Department of Epidemiology Research, Statens Serum Institut, 2300, Copenhagen S, Denmark.
Department of Clinical Medicine, Center for Sexology Research, Aalborg University, 9000, Aalborg, Denmark.
Eur J Epidemiol. 2022 Mar;37(3):251-259. doi: 10.1007/s10654-021-00809-6. Epub 2021 Sep 26.
Whether male circumcision in infancy or childhood provides protection against the acquisition of human immunodeficiency virus (HIV) or other sexually transmitted infections (STIs) in adulthood remains to be established. In the first national cohort study to address this issue, we identified 810,719 non-Muslim males born in Denmark between 1977 and 2003 and followed them over the age span 0-36 years between 1977 and 2013. We obtained information about cohort members' non-therapeutic circumcisions, HIV diagnoses and other STI outcomes from national health registers and used Cox proportional hazards regression analyses to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) associated with foreskin status (i.e., circumcised v. genitally intact). During a mean of 22 years of follow-up, amounting to a total observation period of 17.7 million person-years, 3375 cohort members (0.42%) underwent non-therapeutic circumcision, and 8531 (1.05%) received hospital care for HIV or other STIs. Compared with genitally intact males, rates among circumcised males were not statistically significantly reduced for any specific STI. Indeed, circumcised males had a 53% higher rate of STIs overall (HR = 1.53, 95% CI: 1.24-1.89), and rates were statistically significantly increased for anogenital warts (74 cases in circumcised males v. 7151 cases in intact males, HR = 1.51; 95% CI: 1.20-1.90) and syphilis (four cases in circumcised males v. 197 cases in intact males, HR = 3.32; 95% CI: 1.23-8.95). In this national cohort study spanning more than three decades of observation, non-therapeutic circumcision in infancy or childhood did not appear to provide protection against HIV or other STIs in males up to the age of 36 years. Rather, non-therapeutic circumcision was associated with higher STI rates overall, particularly for anogenital warts and syphilis.
男性割礼是否能在婴幼儿或儿童时期提供预防成人获得人类免疫缺陷病毒（HIV）或其他性传播感染（STI）的保护作用，仍有待确定。在第一项针对这一问题的全国队列研究中，我们确定了 1977 年至 2003 年间出生于丹麦的 810719 名非穆斯林男性，并在 1977 年至 2013 年期间对他们进行了 0 至 36 岁的年龄跨度随访。我们从国家健康登记处获得了队列成员的非治疗性割礼、HIV 诊断和其他 STI 结果的信息，并使用 Cox 比例风险回归分析计算了与包皮状况（即割礼与生殖器完整）相关的风险比（HR）和 95%置信区间（CI）。在平均 22 年的随访期间，总计观察了 1770 万人年，有 3375 名队列成员（0.42%）接受了非治疗性割礼，8531 名（1.05%）因 HIV 或其他 STI 接受了医院治疗。与生殖器完整的男性相比，割礼男性的任何特定 STI 发生率均无统计学显著降低。事实上，割礼男性的 STI 总发生率高 53%（HR=1.53，95%CI：1.24-1.89），肛门生殖器疣（割礼男性 74 例，生殖器完整男性 7151 例，HR=1.51；95%CI：1.20-1.90）和梅毒（割礼男性 4 例，生殖器完整男性 197 例，HR=3.32；95%CI：1.23-8.95）的发生率也有统计学显著增加。在这项跨越三十多年观察的全国队列研究中，婴幼儿或儿童时期的非治疗性割礼似乎并不能为男性提供预防 HIV 或其他 STI 的保护作用，直到 36 岁。相反，非治疗性割礼与总体上更高的 STI 率相关，尤其是肛门生殖器疣和梅毒。
