circ and HPV transmission?

[WNB]

My good friend and I were talking about circumcision, and she mentioned something about how circ. had been shown to reduce transmission of HPV (not HIV, I asked her to make sure she wasn't talking about the HIV studies) to female sex partners. Anyone have a cite to this research, and any insight on the study?

[thatblondegirl69]

http://www.cfpc.ca/cfp/2003/sep/vol4...critical-1.asp

this is what i found. HTH

[littlest birds]

If those tiny percentages are real, for HIV, HPV, etc. they are not enough to make unprotected/uncareful sex safe enough anyway.

I mean, who needs that little edge in unprotected sex with an HIV carrier? Uh, you still need to practice safe sex whether you are circ or not. Unprotected, the risk is too high either way IMO.

Sorry to derail, I know I am refering to HIV rather than HPV (herpes) but I am so frustrated about all the stupid press circ is getting over the HIV thing.

[Quirky]

It is completely bogus to circumcise a baby at birth to reduce the risk of HPV transmission when that baby becomes sexually active. That is forcing baby boys to undergo genital reduction surgery to minimize the risks of disease transmission to someone else, in the future, without regard to whether the boy will grow up to be low-risk or high-risk for STDs.

The article linked in the post above explicitly states that risky sex, not circumcision, makes the difference:

Circumcision is associated with reduced risk of cervical cancer in women with high-risk sexual partners.

In men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of cervical cancer.

It's also important to note that other studies have disproved the link between circumcision status and cervical cancer in female partners. There may be an important genetic component of resistance to HPV. As described in a New York Times article discussing the development of the cervical cancer vaccines:

It had been noted as far back as 1901 that at Leeds General Infirmary and London Hospital, cancer of the cervix “was seldom or never met with among the numerous Jewesses,” according to a Lancet article of the time.
...

The long-held assumption that circumcision was protective was disproved by high cancer rates among Muslim women, who had circumcised husbands, and by relatively low rates among Soviet Jewish women, who often did not. Another myth, that abstaining from sex during menstruation helped prevent the disease, was dispelled by comparing Orthodox women who abstained to others who did not. As with non-Jews, the apparent risk factors for the few Israeli women with the disease were multiple sexual partners and poverty.

Work by Dr. Joseph Menczer of the Wolfson Medical Center in Israel showed that genes were the crucial factor. A protective configuration of the p53 gene is much more common among Jews, except for those from North Africa, the one subgroup likely to contract cervical cancer.

But even assuming there is a link between circumcision and decreased cervical cancer, is it appropriate for parents to decide on genital reduction surgery at birth to reduce the chance of cancer occurring in a future sexual partner? Let's put it the other way -- if it were shown that removing a girl's prepuce (clitoral hood) could be shown to reduce the risks of penile cancer in adult men because circumcising the girl would reduce the risk of transmission of a cancer-causing STD, would it be morally and ethically acceptable to recommend newborn female circumcision?

Especially given that there is now a vaccine available for the types of HPV associated with cervical cancer, it is incumbent on parents to a) educate their children, male and female, about the importance of safe sex and of minimizing the number of sexual partners, b) to help their daughters make an informed decision about whether the HPV vaccine is an appropriate method to reduce their risk of cervical cancer, and c) to educate their daughters about the need for annual Pap smears and gyn checkups.

[WNB]

Quirky, I think in the US at least, given the prevalence of HPV, it is naive and dangerous to think of anyone as low-risk. That certainlt does not mean that neo-natal male circumcision is an appropriate preventive measure, however.

I'm all for decisions regarding cosmetic surgery and sex being made by the person having the surgery and the sex.

Thanks for the links

[liseux]

how does that make sense? Almost 80% of sexually active people in my generation (I`m 34) have HPV and my generation has a very high circ rate, the early 70`s the rate was close to 90% circed.

[Quirky]

Originally Posted by WNB

Quirky, I think in the US at least, given the prevalence of HPV, it is naive and dangerous to think of anyone as low-risk. That certainlt does not mean that neo-natal male circumcision is an appropriate preventive measure, however.

I'm all for decisions regarding cosmetic surgery and sex being made by the person having the surgery and the sex.

Thanks for the links

Are you referring to me as naive? I don't think so. I have HPV, and contracted it from a circumcised partner in 1990. I've been researching it for years. I am hardly naive about it.

And, as Liseux pointed out, given the high rates of HPV and the high rates of circumcision in this country, it is naive and dangerous to assume that circumcision, whether of consenting adults or of unconsenting minors, will do anything to halt the spread of HPV.

[WNB]

No, not calling you naive -- I just think the incidence rate of HPV in the US is so high that _everyone_ (as monogamous relationships frequently aren't) is at a pretty high risk for getting it . My reply was more a response to the quote from the article than to your writing - sorry for the ambiguity.

[Quirky]

OK dokey.

Frankly, I think that the whole circumcision vs. safe sex argument is a red herring argument for HPV considering that condoms/safe sex practices don't prevent HPV transmission.

