Two studies argue for circumcision to prevent UTI and AIDS

Circumcision has fallen out of favor in recent years, but an Australian meta-analysis of published data and a French study for the country's National AIDS Research Agency may turn that trend.

The meta-analysis (Archives of Disease in Childhood 2005; 90:853-958), performed by researchers at The Children's Hospital at Westmead in Sydney, examined data from 12 published randomized controlled trials and observational studies on the effect of circumcision on the risk of urinary tract infection in 402,908 boys. They found that circumcision was associated with a significantly reduced risk of UTI (OR=.13; 95% CI=.08 to .20; p=.001), regardless of study design. Given a risk in normal boys of about 1%, the number needed to treat to prevent one UTI is 111, the researchers said.

In boys with recurrent UTI or high-grade vesicoureteral reflux, the risk of UTI recurrence is 10% and 30%, and the numbers needed to treat were 11 and 4, respectively. The researchers concluded that, assuming an equal risk-benefit ratio, net clinical benefit is likely only in boys at high risk of UTI.

The second study, presented at the recent Third International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, was conducted from 2002-05 on 3,000 healthy, sexually active men in Orange Farm, South Africa, where 32% of the women are HIV positive.

Half of the men were circumcised by medical professionals; the others were uncircumcised. Less than 2 years later, 51 of the uncircumcised men tested were HIV positive compared with 18 of the circumcised men. The researchers, led by Bertrand Auvert, MD, concluded that circumcision reduced the risk of men contracting AIDS during heterosexual intercourse by 65%. However, Dr. Auvert said the study did not analyze the effect of circumcision on male-to-female transmission of HIV, nor did it track the ability of the surgery to prevent HIV transmission long-term.