Circumcision and Sexually Transmitted Diseases (STD’s)

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Contents

History

The mistaken idea that circumcision prevents the acquisition and spread of STD’s is an old myth from the 19th century. The claim that circumcision prevents syphilis first appeared in a publication that dates back to 1855, [1] in the days before germ theory! Doctors where eager to claim that they could treat and prevent the spread of syphilis because of its endemic among pre civil war soldiers.They thought that circumcision would reduce sexual activity hence reducing the spread of STD's.


The theory that circumcision does prevent STD's gained new impetus in the 1940s' Through the determined efforts of urologist Eugene A. Hand. [2] At this time, there was a general panic in the medical profession over African American solders spreading STD’s. [3] It is important to remember that this was in the days before penicillin was cheaply and widely available. STD’s were hard to treat and doctors had little understanding about how they were transmitted. Doctors where desperate and eager to claim that they could treat and prevent STD's.

Sexually Transmitted Diseases (STD’s) and Circumcision

Most American males with gonorrhea or syphilis were poor, uneducated, rural, lower class, sexually promiscuous, and usually a minority race. This category of American was less likely to be circumcised then middle-class white males who were born in private hospitals where compulsory newborn circumcision had been instituted.


Even so, large-scale studies of all kinds performed by objective researchers have found that circumcised men have higher rates of most major STD’s than intact males. This is a shocking fact that circumcisers have tried to cover up.

A famous study on nongonococcal urethritis (NGU) concluded:

"a case-control study of active duty soldiers showed that both black and white circumcised subjects where 1.65 times as likely to have NGU as uncircumcised subjects." [4]


The authors of another valuable 1994 study on the relationship between circumcision and STD’s- especially the various types of gonorrhea- concluded that

"circumcision of men has no significant effect on the incidence of common STD’s in this developed nation setting... we determined no association between circumcision status and a history of NGU or gonorrhea. In the case of gonorrhea this may have been because this was uncommon in our population; the slight trend was for the presence of a foreskin to be “protective”." [5]


An exhaustive 1994 study on herpes simplex virus type 2 (HSV-2) concluded:

"We have found no evidence the presence of an intact foreskin being a risk factor for HSV-2 infection… Importantly, our study group was relatively racially homogeneous, lack of circumcision was not a marker of lower socioeconomic status ." [6]


Dr. Robert Van Howe actually conducted the largest review of the scientific literature on STD’s and circumcision ever published. His conclusions are startling:

"The medical literature does not support the theory that circumcision prevents STD’s" (6) [7]


To confirm this, the National Health and Social Life Survey conducted at the University of Chicago, found:

"First, Circumcision status does not appear to lower the likelihood of contracting an STD. Rather, the opposite pattern holds. Circumcised men were slightly more likely to have had both a bacterial and a viral STD in their lifetime." [8]


Furthermore a recent 2007 study determined.

"Overall, up to age 32 years, the incidence rates for all STI’s were not statistically significantly different—23.4 and 24.4 per 1000 person-years for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics."(8) [9]


Circumcised males had higher rates of all bacterial and viral STD’s. Circumcised males had higher rates of nongonococcal urethritis, herpes, and chlamydia--one of the most common STD’s today. One must ask why circumcisers have been insisting that circumcision does prevent STD’s and have been getting away with this bogus claim for so long.

Behavior and socioeconomic status effect your likely hood of STD transmission far more then circumcision status. All studies conclude that this is the biggest factor for determining likelihood for STD contraction. The plain fact is that it is unimportant how much penis you have; what you do with it determines your risk for contracting STDs. Your sexual behavior and life style choices affect your risk of disease rather than your circumcision status. After all, STD’s are unable to fly through the air and infect innocent people. You have to work hard to get an STD. This category of disease is contracted as a result of poor decision making. Neither circumcision nor intactness can affect your decision making abilities. More important, neither circumcision nor genital intactness will save you from the consequences of poor decisions. Even if circumcision did prevent STD’s It would be irrational to use circumcision as a preventive measure for behavior your son may or may not even engage in. It is far more effective to teach your son how to make good decisions and practice good hygiene.


Opposing Views

Believe it or not some people take these claims seriously, even today! A 2006 meta-analysis claims that circumcision prevents syphilis, chancroid, and genital herpes. [10]


For the association of male circumcision and HSV‐2 they used:

"eight from Africa, one from India, and one from the United States"


In order to examine Association of male circumcision and syphilis seropositivity they used:

"Fourteen studies examined the association between male circumcision and serological evidence of syphilis infection (table 2), from sub-Saharan Africa (nine studies), the United States (two studies), Australia, India, and Peru."


In order to examine Association of male circumcision and chancroid they used:

"Seven studies examined the association between male circumcision and chancroid. Three were from Kenya and the remainder from the United States, United Kingdom, and the US and Australian military"


First of all, study's from Africa are not applicable to developed nations like the United States, because of the drastically different sexual and hygienic behaviour that exists between the groups. This is discussed extensively in the section on HIV.

