Circumcisions & cervical cancer - whats the greater good?

[sera300]

REVIEW SHOWS MALE CIRCUMCISION PROTECTS FEMALE PARTNERS FROM HIV AND OTHER STDs

A statistical review of the past medical files of more than 300 couples in Uganda, in which the female partner was HIV negative and the male was HIV positive, provides solid documentation of the protective effects of male circumcision in reducing the risk of infection among women. Male circumcision also reduced rates of trichomonas and bacterial vaginosis in female partners. The study is believed to be the first to demonstrate the benefits to female partners of male circumcision.
Hopkins scientists Oliver Laeyendecker, M.S., M.B.A., Steven Reynolds, M.D., M.P.H., and Thomas C. Quinn, M.D., in Rakai, Uganda.
Specifically, male circumcision reduced by 30 percent the likelihood that the female partner would become infected with the virus that causes AIDS, with 299 women contracting HIV from uncircumcised partners and only 44 women becoming infected by circumcised men. Similar reductions in risk were observed for the other two kinds of infection, but not for other common STDs, including human papillomavirus, syphilis, gonorrhea and Chlamydia.
According to the Hopkins researchers who led the study, Ronald Gray, M.D., and Steven Reynolds, M.D., M.P.H., the findings support efforts to assess male circumcision as an effective means of preventing HIV infection. Circumcision is a practice common in North America and among Jews and Muslims, but not generally in Eastern and Southern Africa, Europe or Asia.
The couples in the study come from the Rakai cohort, a population of roughly 12,000 in Uganda whom researchers are monitoring to see how HIV infection spreads. The researches based their findings on extensive interviews with each participant and annual check-ups and blood tests.
The findings confirm what has been noticed anecdotally in Africa, where regions in which circumcision is common have lower rates of HIV infection than those without. And, the results confirm what was first reported in summer 2005 from a clinical trial conducted in South Africa about the protective effects of circumcision on HIV-negative men who have sex with HIV-positive women.
According to researchers, circumcision’s effects come from the nature of the foreskin’s inner lining, or mucosa, whose cells bind to the virus more easily and have roughly nine times more virus in them than the outer layer of the foreskin. Removal of the foreskin, they say, may simply reduce the susceptibility factor, or degree of exposure to HIV, for the sexual partner.
Thomas C. Quinn, M.D., professor of infectious diseases at Hopkins and a senior investigator at the National Institute of Allergy and Infectious Disease, will present an overview of this trial, plus two others presently under way, as part of a plenary discussion at CROI on circumcision and HIV. But, he says, “We will have to wait for the ongoing two trials before drawing conclusive recommendations about circumcision for all men, and whether or not the benefits apply to transmission from females to males only, or to females from men as well. However, early indications are dramatic and, if proven, one case of HIV disease could be prevented through circumcising anywhere from 15 to 60 males.”
Male Circumcision and the Risks of Female HIV and STI Acquisition in Rakai, Uganda, by Ronald Gray, Marie Thoma, Oliver Laeyendecker, David Serwadda, Fred Nalugoda, Godfrey Kigozi, Noah Kiwanuka, Nelson Sewankambo, Steven Reynolds, Maria Wawer, and Thomas Quinn. And, Circumcision and HIV Transmission:The Cutting Edge, by Thomas Quinn.

- JHM -

[sera300]

Male circumcision reduces men's HIV infection risk by 65%

Published: Sunday, 25-Feb-2007 Men's Health News

Routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%, according to final data from two NIH-funded studies conducted in Kenya and Uganda published in the Feb. 23 issue of the journal Lancet, the New York Times reports (McNeil, New York Times, 2/23).

