US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet Glob Health. 2017 Nov;5(11):e1113-e1122. doi: 10.1016/S2214-109X(17)30369-8.
Male circumcision reduces men's risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women's health outcomes to benefit women's health programmes.
In this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women's health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency.
60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate.
Scale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly consistent. Synergies between male circumcision and women's health programmes should be explored.
US Centers for Disease Control and Prevention and Jhpiego.
男性割礼可降低男性通过异性性接触感染艾滋病毒和某些性传播感染的风险，是撒哈拉以南非洲地区预防艾滋病毒的重要手段。此外，已有研究调查了男性割礼与女性感染艾滋病毒和性传播感染风险之间的关联。我们旨在综述所有关于男性割礼与女性健康结果之间关联的证据，以促进妇女健康规划。
在本系统评价中，我们检索了截至 2016 年 4 月 11 日发表的同行评审文献和灰色文献，以报告男性割礼与女性健康结果之间的关联。所有研究类型的所有生物医学（非心理或社会）结果均被纳入。检索未对出版物的发表年份或撒哈拉以南非洲地区进行限制。未包含原始数据且非英文的出版物被排除。我们根据出版物之间的一致性，提取数据并评估每个结果的证据，结果分为高、中、低一致性；一致性结果少于 3 个出版物的结果为不确定一致性。
我们的评估纳入了 60 篇出版物。有五项结果的一致性证据较高，表明男性割礼可预防宫颈癌、宫颈发育不良、单纯疱疹病毒 2 型、衣原体和梅毒。有中等一致性证据表明男性割礼可预防人乳头瘤病毒和低危型人乳头瘤病毒。虽然证据表明与艾滋病毒存在保护关联，但因一项试验表明感染艾滋病毒的男性在接受割礼后过早恢复性行为，其女性伴侣的感染风险增加，故该证据被归类为低一致性。包括艾滋病毒在内的七种结果的一致性证据较低，六种结果为不确定。
在撒哈拉以南非洲地区推广男性割礼对女性的几项结果具有公共卫生意义。女性伴侣感染几种疾病风险降低的证据高度一致。应探讨男性割礼与妇女健康规划之间的协同作用。
美国疾病控制与预防中心和 Jhpiego。