Many of these observational studies this meta-analysis included used participants who have life styles that are not representative of average Americans or Africans. They used many studies on long distance truck drivers in Africa. [11] [12] [13] [14] [15] Some of these truck drivers engage in risky sexual activity with prostitutes at trucks stops. These are not indicative of your typical American or African life style. Should you surgically alter your son based on the poor decisions of long distance truck drivers in Kenya?


As if flawed observational studies form Africa are not bad enough, the authors include a study from Australia for their syphilis claim which states the following:

"However, the data for syphilis should be interpreted with caution because of the small number of cases" [16]


Systematic literature searches, like the one used in this publication, should be assessed with a system of checks. If this study is not known to be accurately representative of syphilis in Australia then it is probably better not to use it. By including this study authors and peer reviewers reveal their bias. This makes the analysis look more weighted with study's from developed nations by using garbage data. In any event the results is heavily weighted with data gatherd from inapplicable people and places in developing countries like those in Africa. Even if these study's where well constructed they would still not be applicable to developed nations because true variable isolation is often impossible in reality. [17] [18]


In any event syphilis is the biggest claim of this publication. Since it is so uncommon in developed western nations, even the biggest survey like the one by Laumann et al, could not detect a difference. [19]



References

  1. Hutchinson J. On the influence of circumcision in preventing syphilis. Med Times Gazette 1855; 32; 542-3.
  2. Hand EA. CIRCUMCISION and venereal disease. Archives of Dermatology and Syphilology 1949 sep;60(3):341-6
  3. Heimoff LL. Venereal Disease control program. Bull US Army Med Dept 1945 Apr;3(87):93-100.
  4. Smith GL, Greenup R, Takafuji ET. Circumcision as a risk factor for urethritis in racial groups. AM J Public Health 1987 Apr;77(4):452-4 http://www.cirp.org/library/disease/STD/smith/
  5. Donovan B, Bassett I, Bodsworth NJ. Male circumcision and common sexually transmissible diseases in a developed nation setting. Genitourin Med 1994 Oct;70(5):317 -20. http://www.cirp.org/library/disease/STD/donovan1/
  6. Bassett I, Donovan B, Bodsworth NJ, Field PR, Ho DW, jeansson S, Cunningham AL. Herpes Simplex virus type 2 infection of heterosexual men attending a sexual health centre. Med J Aust 1994 Jun 6:160(11);697-700 http://www.ncbi.nlm.nih.gov/pubmed/8202004
  7. Van Howe R. Does Circumcision Influence Sexually Transmitted diseases?: a literature review. BJU Int 1999 Jan;83 Suppl 1:52-62. http://www.cirp.org/library/disease/STD/vanhowe6/
  8. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual Practice. JAMA 1997 Apr2;277(13):1052-7 http://www.cirp.org/library/general/laumann/
  9. Dickson NP, Van Rood T, Herbison P, Paul C. Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr 2008;152:383-7.http://www.ncbi.nlm.nih.gov/pubmed/18280846.
  10. Weiss HA, et al. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006 Apr;82(2):101-9 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653870/?tool=pubmed
  11. Rakwar J, Lavreys L, Thompson M L. et al Cofactors for the acquisition of HIV‐1 among heterosexual men: prospective cohort study of trucking company workers in Kenya. AIDS 1999. 13607–614.
  12. Manjunath J V, Thappa D M, Jaisankar T J. Sexually transmitted diseases and sexual lifestyles of long‐distance truck drivers: a clinico‐epidemiologic study in south India. Int J STD AIDS 2002. 13612–617.
  13. Rakwar J, Jackson D, Maclean I. et al Antibody to Haemophilus ducreyi among trucking company workers in Kenya. Sex Transm Dis 1997. 24267–271.
  14. Lavreys L, Rakwar J P, Thompson M L. et al Effect of circumcision on incidence of human immunodeficiency virus type 1 and other sexually transmitted diseases: a prospective cohort study of trucking company employees in Kenya. J Infect Dis 1999. 180330–336.
  15. Bwayo J, Plummer F, Omari M. et al Human immunodeficiency virus infection in long‐distance truck drivers in east Africa. Arch Intern Med 1994. 1541391–1396.
  16. Parker S W, Stewart A J, Wren M N. et al Circumcision and sexually transmissible disease. Med J Aust 1983. 2288–290.
  17. How independent are `independent’ effects? Relative risk estimation when correlated exposures are measured imprecisely. J Clin Epidemiol 1991;44:1223± 31
  18. David Smith G, Phillips AN. Confounding in epidemiological studies: why `independent’ effects may not be all they seem. BMJ 1992;305:757± 9
  19. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual Practice. JAMA 1997 Apr2;277(13):1052-7 http://www.cirp.org/library/general/laumann/

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