Early data from the two studies released in December 2006 indicated that circumcision reduced a man's risk of HIV infection by 50%. For the studies, researchers monitored 4,996 men ages 15 to 49 living in Uganda and 2,784 men ages 18 to 24 living in Kenya -- half of whom were randomly assigned to be circumcised and the other half served as a control group -- to determine if circumcision reduced HIV infection. All participants in both studies received counseling on HIV risk reduction and were advised to use condoms. According to researchers, male circumcision eliminates the cells most vulnerable to HIV. In addition, a circumcised penis develops thicker skin that is resistant to HIV infection. The Uganda study found 43 cases of HIV among the uncircumcised men, compared with 22 among the circumcised men -- a 48% reduction of HIV transmission. The Kenya study found 47 cases of HIV among uncircumcised men, compared with 22 among the circumcised men -- a 53% reduction. The results of the studies were so overwhelming that NIH stopped the trials early and offered circumcision to all participants. The results of the Uganda and Kenya studies mirrored similar results of a study conducted in South Africa in 2005 (Kaiser Daily HIV/AIDS Report, 12/14/06). According to the Times, some men assigned to the circumcision groups in Kenya and Uganda never went to clinics to undergo circumcisions, and some men in the control groups had private circumcisions before the study period ended. While re-evaluating the data, the researchers excluded a few men whose HIV status was misdiagnosed during the study. They also combined the results of the Kenya and Uganda trials with the South Africa trial and found that male circumcision might reduce a man's risk of HIV infection through heterosexual sex by 65% (New York Times, 2/23).
Reaction, Next Steps
Kevin de Cock, director of the World Health Organization's HIV/AIDS Department, called the results an "extraordinary development," adding, "Circumcision is the most potent intervention in HIV prevention that has been described." WHO and UNAIDS next month will meet in Switzerland to evaluate the data and decide the next steps in addressing HIV/AIDS, the AP/Globe and Mail reports. Some African countries have met with United Nations agencies to discuss ways to increase access to circumcision. According the AP/Globe and Mail, a 2006 modeling study found that male circumcision could prevent two million HIV cases and 300,000 deaths within the next 10 years (Cheng, AP/Globe and Mail, 2/22). Marie-Louise Newell of the University of KwaZulu-Natal in South Africa and Till Barnighausen of the Harvard School of Public Health in a commentary that accompanied the study said that the findings are "proof of a permanent intervention that can reduce the risk of HIV infection in men." They added that efforts to quickly implement circumcision campaigns should be taken with caution (AFP/Yahoo! News, 2/22). De Cock said that circumcision should not replace other HIV prevention efforts but should be used as an "additional tool" in the fight against HIV/AIDS (AP/Globe and Mail, 2/22). Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said that the President's Emergency Plan for AIDS Relief and WHO would look into providing circumcisions in endemic countries but that training and equipment for medical workers performing the circumcisions should be addressed first. Fauci added that he plans to continue using the 50% reduction in risk cited in the December 2006 study because the accuracy of clinical trials depends on following randomized groups and not selected ones (New York Times, 2/23). According to AFP/Yahoo! News, some experts have cautioned against widespread circumcision over concerns about different cultural attitudes toward the practice.

[Mr. Saint]

Support for routine infant circumcision is not unanimous amongst physicians. In fact doctors are pretty divide on this issue. My physician, who is very good and been practicing for many years, strongly disagrees with circumcision at any age. One of my professors who used to be a sex therapist for over 20 years (now teaches human sex) had her sons circumcised at birth and now she is strongly against routine circumcision. I am sure Brandye is a very good physician, but her word is not god. This issue is very much based on belief and not based on fact. If you were raised with the belief that uncircumcised pennies are “dirty” then you well believe in circumcision. If you were raised to believe that circumcision is child abuse then you well be strongly against it. The fact is there are no conclusive study that dose not have a just as legitimist study saying the exact opposite. For every physician that says to circumcise there is just as good of one saying that there is no point. There is just not enough conclusive evidence to prove that it is medically necessary, just as there is not enough evidence so say that it is harmful. If you and/or your partner want you to get circumcised then go ahead and do it (if you aren’t that close then you should be using a rubber any ways). You would not allow parents to remove a child’s tonsils just because they fell like it. You need a medical reason to do so even if the kid is a minor. As for Brandye being a female doctor, that’s great, I have no problem with it. My mother is a clinical nurse specialist and a friend of mine (female) just got in to Stanford med. I don’t think there is a difference between male and female doctors.

[Mr. Saint]

Studies in Uganda and Kenya don’t apply the same in post-industrial countries like the US. This is because in these countries they do not have easy access to regular hygiene. If you don’t wash under your foreskin and don’t practice protected sex then you are at much higher risk of HIV. That is why these studies only apply to the developing world.

[sera300]

There are big differences--when you practice medicine you see the "unintended consequences" and tonsils were routinely removed and are still done at times--based on the patient and history. Three documented cases of step is not good enough...trust me. Removed at 21 since the scaring from tissue caused respiratory infections was not pleasant by any means. Down side; if a child has the chance to sanguinate there is a high risk--although rare cases.

Professors are great for teaching you; they really are. When your professor becomes your mentor long after graduation [and friend] your outlook changes. Professors are teachers to students and at times they can not have a neutral prospective--they are there to cause you to think. As with myself & professors; 20 years and how do you know their ability? When you leave and employ the knowledge, theorize, research, and evaluate measures on your own--take them before the same professors and you shall have a difference of opinions--they are academics. At times their role later is to force you to evaluate through deducing or can put a different light which no one thought of. It's their mind and process! Have you gone through Grad School yet? For some reason I thought you had.

