Male Circumcision and Neisseria Gonorrhoeae, Chlamydia Trachomatis and Trichomonas Vaginalis: Observ
Male Circumcision and Neisseria Gonorrhoeae, Chlamydia Trachomatis and Trichomonas Vaginalis: Observations After a Randomised Controlled Trial for HIV Prevention
Objective: To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial.
Methods: We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18-24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression.
Results: In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030).
Conclusions: This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.
Trial Registration Number: NCT00122525.
Recent evidence has shown that male circumcision is a promising prevention approach for sexually transmitted infections (STIs): three randomised controlled trials (RCTs) have shown that male circumcision reduces HIV infection among young men in Africa. According to a meta-analysis published in 2006, circumcised men may be at lower risk of herpes simplex virus 2 (HSV-2) infection, chancroid and syphilis. However, there are conflicting results about the association of male circumcision and non-ulcerative STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis infections among men.
Infection with non-ulcerative STIs is major public health issue. There are about 62 million new cases of N gonorrhoeae annually worldwide, with an estimated incidence of 17 million in sub-Saharan Africa. N gonorrhoeae is asymptomatic in only 10% of men but primarily asymptomatic in women and its complications can be lethal. C trachomatis worldwide incidence has been estimated at 92 million annually, with about 16 million occurring in sub-Saharan Africa. It is a significant public health concern because C trachomatis infection is asymptomatic in over 50% of cases among men and women and it can lead to serious health complications if untreated. Finally, T vaginalis is the most common non-viral STI in the world, with 174 million new cases estimated in 1999. In sub-Saharan Africa, the incidence is estimated at 32 million. The infection is asymptomatic in about 50% of infected women and in over 90% of men; thus, re-infection and re-exposure is problematic. Furthermore, co-infections among these three STIs are common.
The objective of this study was to analyse the effect of male circumcision on N gonorrhoeae, C trachomatis and T vaginalis prevalence using data collected during a male circumcision RCT conducted in Orange Farm, South Africa.
Abstract and Introduction
Abstract
Objective: To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial.
Methods: We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18-24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression.
Results: In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030).
Conclusions: This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.
Trial Registration Number: NCT00122525.
Introduction
Recent evidence has shown that male circumcision is a promising prevention approach for sexually transmitted infections (STIs): three randomised controlled trials (RCTs) have shown that male circumcision reduces HIV infection among young men in Africa. According to a meta-analysis published in 2006, circumcised men may be at lower risk of herpes simplex virus 2 (HSV-2) infection, chancroid and syphilis. However, there are conflicting results about the association of male circumcision and non-ulcerative STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis infections among men.
Infection with non-ulcerative STIs is major public health issue. There are about 62 million new cases of N gonorrhoeae annually worldwide, with an estimated incidence of 17 million in sub-Saharan Africa. N gonorrhoeae is asymptomatic in only 10% of men but primarily asymptomatic in women and its complications can be lethal. C trachomatis worldwide incidence has been estimated at 92 million annually, with about 16 million occurring in sub-Saharan Africa. It is a significant public health concern because C trachomatis infection is asymptomatic in over 50% of cases among men and women and it can lead to serious health complications if untreated. Finally, T vaginalis is the most common non-viral STI in the world, with 174 million new cases estimated in 1999. In sub-Saharan Africa, the incidence is estimated at 32 million. The infection is asymptomatic in about 50% of infected women and in over 90% of men; thus, re-infection and re-exposure is problematic. Furthermore, co-infections among these three STIs are common.
The objective of this study was to analyse the effect of male circumcision on N gonorrhoeae, C trachomatis and T vaginalis prevalence using data collected during a male circumcision RCT conducted in Orange Farm, South Africa.