Quote:
Originally Posted by mamabain  |
We've had two threads talking about this but here is the jist of this issue:
Starting with HPV, the doctor should probably know that for the last three years there has been not one but two very effective (90-100%) vaccines which target the two types of HPV linked to more than 70% of cervical cancers. Research recently released indicates that it is also at least 40% effective at the next two most common types as well as 25% effective against at least 8 others. This vaccine, Gardasil, is currently in the process of getting FDA approval for boys in the same age range as girls. Trials completed last year demonstrated that Gardasil was estimated to be about 90% efficient in preventing infection with four HPV types, as well as genital warts and precancerous lesions [1]. Interestingly, part of the debate over approval is whether it is right to ask boys to take a vaccine that clearly is really only beneficial for women [1]. Why on earth would one consider circumcision when we have a far more effective vaccine as an option? I think only an American doctor would suggest that.
As far as HIV is concerned [I have written on this extensively if you want the link I'll have to provide it later but], while it is the case that three trials in African countries did show a 50-60% relative risk reduction, most people forget to mention that the WHO recommendations on this situation apply only to third world countries with high prevalence of HIV in the general population and where transmission is primarily through heterosexual contact. It is not a recommendation for countries such as the US where prevalence is low and concentrated in specific high risk groups. Since the release of these trials several first world HIV agencies have made note of that including the French National Council on Aids (Conseil national du SIDA)[2] and the Australian Federation of AIDS Organization[3]. In fact the AFAO noted the curious fact that: the USA has a growing heterosexual epidemic and very high rates of circumcision. Which is a bit of an understatement. In fact, the US has the highest rate of HIV prevalence and by far one of the highest rate of circumcision in the industrialized first world. The prevalence in the US is between 2 and 6 times nearly all European countries, Japan, New Zealand, Australia, and others places where circumcision is extremely rare. Even when looking solely at rates of heterosexual transmission, we are near the bottom among those countries in many respects. This has been noted in many stories including this one last year [4]: The U.S. has the highest STD rates of any country in the industrialized world. (according to the CDC). The rates for some of these are compared by Advocates for Youth here [5]. Clearly, we in the US don't have too much to be proud of but it does demonstrate that circumcision is not a necessary component for public health (STDs or HIV) particularly in first world countries.
Which brings us to HSV. As before, the rates of HSV in the US as compared to other countries don't necessarily make a good case for circumcision. If it did, this would have been clearly noticed long ago. Considering though that sexual health is at least as good in Europe as it is in the US (actually it seems to be much better) it hard to make any reasonable case for circumcision as a prophylaxis for HSV. In fact, to the best of my knowledge no vaccine which was only 25% efficient would ever move forward in a clinical trial. A recent clinical trial of a vaginal gel preventing HIV infection was only grudgingly advanced with its 30% efficiency because there isn't anything else available so it's difficult to see what all the noise over a supposed 25% which hasn't been seen in the general population of first world countries anyway.
It's not hard to understand why there is all this 'excitement' about circumcision in the US press and amongst US doctors. It's a procedure that they've been desperately trying to justify for more than 100 years with one ill conceived excuse after another. I think the BBC story on this research that the doctor is writing about said it best[6]: "Dr Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections."
That's what it is, an "obsession" we have here in the US. It is instructive how the British covered this, they for example noted the fact the Gardasil exists, HIV prevalence in first world countries don't justify circumcision, and that the risk reduction for HSV is really small.
1.
http://tinyurl.com/dg6s4r
2.
http://tinyurl.com/5zsm7v
3.
http://tinyurl.com/dyusnv
4.
http://tinyurl.com/58exfn
5.
http://tinyurl.com/yt8ngt
6.
http://tinyurl.com/can3zk
If you need some more info I can try to provide it just ask.
you sound like me. Except mine is... "I plan on teaching my children to respect their body and think long and hard about the repercussions of intercourse. There are a million other ways to be intimate, save sex for someone special, and unless you are grown and trying for a child, use protection. Nothing and no one but YOU are responsible for your sexual health, not your penis turtleneck, not a condom, not the pope, not your mother. You need to make your decisions and then live with them"