As far as expertise in the area..Clinical Nurse Specialists are great. However, they have limitations beyond what many can do currently as a NP with extensive trauma experience and adult/pediatric care.

You do well--I hate to say this though...I had an idealistic approach long ago and found the reality of life is imperative for clinical practice or statistical implementation.

Brandye has her personal reasons; I cited a few which sound familiar.

[DVDBear]

Originally Posted by Mr. Saint

As for Brandye being a female doctor, that’s great, I have no problem with it. My mother is a clinical nurse specialist and a friend of mine (female) just got in to Stanford med. I don’t think there is a difference between male and female doctors.

Three out of my last four GPs have been women, and my endocrinologist is now. When given an option I usually prefer to give a woman the shot, because (mistaken belief or otherwise) they tend to be less uncomfortable with a gay male patient. That's been my experience anyway, and I think the reasons should be obvious.

But from overall perspective I have no bias as to which sex makes the best doctors. Good and bad in both.

[Mr. Saint]

I am an undergrad student, but I have worked with both graduate students as well as PhDs. You probably assume that I was a grad student because I mentioned my research in the thread about numerology. I think I am pretty much done with this debate. So here is my closing statement. I don’t like the idea of anyone being able to alter your body with out your consent. I have no problem with people getting circumcised when they are able to make the decision for them self. But I do not think there is sufficient evidence of the benefit in post-industrial nations to justify violating, what I view, as the right to security of ones body. I value the opinions off everyone that contributed to this debate expeshaly Brandye and Sera, and have great respect for you. Thanks for the great debate, it was fun.

[Hugh7]

Originally Posted by sera300

Really huh? All they use in a newborn is a topical anesthetic...

You're arguing backward. What doctors use does not affect what babies may need. They use topical because it's not safe to use general on neonates, but studies have found topical is not enough, and some doctors don't even use that, for reasons that have nothing to do with the "painlessness" of circumcision.

the healing is faster than any adults.

So? A grown man won't get urine in the wound while it does.

A grown man will hurt more--this is medical common sense.

No it isn't. That "babies can't feel pain" myth was debunked long ago. A baby can't brace himself.

Men choose to go for general anesthesia which leads to a higher rate of mortality.

Neonatal circumcsision has ways of killing that are uniquely its own.

Yeah, I trust a young man to make the right choice...Parents have the right to do it in the US at birth. And it is pretty common & since a child under the age of 18 has no right to consent to treatment, unless raped, potentially pregnant, emancipated minor, or has a std; it falls upon a parent. This comparison of yours is much like saying my toddler has strep throat but refuses to take his antibiotic...its the baby's right to refuse. Or to refuse a tonsillectomy. Or better yet...my child went over the handlebars and ruptured his spleen--he refuses the surgery & it's his right to die.

You must be into Scientology. Practice medicine a good long time and the concepts fit.

Poor analogies, and it sounds like the only "right" choice you trust a young man to make is YOUR choice.

[Hugh7]

Originally Posted by sera300

Apparently a few men here have chosen later in life to become circumcised; it's their choice not yours, mine, or Brandye's.

So the choice to become circumcised is the man's alone but not the choice to remain intact? Anyone else see the fallacy in that?

[sera300]

Originally Posted by Hugh7

So the choice to become circumcised is the man's alone but not the choice to remain intact? Anyone else see the fallacy in that?

Go tell the US government you don't like their policy, oh look another "johnny come lately"...speak to the WHO or gov't regarding you dislike and that our GOVERNMENT should mandate bans on surgery, take the PARENTAL choice away. See how far you get.

No a child has nor right here is the parents choice and a tad of info, I went in with a male new born, family member, and held him...yes it is done properly & perhaps Dad has to get off his ass and watch, rather than bitching & moaning about how "I cannot see that". A small slice of the foreskin to prevent STD's? Why not? Women get punch biopsies,cryo, laser, etc from their spouses which are unfaithful. And a lifetime of concern and worry. And you worry about a small decrease in sensation? Get dilated for Endometrial BX.

Do you Practice medicine in the US? Doubt it...if you did you would be spouting all articulated responses from a medical aspect. Sounds as if another kid signed on.

Similarly, when an infant/toddler falls and requires sutures [generally to the head]; they have to be restrained, local injections for anesthetic performed as well, and sutured. Perhaps in the US we should leave them due to such emotional trauma and the child can wonder later in life "Why Mom & Dad did this" or why they have facial scaring? No one discusses this as being traumatizing. Leave an open and gaping wound on the face, look at the disfigurement later in life, should that not be left of a young teen to correct? Certainly the risk for infection is greater in a laceration & suture than a circumcision.