Department of Epidemiology, University of Washington, 404 E. Harrison St. 301, Seattle, WA 98102, USA.
Sex Transm Dis. 2010 Mar;37(3):147-52. doi: 10.1097/OLQ.0b013e3181bd0ff0.
Observational studies evaluating the association of circumcision and HIV infection among men who have sex with men (MSM) have yielded mixed results. We examined the relationship between circumcision and HIV, herpes simplex virus type-2 (HSV-2), syphilis, urethral gonorrhea, and urethral chlamydia among MSM stratified by anal sexual role.
Between October 2001 and May 2006, 4749 MSM who reported anal intercourse in the previous 12 months attended the Public Health-Seattle and King County STD clinic for 8337 evaluations. Clinicians determined circumcision status by examination and anal sexual role in the previous year by interview. Blood samples were used to test HIV, syphilis, and HSV-2 serostatus. Urethral gonorrhea and chlamydia were tested by culture or nucleic acid amplification. We used generalized estimating equations to evaluate the association between circumcision and specific diagnoses, adjusted for race/ethnicity and age.
Among the 3828 men whose circumcision status was assessed, 3241 (85%) were circumcised and 587 (15%) were not. The proportion of men newly testing HIV-positive or with previously diagnosed HIV did not differ by circumcision status when stratified by men's anal sexual role in the preceding year, even when limited to men who reported only insertive anal intercourse in the preceding 12 months (OR = 1.45; 95% CI: 0.30, 7.12). Similarly, we did not observe a significant association between circumcision status and the other sexually transmitted infections (STI).
Our findings suggest that male circumcision would not be likely to have a significant impact on HIV or sexually transmitted infections acquisition among MSM in Seattle.
评估男性同性性行为者（MSM）中包皮环切术与 HIV 感染之间关联的观察性研究得出的结果参差不齐。我们检查了包皮环切术与 HIV、单纯疱疹病毒 2 型（HSV-2）、梅毒、尿道淋病和尿道衣原体之间的关系，这些关系是根据肛门性角色分层的 MSM。
2001 年 10 月至 2006 年 5 月，4749 名在过去 12 个月内报告有肛门性交的 MSM 参加了公共卫生-西雅图和金县性传播疾病诊所，进行了 8337 次评估。临床医生通过检查和过去一年的肛门性角色访谈确定了包皮环切术的状况。血液样本用于检测 HIV、梅毒和 HSV-2 血清状态。尿道淋病和衣原体通过培养或核酸扩增进行检测。我们使用广义估计方程评估了包皮环切术与特定诊断之间的关联，调整了种族/民族和年龄因素。
在 3828 名包皮环切术状况得到评估的男性中，3241 名（85%）接受了包皮环切术，587 名（15%）未接受。当按前一年男性的肛门性角色分层时，包皮环切术状况与新检出 HIV 阳性或以前诊断为 HIV 的男性比例没有差异，即使将这些男性限制在过去 12 个月内仅报告插入性肛门性交的男性（OR = 1.45；95%CI：0.30，7.12）。同样，我们也没有观察到包皮环切术状况与其他性传播感染（STI）之间存在显著关联。
我们的研究结果表明，在西雅图的 MSM 中，男性包皮环切术不太可能对 HIV 或性传播感染的获得产生显著影响。
