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Circumcision and Acquisition of Human Papillomavirus Infection in Young Men

VanBuskirk, Kelley PhD*; Winer, Rachel L. PhD*; Hughes, James P. PhD; Feng, Qinghua PhD; Arima, Yuzo PhD§; Lee, Shu-Kuang MS; Stern, Michael E. MN, ARNP; O'Reilly, Sandra F. BS*; Koutsky, Laura A. PhD*

doi: 10.1097/OLQ.0b013e31822e60cb
Original Study

Background: The role of circumcision in male HPV acquisition is not clear.

Methods: Male university students (aged 18–20 years) were recruited from 2003 to 2009 and followed up triannually. Shaft/scrotum, glans, and urine samples were tested for 37 α human papillomavirus (HPV) genotypes. Cox proportional hazards methods were used to evaluate the association between circumcision and HPV acquisition. Logistic regression was used to assess whether the number of genital sites infected at incident HPV detection or site of incident detection varied by circumcision status.

Results: In 477 men, rates of acquiring clinically relevant HPV types (high-risk types plus types 6 and 11) did not differ significantly by circumcision status (hazard ratio for uncircumcised relative to circumcised subjects: 0.9 [95% confidence interval{CI}: 0.7–1.2]). However, compared with circumcised men, uncircumcised men were 10.1 (95% CI: 2.9–35.6) times more likely to have the same HPV type detected in all 3 genital specimens than in a single genital specimen and were 2.7 (95% CI: 1.6–4.5) times more likely to have an HPV-positive urine or glans specimen at first detection.

Conclusions: Although the likelihood of HPV acquisition did not differ by circumcision status, uncircumcised men were more likely than circumcised men to have infections detected at multiple genital sites, which may have implications for HPV transmission.

In male university students, circumcision status was unrelated to genital human papillomavirus acquisition. However, incident infections in uncircumcised men were more likely to be multifocal than those in circumcised men.

From the Departments of *Epidemiology, †Biostatistics, and ‡Pathology, University of Washington, Seattle, WA; §Emerging Disease Surveillance and Response, Division of Health Security and Emergencies, Western Pacific Regional Office, World Health Organization, Manila, Philippines; and ¶Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA

Supported by the National Institutes of Health (grant R01 CA105181) (to L.A.K.).

Correspondence: Rachel L. Winer, PhD, HPV Research Group, Box 359933, 325 9th Avenue, Seattle, WA 98104. E-mail:

Received for publication May 9, 2011, and accepted July 18, 2011.

© Copyright 2011 American Sexually Transmitted Diseases Association