Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.
Clin Microbiol Infect. 2023 Aug;29(8):968-978. doi: 10.1016/j.cmi.2023.03.028. Epub 2023 Apr 1.
BACKGROUND: Previous studies have suggested a protective effect of male circumcision on human papillomavirus (HPV) infections in males, and that this protection may be conferred to their female sexual partners. OBJECTIVES: To synthesize the available evidence on the association between male circumcision and HPV infections in males and females. DATA SOURCES: We searched MEDLINE, Embase, Scopus, Cochrane, LILACS, and ProQuest Dissertations & Theses Global for records published up to 22 June 2022. STUDY ELIGIBILITY: We considered observational and experimental studies that assessed male circumcision status and HPV prevalence, incidence, or clearance in males or females for inclusion. PARTICIPANTS: Males and their female sexual partners who were tested for genital HPV infection. INTERVENTIONS: Male circumcision compared with no circumcision. THE RISK-OF-BIAS ASSESSMENT: The Newcastle-Ottawa scale was used for observational studies, and the Cochrane risk-of-bias tool was used for randomized trials. DATA SYNTHESIS: We estimated summary measures of effect and 95% CIs for the prevalence, incidence, and clearance of HPV infections in males and females using random-effects meta-analysis. We assessed the effect modification of circumcision on HPV prevalence by the penile site in males using random-effects meta-regression. RESULTS: Across 32 studies, male circumcision was associated with decreased odds of prevalent HPV infections (odds ratio, 0.45; 95% CI, 0.34-0.61), a reduced incidence rate of HPV infections (incidence rate ratio, 0.69; 95% CI, 0.57-0.83), and an increased risk of clearing HPV infections (risk ratio, 1.44; 95% CI, 1.28-1.61) at the glans penis among male subjects. Circumcision conferred greater protection against infection at the glans than the shaft (odds ratio, 0.68; 95% CI, 0.48-0.98). Females with circumcised partners were protected from all outcomes. CONCLUSIONS: Male circumcision may protect against various HPV infection outcomes, suggesting its prophylactic potential. Understanding the site-specific effects of circumcision on HPV infection prevalence has important implications for studies of HPV transmission.
背景：先前的研究表明，男性包皮环切术对人乳头瘤病毒（HPV）感染具有保护作用，这种保护作用可能会传递给他们的女性性伴侣。
目的：综合现有证据，评估男性包皮环切术与男性和女性 HPV 感染之间的关联。
数据来源：我们检索了 MEDLINE、Embase、Scopus、Cochrane、LILACS 和 ProQuest Dissertations & Theses Global，检索截至 2022 年 6 月 22 日。
研究入选标准：我们纳入了评估男性包皮环切术状况以及男性和女性 HPV 流行率、发病率或清除率的观察性和实验性研究。
研究对象：接受生殖器 HPV 感染检测的男性及其女性性伴侣。
干预措施：包皮环切术与未行包皮环切术。
偏倚风险评估：使用纽卡斯尔-渥太华量表评估观察性研究，使用 Cochrane 偏倚风险工具评估随机试验。
数据综合：我们使用随机效应荟萃分析，估计了男性和女性 HPV 感染流行率、发病率和清除率的综合效应指标及其 95%置信区间。我们使用随机效应荟萃回归，评估了包皮环切术对男性阴茎部位 HPV 流行率的影响修饰作用。
结果：在 32 项研究中，男性包皮环切术与降低现患 HPV 感染的几率相关（比值比，0.45；95%置信区间，0.34-0.61），降低 HPV 感染的发病率（发病率比，0.69；95%置信区间，0.57-0.83），并增加男性阴茎龟头的 HPV 清除率（风险比，1.44；95%置信区间，1.28-1.61）。与阴茎体相比，包皮环切术对龟头的保护作用更强（比值比，0.68；95%置信区间，0.48-0.98）。有环切术伴侣的女性在所有结局中都受到保护。
结论：男性包皮环切术可能对各种 HPV 感染结局具有保护作用，提示其具有预防作用。了解包皮环切术对 HPV 感染流行率的特定部位影响，对 HPV 传播研究具有重要意义。
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