time preventative intervention likely to reduce the burden of HPV-related diseases both in men and women, particularly among those countries in which HPV vaccination programs and cervical screening are not available.

From the *Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), “CIBER en Epidemiología y Salud Pública”, Madrid, Spain; Program in Public Health and the Methodology of Biomedical Research, Universitat Autónoma de Barcelona (UAB), Campus Universitat Autònoma, Barcelona, Spain; §Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; and Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain

Supported by Spanish public grants from the Instituto de Salud Carlos III (grants FIS PI030240, FIS PI061246, RCESP C03/09, RTICESP C03/10, RTIC RD06/0020/0095 and CIBERESP), from the Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR 2005SGR 00695, 2009SGR1026 and 2009 BE-2 001444), and from the Marató de TV3 Foundation (051530).

Correspondence: Anna R. Giuliano, PhD, Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. E-mail: anna.giuliano@moffitt.org.

Received for publication April 18, 2011, and accepted August 4, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association