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Randomized Controlled Trial
. 2021 Jun;30(6):1139-1148.
doi: 10.1158/1055-9965.EPI-20-1272. Epub 2021 May 10.

Male Circumcision Reduces Penile HPV Incidence and Persistence: A Randomized Controlled Trial in Kenya

Jennifer S Smith  1   2 , Danielle M Backes  3 , Michael G Hudgens  4 , Wenwen Mei  4 , Hrishikesh Chakraborty  5 , Eliane Rohner  3   6 , Stephen Moses  7 , Kawango Agot  8 , Chris J L M Meijer  9 , Robert C Bailey  10
Affiliations
Randomized Controlled Trial

Male Circumcision Reduces Penile HPV Incidence and Persistence: A Randomized Controlled Trial in Kenya

Jennifer S Smith et al. Cancer Epidemiol Biomarkers Prev. 2021 Jun.

Abstract

Background: Male circumcision reduces the risk of human immunodeficiency virus infection in men. We assessed the effect of male circumcision on the incidence and natural history of human papillomavirus (HPV) in a randomized clinical trial in Kisumu, Kenya.

Methods: Sexually active, 18- to 24-year-old men provided penile exfoliated cells for HPV DNA testing every 6 months for 2 years. HPV DNA was detected via GP5+/6+ PCR in glans/coronal sulcus and in shaft samples. HPV incidence and persistence were assessed by intent-to-treat analyses.

Results: A total of 2,193 men participated (1,096 randomized to circumcision; 1,097 controls). HPV prevalence was 50% at baseline for both groups and dropped to 23.7% at 24 months in the circumcision group, and 41.0% in control group. Incident infection of any HPV type over 24 months was lower among men in the circumcision group than in the control group [HR = 0.61; 95% confidence interval (CI), 0.52-0.72]. Clearance rate of any HPV infection over 24 months was higher in the circumcision group than in the control group (HR = 1.87; 95% CI, 1.49-2.34). Lower HPV point-prevalence, lower HPV incidence, and higher HPV clearance in the circumcision group were observed in glans but not in shaft samples.

Conclusion: Male circumcision reduced the risk of HPV acquisition and reinfection, and increased HPV clearance in the glans.

Impact: Providing voluntary, safe, and affordable male circumcision should help reduce HPV infections in men, and consequently, HPV-associated disease in their partners.

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Conflict of interest statement

Conflicts of interest:

J. S. Smith has received research grants and consultancies from BD Diagnostics and Hologic, and supply donations from Rovers and Arbor Vita over the past five years. D. Backes, H. Chakraborty, S. Moses, K. Agot, M.G. Hudgens, W. Mei, E.Rohner, and R. C. Bailey do not have a conflict of interest with this manuscript. CJLMM is minority shareholder and part-time CEO of Self-screen B.V., a spin-off company of AmsterdamUMC (location VUmc) which develops, manufactures and licenses the high-risk HPV assay and methylation marker assays for cervical cancer screening CJLMM has a very small number of shares of Qiagen and MDXHealth, has received speakers fees from GSK, Qiagen, and SPMSD/Merck, and served occasionally on the scientific advisory boards (expert meeting) of these companies.

Figures

Figure 1:
Figure 1:
Kaplan Meier curve of the cumulative incidence (A) and cumulative clearance (B) of penile HPV infections in the glans or shaft specimen, stratified by randomization arm in intention-to-treat analyses
See this image and copyright information in PMC

Comment in

References

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    1. Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control 2009; 20: 449–57. - PubMed
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