Newborn Circumcision: A Long-Term Strategy for AIDS Prevention

The Penile Microbiota in Uncircumcised and Circumcised Men: Relationships With HIV and Human Papillomavirus Infections and Cervicovaginal Microbiota

While the human microbiota especially that of the gut, cervix, and vagina continue to receive great attention, very little is currently known about the penile (glans, coronal sulcus, foreskin, and shaft) microbiota. The best evidences to date for the potential role of the penile microbiota in human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) acquisition have come from studies examining medical male circumcision. We are still at the foothills of identifying specific penile bacteria that could be associated with increased risk of STI/HIV acquisition. In this review, we summarize the available literature on the human penile microbiota and how it is impacted by circumcision. We also discuss the potential role of penile microbiota in STIs and its impact on cervicovaginal microbiota. Taken together, the findings from the penile microbiota studies coupled with observational studies on the effect of male circumcision for reduction of STI/HIV infection risk suggest that specific penile anaerobic bacteria such as Prevotella spp. potentially have a mechanistic role that increases the risk of genital infections and syndromes, including bacterial vaginosis in sexual partners. Although penile Corynebacterium and Staphylococcus have been associated with healthy cervicovaginal microbiota and have been found to increase following male circumcision, further investigations are warranted to ascertain the exact roles of these bacteria in the reproductive health of men and women. This review aims to address existing gaps and challenges and future prospects in the penile microbiota research. The information described here may have translational significance, thereby improving reproductive health and management of STI/HIV.

Male circumcision as an HIV control strategy: not a 'natural condom'

Recent epidemiological studies have shown fairly convincingly that in high-risk populations in sub-Saharan Africa, male circumcision is associated with a reduced risk of HIV infection. Following a consultation at the XIII International AIDS Conference in July 2000 in Durban, there was growing interest in such an intervention. This paper explores what is known about male circumcision, the risks associated with it, its relationship with sexual health, including HIV and other sexually transmitted infections (STIs), and the potential problems with implementing circumcision as an intervention internationally, particularly in traditionally non-circumcising communities and those where access to medical facilities is limited. Proponents of male circumcision as an HIV prevention strategy are convinced and convincing, but circumcision is a surgical procedure with associated risks and has strong religious and cultural significance for many groups. Hence, there are ethical and practical barriers to implementing it as a public health intervention. The evidence suggests that circumcision may reduce the risk of infection, but circumcision does not appear to have any impact on transmission rates from HIV positive men to their partners. Until we know why and how circumcision is protective, exactly what the relationship is between circumcision status and other STIs, and whether the effect seen in high-risk populations is generalisable to other groups, the wisest course is to recommend risk reduction strategies of proven efficacy, such as condom use.