Hubert H. Humphrey Fellowship Program, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
PLoS One. 2007 Sep 12;2(9):e861. doi: 10.1371/journal.pone.0000861.
Recent experimental evidence has demonstrated the benefits of male circumcision for the prevention of human immunodeficiency virus (HIV) infection. Studies have also shown that male circumcision is cost-effective and reduces the risk for certain ulcerative sexually transmitted diseases (STDs). The epidemiology of male circumcision in the United States is poorly studied and most prior reports were limited by self-reported measures. The study objective was to describe male circumcision trends among men attending the San Francisco municipal STD clinic, and to correlate the findings with HIV, syphilis and sexual orientation.
A cross sectional study was performed by reviewing all electronic records of males attending the San Francisco municipal STD clinic between 1996 and 2005. The prevalence of circumcision over time and by subpopulation such as race/ethnicity and sexual orientation were measured. The findings were further correlated with the presence of syphilis and HIV infection. Circumcision status was determined by physical examination and disease status by clinical evaluation with laboratory confirmation. Among 58,598 male patients, 32,613 (55.7%, 95% Confidence Interval (CI) 55.2-56.1) were circumcised. Male circumcision varied significantly by decade of birth (increasing between 1920 and 1950 and declining overall since the 1960's), race/ethnicity (Black: 62.2%, 95% CI 61.2-63.2, White: 60.0%, 95% CI 59.46-60.5, Asian Pacific Islander: 48.2%, 46.9-49.5 95% CI, and Hispanic: 42.2%, 95% CI 41.3-43.1), and sexual orientation (gay/bisexual: 73.0%, 95% CI 72.6-73.4; heterosexual: 66.0%, 65.5-66.5). Male circumcision may have been modestly protective against syphilis in HIV-uninfected heterosexual men (PR 0.92, 95% C.I. 0.83-1.02, P = 0.06).
Male circumcision was common among men seeking STD services in San Francisco but has declined substantially in recent decades. Male circumcision rates differed by race/ethnicity and sexual orientation. Given recent studies suggesting the public health benefits of male circumcision, a reconsideration of national male circumcision policy is needed to respond to current trends.
最近的实验证据表明，男性割礼可预防人体免疫缺陷病毒（HIV）感染。研究还表明，男性割礼具有成本效益，并降低某些溃疡性性传播疾病（STD）的风险。美国男性割礼的流行病学研究甚少，大多数先前的报告均受到自我报告措施的限制。本研究的目的是描述在旧金山市性病诊所就诊的男性中割礼的趋势，并将发现结果与 HIV、梅毒和性取向相关联。
通过回顾 1996 年至 2005 年间在旧金山市性病诊所就诊的所有男性的电子记录，进行了一项横断面研究。测量了随时间推移和按种族/民族和性取向等亚人群的割礼流行率。进一步将这些发现与梅毒和 HIV 感染的存在相关联。通过体格检查确定割礼状况，通过临床评估并经实验室确认确定疾病状况。在 58598 名男性患者中，有 32613 名（55.7%，95%置信区间（CI）55.2-56.1）进行了割礼。割礼状况因出生年代（1920 至 1950 年期间增加，而自 20 世纪 60 年代以来总体呈下降趋势）、种族/民族（黑人：62.2%，95%CI 61.2-63.2，白人：60.0%，95%CI 59.46-60.5，亚太裔：48.2%，46.9-49.5 95%CI，和西班牙裔：42.2%，95%CI 41.3-43.1）和性取向（男同性恋/双性恋：73.0%，95%CI 72.6-73.4；异性恋：66.0%，95%CI 65.5-66.5）而存在显著差异。在未感染 HIV 的异性恋男性中，割礼可能对梅毒有一定的保护作用（PR 0.92，95%CI 0.83-1.02，P = 0.06）。
在旧金山寻求性病服务的男性中，割礼很常见，但近几十年来已大幅下降。割礼率因种族/民族和性取向而异。鉴于最近的研究表明男性割礼具有公共卫生益处，需要重新考虑国家的男性割礼政策，以应对当前的趋势。