OTOH, I think the scaremongering around HPV is overblown. Yes, certain types can lead to cervical cancer, but most types are fairly easily dealt with by most people and are relatively treatable (of course there are exceptions). Between safer sex practices, minimizing the number of sexual partners, education, and regular gyn care/Pap smears, plus the vaccine, I think the number of cervical cancer cases can continue to drop. The Pap smear has already reduced the lethality of cervical cancer in this country by a huge amount.

Which is not to say that HPV should be dismissed as harmless, but given how widespread it is I think we have to recognize it and deal with it forthrightly without exaggerating its risks.

[glongley]

First, here is a rebuttal to the Castellseague article associating lack of circumcision with HPV/cervical cancer:
http://www.circumstitions.com/Cancer-cervNEJM.html

Second, here are some excerpts from several studies looking at HPV and circumcision status:

L S Cook, L A Koutsky, K K Holmes
GENITOURINARY MEDICINE, Volume 69 Number 4, Pages 262-264, August 1993. Clinical Presentation of Genital Warts Among Circumcised and Uncircumcised Heterosexual Men Attending an Urban STD Clinic

In summary, among heterosexual men at our STD clinic, uncircumcised men had a lower prevalence of genital warts [genital warts are caused by HPV] than circumcised men.

B Donovan, I Bassett, N J Bodsworth
GENITOURINARY MEDICINE (U.K.), Volume 70, Pages 317-320, October 1994. Male circumcision and common sexually transmissible diseases in a developed nation setting

Previous studies of the effect of circumcision status on genital warts have produced conflicting results. In more heterogeneous populations lack of circumcision has variously been reported as making symptomatic genital warts both more1,9,10 and less11 common. We found it exerted no effect.


R S Van Howe
BJU INTERNATIONAL, Volume 83 Supplement 1, Pages 52-62, January 1999. Does circumcision influence sexually transmitted diseases?: A literature review

In recent studies, HPV-associated lesions are either equally common [15,23,27] or more common in circumcised men… While the number of confounding factors and the inability to perform a random, double-blind, prospective trial make assessing the role of circumcision in STD acquisition difficult, there is no clear evidence that circumcision prevents STDs. The only consistent trend is that uncircumcised males may be more susceptible to GUD, while circumcised men are more prone to urethritis.

Gillian

[WNB]

Awesome!! Thanks for the information.

[frenchie]

"According to the CDC, the only way you can totally protect yourself against HPV is to avoid any sexual activity that involves genital contact. HPV Types 6, 11, 16, and 18 account for the majority of HPV-related clinical diseases."

Well...that just about negates the circumcision arguement! Seriously...America needs to step out of the damn dark ages and get with the program. Circumcision IS NOT a friggen invisible condom. EDUCATION, NOT circumcsion, is what will push us in the right direction to lowering STD/HIV rates.
As an American myself, I have to say, we are the most arrogant bunch of "know it alls" when it comes to medical knowledge/treatment.

[Cersha]

Originally Posted by deeporgarten

If those tiny percentages are real, for HIV, HPV, etc. they are not enough to make unprotected/uncareful sex safe enough anyway.

I mean, who needs that little edge in unprotected sex with an HIV carrier? Uh, you still need to practice safe sex whether you are circ or not. Unprotected, the risk is too high either way IMO.

Sorry to derail, I know I am refering to HIV rather than HPV (herpes) but I am so frustrated about all the stupid press circ is getting over the HIV thing.

No one said anything about this, and I just wanted to note that HPV is NOT Herpes.

BUt yeah, I totally agree with another poster, circ is not an invisible condom.

[frenchie]

Originally Posted by Cersha

No one said anything about this, and I just wanted to note that HPV is NOT Herpes.

Yes...I think many people confuse genital warts (and/or chlamydia) with herpes. HPV can manifest itself as genital warts/chlamydia, but it is not herpes.

[Quirky]

Originally Posted by frenchie

Yes...I think many people confuse genital warts (and/or chlamydia) with herpes. HPV can manifest itself as genital warts/chlamydia, but it is not herpes.

HPV is also not chlamydia. HPV is a virus (or actually a family of viruses), chlamydia is a bacterium.

http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm

http://www.cdc.gov/std/HPV/STDFact-HPV.htm

[littlest birds]

Originally Posted by Cersha

No one said anything about this, and I just wanted to note that HPV is NOT Herpes.

BUt yeah, I totally agree with another poster, circ is not an invisible condom.

true I wasn't thinking through but just made a quick connection/assumption because herpes was the first think i association with "H" I was really just being general about unprotected circ vs. unprotected intact not seeming a relevant comparison since neither is safe against STDs in general

[DocsNemesis]

I have to say I find that rather amusing. Its just cause of two of our friends...
Our friend's girlfriend caught HPV from her circumcised partner and ended up with cervical cancer. And our circumcised friend has full blown AIDS. Hmmm....