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Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples.
Lancet Glob Health. 2014 Nov; 2(11):e664-71.LG

Abstract

BACKGROUND

Male circumcision is a primary HIV-1 prevention intervention for men, but whether the procedure reduces the risk of syphilis among men and their female partners is uncertain. We aimed to assess whether male circumcision was associated with incident syphilis in men and in their female partners.

METHODS

In this large prospective cohort study, participants were members of Kenyan and Ugandan HIV-1 serodiscordant heterosexual couples enrolled in a randomised safety and efficacy clinical trial of pre-exposure prophylaxis for HIV-1 prevention (the Partners PrEP Study). Participants attended monthly or quarterly follow-up visits for up to 36 months. Annually, syphilis serology testing was done and male circumcision status was assessed. We used multivariate Andersen-Gill survival methods, adjusted for age, sexual behaviour, and plasma HIV RNA levels of the HIV-infected partner.

FINDINGS

4716 HIV-1 serodiscordant couples (38%) with a man with HIV were followed for a median of 2·75 years. At enrolment, 1575 (53%) men with HIV and 560 (32%) men without HIV were circumcised; an additional 69 (4%) men with HIV and 132 (5%) men without HIV were circumcised during study follow-up. 221 incident syphilis infections were reported: 46 (21%) in men with HIV (incidence 1·10 per 100 person-years), 76 (34%) in men without HIV (1·09), 54 (24%) in women with HIV (0·77), and 45 (24%) in women without HIV (1·11). Male circumcision was associated with a 42% reduction in incident syphilis in men (adjusted hazard ratio [aHR] 0·58, 95% CI 0·37-0·91) including a 62% reduction in men with HIV (0·38, 0·18-0·81), and a non-significant reduction in incident syphilis in men without HIV (0·64, 0·36-1·11). In women, circumcision of their male partners was associated with a 59% reduction in incident syphilis (aHR 0·41, 95% CI 0·25-0·69), including a 75% reduction in women without HIV (0·25, 0·08-0·76) and a 48% reduction in women with HIV (0·52, 0·27-0·97).

INTERPRETATION

Male circumcision was associated with decreased risk of incident syphilis in men and women. If confirmed, these results suggest that medical male circumcision could substantially reduce incidence of syphilis and its sequelae.

FUNDING

Bill & Melinda Gates Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Authors+Show Affiliations

Department of Global Health, University of Washington, Seattle, WA, USA; Department of Nursing, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.Departments of Medicine and Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Infectious Disease Institute, Makerere University, Kampala, Uganda.Department of Global Health, University of Washington, Seattle, WA, USA; Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Obstetrics, Gynecology and Reproductive Sciences University of California-San Francisco, San Francisco, CA, USA.Department of Reproductive Health, Moi University, Eldoret, Kenya.Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Obstetrics, Gynecology and Reproductive Sciences University of California-San Francisco, San Francisco, CA, USA.Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.Department of Global Health, University of Washington, Seattle, WA, USA. Electronic address: rheffron@uw.edu.No affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25442691

Citation

Pintye, Jillian, et al. "Association Between Male Circumcision and Incidence of Syphilis in Men and Women: a Prospective Study in HIV-1 Serodiscordant Heterosexual African Couples." The Lancet. Global Health, vol. 2, no. 11, 2014, pp. e664-71.
Pintye J, Baeten JM, Manhart LE, et al. Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples. Lancet Glob Health. 2014;2(11):e664-71.
Pintye, J., Baeten, J. M., Manhart, L. E., Celum, C., Ronald, A., Mugo, N., Mujugira, A., Cohen, C., Were, E., Bukusi, E., Kiarie, J., & Heffron, R. (2014). Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples. The Lancet. Global Health, 2(11), e664-71. https://doi.org/10.1016/S2214-109X(14)70315-8
Pintye J, et al. Association Between Male Circumcision and Incidence of Syphilis in Men and Women: a Prospective Study in HIV-1 Serodiscordant Heterosexual African Couples. Lancet Glob Health. 2014;2(11):e664-71. PubMed PMID: 25442691.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples. AU - Pintye,Jillian, AU - Baeten,Jared M, AU - Manhart,Lisa E, AU - Celum,Connie, AU - Ronald,Allan, AU - Mugo,Nelly, AU - Mujugira,Andrew, AU - Cohen,Craig, AU - Were,Edwin, AU - Bukusi,Elizabeth, AU - Kiarie,James, AU - Heffron,Renee, AU - ,, Y1 - 2014/10/22/ PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/11/18/medline SP - e664 EP - 71 JF - The Lancet. Global health JO - Lancet Glob Health VL - 2 IS - 11 N2 - BACKGROUND: Male circumcision is a primary HIV-1 prevention intervention for men, but whether the procedure reduces the risk of syphilis among men and their female partners is uncertain. We aimed to assess whether male circumcision was associated with incident syphilis in men and in their female partners. METHODS: In this large prospective cohort study, participants were members of Kenyan and Ugandan HIV-1 serodiscordant heterosexual couples enrolled in a randomised safety and efficacy clinical trial of pre-exposure prophylaxis for HIV-1 prevention (the Partners PrEP Study). Participants attended monthly or quarterly follow-up visits for up to 36 months. Annually, syphilis serology testing was done and male circumcision status was assessed. We used multivariate Andersen-Gill survival methods, adjusted for age, sexual behaviour, and plasma HIV RNA levels of the HIV-infected partner. FINDINGS: 4716 HIV-1 serodiscordant couples (38%) with a man with HIV were followed for a median of 2·75 years. At enrolment, 1575 (53%) men with HIV and 560 (32%) men without HIV were circumcised; an additional 69 (4%) men with HIV and 132 (5%) men without HIV were circumcised during study follow-up. 221 incident syphilis infections were reported: 46 (21%) in men with HIV (incidence 1·10 per 100 person-years), 76 (34%) in men without HIV (1·09), 54 (24%) in women with HIV (0·77), and 45 (24%) in women without HIV (1·11). Male circumcision was associated with a 42% reduction in incident syphilis in men (adjusted hazard ratio [aHR] 0·58, 95% CI 0·37-0·91) including a 62% reduction in men with HIV (0·38, 0·18-0·81), and a non-significant reduction in incident syphilis in men without HIV (0·64, 0·36-1·11). In women, circumcision of their male partners was associated with a 59% reduction in incident syphilis (aHR 0·41, 95% CI 0·25-0·69), including a 75% reduction in women without HIV (0·25, 0·08-0·76) and a 48% reduction in women with HIV (0·52, 0·27-0·97). INTERPRETATION: Male circumcision was associated with decreased risk of incident syphilis in men and women. If confirmed, these results suggest that medical male circumcision could substantially reduce incidence of syphilis and its sequelae. FUNDING: Bill & Melinda Gates Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. SN - 2214-109X UR - https://www.unboundmedicine.com/medline/citation/25442691/Association_between_male_circumcision_and_incidence_of_syphilis_in_men_and_women:_a_prospective_study_in_HIV_1_serodiscordant_heterosexual_African_couples_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(14)70315-8 DB - PRIME DP - Unbound Medicine ER -