Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Male circumcision decreases high-risk human papillomavirus viral load in female partners: a randomized trial in Rakai, Uganda

TitleMale circumcision decreases high-risk human papillomavirus viral load in female partners: a randomized trial in Rakai, Uganda
Publication TypeJournal Article
Year of Publication2013
AuthorsDavis, MA, Gray, RH, Grabowski, MK, Serwadda, D, Kigozi, G, Gravitt, PE, Nalugoda, F, Watya, S, Wawer, MJ, Quinn, TC, Tobian, AA
JournalInternational Journal of Cancer. Journal International du Cancer
Date PublishedSep 1
ISBN Number1097-0215 (Electronic)0020-7136 (Linking)
Accession Number23400966
KeywordsAdolescent, Adult, Circumcision, Male, Female, Humans, Male, Middle Aged, Papillomaviridae/ isolation & purification, Risk, Sexual and Reproductive Health, Uganda, Viral Load

Male circumcision (MC) reduces high-risk human papillomavirus (HR-HPV) infection in female partners. We evaluated the intensity of HR-HPV viral DNA load in HIV-negative, HR-HPV-positive female partners of circumcised and uncircumcised men. HIV-negative men and their female partners were enrolled in randomized trials of MC in Rakai, Uganda. Vaginal swabs were tested for HR-HPV genotypes by Roche HPV Linear Array which provides a semi-quantitative measure of HPV DNA by the intensity of genotype-specific bands (graded:1-4). We assessed the effects of MC on female HR-HPV DNA load by comparing high intensity linear array bands (3-4) to low intensity bands (1-2) using an intention-to-treat analysis. Prevalence risk ratios (PRR) of high intensity bands in partners of intervention versus control arm men were estimated using log-binomial regression with robust variance. The trial included 335 women with male partners in the intervention arm and 340 in the control arm. At enrollment, the frequency of HR-HPV high intensity linear array bands was similar in both study arms. At 24 months follow-up, the prevalence of high intensity bands among women with detectable HR-HPV was significantly lower in partners of intervention arm (42.7%) than control arm men (55.1%, PRR = 0.78, 95% CI 0.65-0.94, p = 0.02), primarily among incident HR-HPV infections (PRR = 0.66, 95% CI 0.50-0.87, p = 0.003), but not persistent infections (PRR = 1.02, 95% CI 0.83-1.24). Genotypes with high HR-HPV band intensity were more likely to persist (adjHR = 1.27 95% CI 1.07-1.50), irrespective of male partner circumcision status. MC reduces HR-HPV DNA load in newly infected female partners.