Diseker R A, Peterman T A, Kamb M L, Kent C, Zenilman J M, Douglas J M, Rhodes F, Iatesta M
Kaiser Permanente Research Department, Nine Piedmont Center, 3495 Piedmont Road, NE, Atlanta, GA 30305-1736, USA.
Sex Transm Infect. 2000 Dec;76(6):474-9. doi: 10.1136/sti.76.6.474.
Male circumcision status has been shown to be associated with sexually transmitted disease (STD) acquisition in some, but not all, studies. Most studies have been cross sectional.
We examined the association between circumcision status and the prevalence and incidence of gonorrhoea, chlamydia, and syphilis.
We analysed cross sectional and cohort study data from a multicentre controlled trial in the United States. Between July 1993 and September 1996, 2021 men visiting public inner city STD clinics in the United States were examined by a clinician at enrolment and 1456 were examined at follow up visits 6 and 12 months later. At each visit, men had laboratory tests for gonorrhoea, chlamydia, and syphilis and were examined for circumcision status. We used multiple logistic regression to compare STD risk among circumcised and uncircumcised men adjusted for potentially confounding factors.
Uncircumcised men were significantly more likely than circumcised men to have gonorrhoea in the multivariate analyses, adjusted for age, race, and site, in both the cross sectional (odds ratio (OR), 1.3; 95% confidence interval (CI), 0.9 to 1.7) and in the cohort analysis (OR, 1.6; 95% CI, 1.0 to 2.6). There was no association between lack of circumcision and chlamydia in either the cross sectional (OR, 1.0; 95% CI 0.7-1.4) or the cohort analysis (OR, 0.9; 95% CI 0.5-1.5). The magnitude of association between lack of circumcision and syphilis was similar in the cross sectional (OR, 1.4; 95% CI 0.6 to 3.3) and cohort analysis (OR, 1.5; 95% CI 0.4 to 6.1).
Uncircumcised men in the United States may be at increased risk for gonorrhoea and syphilis, but chlamydia risk appears similar in circumcised and uncircumcised men. Our results suggest that risk estimates from cross sectional studies would be similar to cohort findings.
在部分但并非所有研究中，男性包皮环切状况已被证明与性传播疾病（STD）感染有关。大多数研究为横断面研究。
我们研究了包皮环切状况与淋病、衣原体感染和梅毒的患病率及发病率之间的关联。
我们分析了来自美国一项多中心对照试验的横断面和队列研究数据。1993年7月至1996年9月期间，2021名到美国市中心公共性病诊所就诊的男性在入组时由临床医生进行检查，1456名男性在6个月和12个月后的随访时接受检查。每次就诊时，男性接受淋病、衣原体感染和梅毒的实验室检测，并检查包皮环切状况。我们使用多元逻辑回归比较经潜在混杂因素调整后的包皮环切和未包皮环切男性的性传播疾病风险。
在多变量分析中，经年龄、种族和地点调整后，未包皮环切男性患淋病的可能性显著高于包皮环切男性，在横断面研究（优势比（OR），1.3；95%置信区间（CI），0.9至1.7）和队列分析（OR，1.6；95%CI，1.0至2.6）中均如此。在横断面研究（OR，1.0；95%CI 0.7 - 1.4）或队列分析（OR，0.9；95%CI 0.5 - 1.5）中，未进行包皮环切与衣原体感染之间均无关联。在横断面研究（OR，1.4；95%CI 0.6至3.3）和队列分析（OR，1.5；95%CI 0.4至6.1）中，未进行包皮环切与梅毒之间的关联程度相似。
美国未包皮环切男性感染淋病和梅毒的风险可能增加，但包皮环切和未包皮环切男性感染衣原体的风险似乎相似。我们的结果表明，横断面研究的风险估计与队列研究结果相似。
